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Hey P, Hoermann R, Sinclair M, Chapman B, Testro A, Apostolov R, Angus P, Gow P. Branched-chain amino acid supplementation does not improve measures of sarcopenia in cirrhosis: results of a randomised controlled trial. Aliment Pharmacol Ther 2024; 59:941-952. [PMID: 38404263 DOI: 10.1111/apt.17917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/08/2023] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Sarcopenia is associated with adverse outcomes in cirrhosis. Branched-chain amino acids (BCAA) target several pathways that lead to muscle loss in this population. AIMS We aimed to evaluate the impact of BCAA supplementation on sarcopenia measures in patients with cirrhosis. METHODS We conducted a 12-month double-blinded, randomised, controlled trial of BCAA supplementation (30 g daily) compared to an equicaloric, equi-nitrogenous whey protein in volunteers with cirrhosis and reduced muscle strength. The primary endpoint was an increase in grip strength and upper limb lean mass measured on DEXA. Mean-adjusted differences (MAD, 95% CI) between groups at 6 and 12 months are reported as treatment effect using a linear mixed model for repeated measures. RESULTS A total of 150 volunteers entered the trial (74 BCAA, 76 control), with a median age of 58 years [IQR 48; 63] and MELD of 14 [12; 17]. At 12 months, 57% in the BCAA arm and 61% in the control arm met the primary endpoint (p = 0.80). No significant between-group difference was found in grip strength (MAD -0.15 kg [-0.37; 0.06], p = 0.29) or upper limb lean mass (1.7 kg [-0.2; 3.6], p = 0.22) at 12 months. No significant differences in other body composition parameters, physical performance, frailty, rates of hospitalisation or mortality were found between the BCAA and the control group. Fatigue improved across the entire cohort, without significant between-group differences. 15% of volunteers reported side effects, with distaste higher in the BCAA arm (p = 0.045). CONCLUSION BCAA supplementation did not improve measures of muscle strength, mass or performance or physical frailty compared to a whey protein supplement in a randomised controlled setting. ACTRN12618000802202.
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Affiliation(s)
- Penelope Hey
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Marie Sinclair
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Brooke Chapman
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | - Adam Testro
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Ross Apostolov
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Peter Angus
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Gow
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
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Chapman B, Wong D, Sinclair M, Hey P, Terbah R, Gow P, Majumdar A, Testro A. Reversing malnutrition and low muscle strength with targeted enteral feeding in patients awaiting liver transplant: A randomized controlled trial. Hepatology 2024:01515467-990000000-00794. [PMID: 38456800 DOI: 10.1097/hep.0000000000000840] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Most patients with decompensated cirrhosis fail to meet their nutrition targets. The impact of nasogastric feeding (NGF) on malnutrition in cirrhosis remains unknown. This study aims to assess the impact of pretransplant NGF on pre-liver transplant and post-liver transplant outcomes. APPROACH AND RESULTS This single-center, prospective randomized controlled trial of 55 patients with severe malnutrition and low handgrip strength (HGS) compared a standard high-energy high-protein diet to diet plus supplemental nocturnal NGF while awaiting transplant. The primary outcome was a change in HGS. The median age was 58.5 years (IQR: 51.1-64), median MELD was 24 (20-28.5), and 32 (58%) patients were male. The median duration of NGF was 63.0 days (34.5-127), following which time the median between-group difference in HGS was 3.6 kg (95% CI: 1.7-5.2, p <0.001), an increase of 20% from baseline. Mid-upper-arm circumference, triceps skinfold, and immune function all increased significantly with NGF. Muscle and nutritional parameters continued to improve with increasing duration of feeding. NGF significantly increased daily energy intake between groups by 1285 kcal (95% CI: 860-1677) and protein intake by 51 g (95% CI: 32-71) (both p <0.001). All NGF patients met >100% of their measured nutritional requirements. Posttransplant clinical outcomes were similar between groups. CONCLUSIONS Targeted enteral feeding before liver transplant improves HGS, anthropometry, and immune function in severely malnourished patients with cirrhosis. These findings provide a strong rationale for early consideration of NGF to reverse malnutrition and improve muscle strength. Appropriately powered studies should explore whether NGF can also impact clinically relevant outcomes including pretransplant and posttransplant mortality.
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Affiliation(s)
- Brooke Chapman
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Darren Wong
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Penelope Hey
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Ryma Terbah
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Avik Majumdar
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Terbah R, Testro AG, Hoermann R, Majumdar A, Chapman B, Gow PJ, Sinclair M. Continuous home terlipressin infusion increases handgrip strength and reduces ascites-A prospective randomized crossover study. Hepatology 2024:01515467-990000000-00783. [PMID: 38442012 DOI: 10.1097/hep.0000000000000820] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND AIMS Observational studies suggest a beneficial effect of continuous terlipressin infusion (CTI) on ascites and sarcopenia in decompensated cirrhosis with portal hypertension. APPROACH AND RESULTS This single-center, prospective, cross-over study randomized 30 patients with cirrhosis, ascites, and sarcopenia to commence on 12 weeks of home CTI or 12 weeks of observation prior to cross-over. The co-primary outcomes were change in handgrip strength and paracentesis volume. Secondary outcomes included quality of life, sarcopenia measures, renal function, safety, and hospitalization. The median age of participants was 62 years (IQR: 57-64), the median Model for End-Stage Liver Disease-Sodium was 16 (12.3-20.8), and 22 (73%) were male. Handgrip strength increased by a mean adjusted difference (MAD) of 3.09 kg (95% CI: 1.11-5.08 kg) between CTI and observation ( p =0.006); an 11.8% increase from baseline. The total volume of ascites drained decreased by a MAD of 11.39L (2.99-19.85, p =0.01), with 1.75 fewer episodes of paracentesis (0.925-2.59, p <0.001) on CTI. Serum creatinine decreased, urinary sodium excretion increased, and quality of life was significantly higher on CTI (all p <0.001), with an increase in Chronic Liver Disease Questionnaire score of 0.41 points (0.23-0.59). There were 7 minor line-related complications but no cardiac events or pulmonary edema. CONCLUSIONS This novel study demonstrates a significant increase in handgrip strength, reduction in paracentesis volume, and improved quality of life in patients with decompensated cirrhosis treated with continuous terlipressin infusion. These findings provide a strong rationale for the use of ambulatory CTI in appropriately selected patients with cirrhosis.
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Affiliation(s)
- Ryma Terbah
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Adam G Testro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Avik Majumdar
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Brooke Chapman
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
| | - Marie Sinclair
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (Austin), The University of Melbourne, Victoria, Australia
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Chapman B, Wong D, Whitcher B, Sinclair M, Gow P, Majumdar A, Testro A. Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach. Nutrients 2023; 15:4770. [PMID: 38004164 PMCID: PMC10675823 DOI: 10.3390/nu15224770] [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: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Malnutrition is ubiquitous in cirrhotic patients presenting for liver transplant (LT). Providing an appropriate energy prescription is fundamental to effective nutrition therapy. We aimed to compare measured energy expenditure (mEE) with predicted energy expenditure (pEE) in patients awaiting LT and determine clinical factors associated with mEE. In this prospective observational study, energy expenditure was measured by indirect calorimetry in 110 adult patients referred for LT and predicted by commonly utilized equations (Harris-Benedict, Schofield, and EASL guidelines). Nutritional status, anthropometry, muscle function, biochemical and clinical data were also collected. The median model for end-stage liver disease (MELD) was 19 (IQR 13, 25), and the majority were Child-Pugh B (51%) or C (37%). Malnutrition was evident in 85%. Median mEE by calorimetry was 1756 (1531, 2104) kcal/d and significantly higher than pEE as per Harris-Benedict 1480 (1322, 1722) kcal/d and Schofield 1474 (1349, 1723) kcal/d (both p < 0.001), but lower than EASL guidelines (35 kcal/kg) when an activity factor was applied to mEE; 2283 (1990, 2735) kcal/d versus 2590 (2178, 3010) kcal/d (p < 0.001). Hypermetabolism (mEE:pEE > 1.2) was evident in 48% of the cohort. Multivariate analysis found MELD, Child-Pugh class, diuretic use, and severe malnutrition to be independent predictors of hypermetabolism. A new liver-specific predictive model has been developed, showing superior agreement with mEE than common predictive equations. In conclusion, there is a poor correlation between mEE and pEE in patients awaiting LTs, and hypermetabolism is common. Relying on historical predictive equations in this patient population may result in significant under or over-feeding. A tailored energy prescription based on indirect calorimetry or a liver-specific predictive model is recommended for LT candidates.
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Affiliation(s)
- Brooke Chapman
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, VIC 3084, Australia
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Darren Wong
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Bethany Whitcher
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Avik Majumdar
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, Heidelberg, VIC 3084, Australia; (D.W.); (B.W.); (M.S.); (P.G.); (A.M.); (A.T.)
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
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Hey P, Chapman B, Wong D, Gow P, Testro A, Terbah R, Sinclair M. Transjugular intrahepatic portosystemic shunt insertion improves muscle mass but not muscle function or frailty measures. Eur J Gastroenterol Hepatol 2023; 35:997-1003. [PMID: 37395688 DOI: 10.1097/meg.0000000000002592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Sarcopenia in cirrhosis is associated with poor outcomes. While transjugular intrahepatic portosystemic shunt (TIPS) insertion improves radiological measures of muscle mass, its impact on muscle function, performance and frailty has not been evaluated. METHODS Patients with cirrhosis referred for TIPS were prospectively recruited and followed for 6 months. L3 CT scans were used to calculate skeletal muscle and adipose tissue parameters. Handgrip strength, Liver Frailty Index and short physical performance battery were serially monitored. Dietary intake, insulin resistance, insulin-like growth factor (IGF)-1, and immune function using QuantiFERON Monitor (QFM) were measured. RESULTS Twelve patients completed the study with a mean age of 58 ± 9 years and model for end-stage liver disease score of 16 ± 5. At 6 months post-TIPS, skeletal muscle area increased from 139.33 cm 2 ± 22.72 to 154.64 ± 27.42 ( P = 0.012). Significant increases were observed in the subcutaneous fat area ( P = 0.0076) and intermuscular adipose tissue ( P = 0.041), but not muscle attenuation or visceral fat. Despite marked changes in muscle mass, no improvements were observed in handgrip strength, frailty, or physical performance. At 6 months post-TIPS, IGF-1 ( P = 0.0076) and QFM ( P = 0.006) increased compared to baseline. Nutritional intake, hepatic encephalopathy measures, insulin resistance and liver biochemistry were not significantly impacted. CONCLUSION Muscle mass increased following TIPS insertion as did IGF-1, a known driver of muscle anabolism. The lack of improvement in muscle function was unexpected and may relate to impairment in muscle quality and the effects of hyperammonaemia on muscle contractile function. Improvements in QFM, a marker of immune function, may suggest a reduction in infection susceptibility in this at-risk population and requires further evaluation.
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Affiliation(s)
- Penelope Hey
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
| | - Brooke Chapman
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | - Darren Wong
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
| | - Paul Gow
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
| | - Adam Testro
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
| | - Ryma Terbah
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
| | - Marie Sinclair
- Department of Gastroenterology, Austin Health, Heidelberg
- Department of Medicine, The University of Melbourne, Parkville
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Ukovic B, Chapman B, Schulberg J, De Cruz P, Choy MC. Novel Use of the Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition for the Treatment of Crohn's Disease During Pregnancy. ACG Case Rep J 2023; 10:e01078. [PMID: 37457641 PMCID: PMC10344521 DOI: 10.14309/crj.0000000000001078] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023] Open
Abstract
The Crohn's Disease Exclusion Diet (CDED) with partial enteral nutrition (PEN) is an emerging treatment option for Crohn's disease (CD). A 35-year-old pregnant woman presented with newly diagnosed ileal CD. At 14/40 gestation, CDED + PEN was prescribed without drug therapy. Outcomes included Harvey-Bradshaw Index, weight, and bowel wall thickness/Limberg score measured on intestinal ultrasound (IUS). In this patient, CDED + PEN achieved clinical and biochemical remission, improvements on IUS, gestational weight gain, and healthy birth weight without drug therapy. Sustained remission was achieved postpartum. Our case highlights the potential effectiveness of CDED + PEN to induce remission for active CD during pregnancy.
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Affiliation(s)
- Bianca Ukovic
- Nutrition and Dietetics Department, Division of Allied Health, Austin Health, Heidelberg, Australia
| | - Brooke Chapman
- Nutrition and Dietetics Department, Division of Allied Health, Austin Health, Heidelberg, Australia
| | - Julien Schulberg
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Medicine, Austin Academic Centre, University of Melbourne, Heidelberg, Australia
| | - Matthew C. Choy
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Medicine, Austin Academic Centre, University of Melbourne, Heidelberg, Australia
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Pironi L, Steiger E, Joly F, Jeppesen PB, Wanten G, Sasdelli AS, Chambrier C, Aimasso U, Mundi MS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Santarpia L, Guglielmi FW, Kozjek NR, Schneider SM, Ellegard L, Thibault R, Matras P, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Udvarhelyi G, Jones L, Won Lee AD, Masconale L, Orlandoni P, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui MEP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Youssef NN, Brillanti G, Nardi E, Lal S. Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey. Clin Nutr ESPEN 2021; 45:433-441. [PMID: 34620351 DOI: 10.1016/j.clnesp.2021.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. METHODS The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. RESULTS In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. CONCLUSIONS SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
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Affiliation(s)
- Loris Pironi
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France.
| | - Ezra Steiger
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Palle B Jeppesen
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anna S Sasdelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | | | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | - Miriam Theilla
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Mireille Serlie
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, Université Côte D'Azur, Nice, France
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Institute of Internal Medicine, University of Tartu, Tartu, Estonia, And Previously at Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Marina Taus
- SOD Dietetica e Nutrizione Clinica, Centro Riferimento Regionale NAD, Ospedali Riuniti di Ancona, Italy
| | - Nuria M Virgili
- Facultatiu Especialista. Servei D'Endocrinologia I Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D Won Lee
- Hospital Das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Nutrizione Clinica-Centro di Riferimento Regionale NAD, IRCCS-INRCA, Ancona, Italy
| | | | - Marta Bueno Díez
- Servei D'Endocrinologia I Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nader N Youssef
- VectivBio AG Basel, Switzerland, Digestive Healthcare Center, NJ, USA
| | - Giorgia Brillanti
- Alma Mater Studiorum, University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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West J, Gow PJ, Testro A, Chapman B, Sinclair M. Exercise physiology in cirrhosis and the potential benefits of exercise interventions: A review. J Gastroenterol Hepatol 2021; 36:2687-2705. [PMID: 33638197 DOI: 10.1111/jgh.15474] [Citation(s) in RCA: 4] [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: 10/19/2020] [Revised: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Reduction in muscle mass is a highly prevalent phenomenon in cirrhosis and is now well-documented to be associated with significant morbidity and mortality. Research into muscle loss in cirrhosis remains limited by an ongoing poor understanding of its relationship with muscle function, physical activity, and aerobic capacity. Alterations in exercise physiology have been documented in studies of individuals with cirrhosis that provide important information on physical function that is not captured by simple quantification of muscle mass. Despite expert consensus recommending regular exercise in end-stage liver disease to maintain muscle mass and function, there is little evidence guiding clinicians as to which form of exercise or delivery mechanism is most effective. It also remains unproven whether any specific intervention can alter clinically relevant outcomes. This review article summarizes the available literature regarding the changes in exercise physiology observed in cirrhosis, the associated impact on physical capacity, and the results of existing trials that examine the potential benefits of exercise delivery in patients with cirrhosis, particularly pertaining to their impact on exercise physiology.
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Affiliation(s)
- Jack West
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul J Gow
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Brooke Chapman
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Marie Sinclair
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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Brandão J, Gangneux JP, Arikan-Akdagli S, Barac A, Bostanaru AC, Brito S, Bull M, Çerikçioğlu N, Chapman B, Efstratiou MA, Ergin Ç, Frenkel M, Gitto A, Gonçalves CI, Guégan H, Gunde-Cimerman N, Güran M, Irinyi L, Jonikaitė E, Kataržytė M, Klingspor L, Mares M, Meijer WG, Melchers WJG, Meletiadis J, Meyer W, Nastasa V, Babič MN, Ogunc D, Ozhak B, Prigitano A, Ranque S, Rusu RO, Sabino R, Sampaio A, Silva S, Stephens JH, Tehupeiory-Kooreman M, Tortorano AM, Velegraki A, Veríssimo C, Wunderlich GC, Segal E. Mycosands: Fungal diversity and abundance in beach sand and recreational waters - Relevance to human health. Sci Total Environ 2021; 781:146598. [PMID: 33812107 DOI: 10.1016/j.scitotenv.2021.146598] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
The goal of most studies published on sand contaminants is to gather and discuss knowledge to avoid faecal contamination of water by run-offs and tide-retractions. Other life forms in the sand, however, are seldom studied but always pointed out as relevant. The Mycosands initiative was created to generate data on fungi in beach sands and waters, of both coastal and freshwater inland bathing sites. A team of medical mycologists and water quality specialists explored the sand culturable mycobiota of 91 bathing sites, and water of 67 of these, spanning from the Atlantic to the Eastern Mediterranean coasts, including the Italian lakes and the Adriatic, Baltic, and Black Seas. Sydney (Australia) was also included in the study. Thirteen countries took part in the initiative. The present study considered several fungal parameters (all fungi, several species of the genus Aspergillus and Candida and the genera themselves, plus other yeasts, allergenic fungi, dematiaceous fungi and dermatophytes). The study considered four variables that the team expected would influence the results of the analytical parameters, such as coast or inland location, urban and non-urban sites, period of the year, geographical proximity and type of sediment. The genera most frequently found were Aspergillus spp., Candida spp., Fusarium spp. and Cryptococcus spp. both in sand and in water. A site-blind median was found to be 89 Colony-Forming Units (CFU) of fungi per gram of sand in coastal and inland freshwaters, with variability between 0 and 6400 CFU/g. For freshwater sites, that number was 201.7 CFU/g (0, 6400 CFU/g (p = 0.01)) and for coastal sites was 76.7 CFU/g (0, 3497.5 CFU/g). For coastal waters and all waters, the median was 0 CFU/ml (0, 1592 CFU/ml) and for freshwaters 6.7 (0, 310.0) CFU/ml (p < 0.001). The results advocate that beaches should be monitored for fungi for safer use and better management.
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Affiliation(s)
- J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for Environmental and Marine Studies (CESAM) - Department of Animal Biology, University of Lisbon, Lisbon, Portugal.
| | - J P Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - S Arikan-Akdagli
- Mycology Laboratory at Department of Medical Microbiology of Hacettepe University Medical School, Ankara, Turkey
| | - A Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Faculty of Medicine, University of Belgrade, Serbia
| | - A C Bostanaru
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - S Brito
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - M Bull
- Quantal Bioscience, North Parramatta, Australia
| | - N Çerikçioğlu
- Mycology Laboratory at Department of Medical Microbiology of Marmara University Medical School, Istanbul, Turkey
| | - B Chapman
- Quantal Bioscience, North Parramatta, Australia
| | - M A Efstratiou
- Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Greece
| | - Ç Ergin
- Department of Medical Microbiology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - M Frenkel
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Gitto
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - C I Gonçalves
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - H Guégan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - N Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - M Güran
- Faculty of Medicine, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin 10, Turkey
| | - L Irinyi
- Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - E Jonikaitė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - M Kataržytė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - L Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicin, Karolinska Institutet, Stockholm, Sweden
| | - M Mares
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - W G Meijer
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - W J G Melchers
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - J Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - W Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - V Nastasa
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - M Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - D Ogunc
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - B Ozhak
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - A Prigitano
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - S Ranque
- Aix Marseille Univ, IHU-Méditerranée Infection, AP-HM, IRD, SSA, VITROME, Marseille, France
| | - R O Rusu
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - R Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Sampaio
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), UTAD, Vila Real, Portugal
| | - S Silva
- Department of Epidemiology, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - J H Stephens
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - M Tehupeiory-Kooreman
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - A M Tortorano
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece and Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - C Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - G C Wunderlich
- Quantal Bioscience, North Parramatta, Australia; Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - E Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Currin-McCulloch J, Chapman B, Carson C, Fundalinski K, Hays M, Budai P, Kaushik S. Hearts above water: Palliative care during a pandemic. Soc Work Health Care 2021; 60:93-105. [PMID: 33554768 DOI: 10.1080/00981389.2021.1885562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/06/2021] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
Social workers and nurses, as members of interprofessional palliative medicine teams, faced unfamiliar challenges and opportunities as they endeavored to provide humanistic care to patients and families during the coronavirus (COVID-19) pandemic. Typical methods for engaging patients and families in medical decision-making became thwarted by visitation restrictions and patients' dramatic health declines. This paper presents an innovative social work and nursing intervention aimed at enhancing humanistic patient/family care and advanced directive dialogs. Through incorporating a narrative synthesis of the teams' reflective journals from COVID-19, the paper chronicles the intervention implementation, patient/family responses, and team members' personal and professional meaning-making processes.
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Affiliation(s)
| | - Brooke Chapman
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Colleen Carson
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Kathleen Fundalinski
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Magan Hays
- UCHealth Palliative Medicine, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Peggy Budai
- UCHealth Palliative Medicine, Poudre Valley Hospital, Fort Collins, Colorado, USA
| | - Shivani Kaushik
- Colorado State University School of Social Work, Fort Collins, Colorado, USA
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Hey P, Gow P, Testro AG, Apostolov R, Chapman B, Sinclair M. Nutraceuticals for the treatment of sarcopenia in chronic liver disease. Clin Nutr ESPEN 2021; 41:13-22. [PMID: 33487256 DOI: 10.1016/j.clnesp.2020.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Sarcopenia, defined as loss of muscle mass, strength and function, is associated with adverse clinical outcomes in patients with cirrhosis. Despite improved understanding of the multifaceted pathogenesis, there are few established therapies to treat or prevent muscle loss in this population. This narrative review examines the available literature investigating the role of nutraceuticals for the prevention or treatment of muscle wasting in chronic liver disease. METHODS A comprehensive search or Medline and PubMED databases was conducted. Reference lists were screened to identify additional articles. RESULTS A number of nutritional supplements and vitamins target the specific metabolic derangements that contribute to sarcopenia in cirrhosis including altered amino acid metabolism, hyperammonaemia and inflammation. Branched chain amino acid (BCAA) supplementation has proposed anabolic effects through dual pathways of enhanced ammonia clearance and stimulation of muscle protein synthesis. l-carnitine also has multimodal effects on muscle and shows promise as a therapy for muscle loss through anti-inflammatory, antioxidant and ammonia lowering properties. Other nutraceuticals including l-ornithine l-aspartate, omega-3 polyunsaturated fatty acids and zinc and vitamin D supplementation, may similarly have positive effects on muscle homeostasis, however further evidence to support their use in cirrhotic populations is required. CONCLUSION Nutraceuticals offer a promising and likely safe adjunct to standard care for sarcopenia in cirrhosis. While there is most evidence to support the use of BCAA and l-carnitine supplementation, further well-designed clinical trials are needed to elucidate their efficacy as a therapy for muscle loss in this population.
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Affiliation(s)
- Penelope Hey
- Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
| | - Paul Gow
- Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
| | - Adam G Testro
- Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
| | - Ross Apostolov
- Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
| | - Brooke Chapman
- The University of Melbourne, Parkville, Victoria, Australia; Department of Nutrition and Dietetics, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia.
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
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12
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Li R, Dworkin R, Chapman B, Becerra A, Yang L, Mooney C, Seplaki C. Prevalence, Incidence, and Recovery Rate of Impactful Chronic Pain, and Predictors for the Recovery Process in Later Life. Ann Epidemiol 2020. [DOI: 10.1016/j.annepidem.2020.08.051] [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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13
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Abstract
Malnutrition is highly prevalent in liver cirrhosis and its presence carries important prognostic implications. The clinical conditions and pathophysiological mechanisms that cause malnutrition in cirrhosis are multiple and interrelated. Anorexia and liver decompensation symptoms lead to poor dietary intake; metabolic changes characterised by elevated energy expenditure, reduced glycogen storage, an accelerated starvation response and protein catabolism result in muscle and fat wasting; and, malabsorption renders the cirrhotic patient unable to fully absorb or utilise food that has been consumed. Malnutrition is therefore a considerable challenge to manage effectively, particularly as liver disease progresses. A high energy, high protein diet is recognised as standard of care, yet patients struggle to follow this recommendation and there is limited evidence to guide malnutrition interventions in cirrhosis and liver transplantation. In this review, we seek to detail the factors which contribute to poor nutritional status in liver disease, and highlight complexities far greater than "poor appetite" or "reduced oral intake" leading to malnutrition. We also discuss management strategies to optimise nutritional status in this patient group, which target the inter-related mechanisms unique to advanced liver disease. Finally, future research requirements are suggested, to develop effective treatments for one of the most common and debilitating complications afflicting cirrhotic patients.
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Affiliation(s)
- Brooke Chapman
- Nutrition and Dietetics Department, Austin Health, Heidelberg 3084, Australia.
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
| | - Paul J Gow
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
| | - Adam G Testro
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
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14
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Pironi L, Steiger E, Joly F, Wanten GJA, Chambrier C, Aimasso U, Sasdelli AS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie MJ, Cooper SC, Poullenot F, Rasmussen HH, Compher CW, Crivelli A, Hughes SJ, Santarpia L, Guglielmi FW, Rotovnik Kozjek N, Ellegard L, Schneider SM, Matras P, Forbes A, Wyer N, Zmarzly A, Taus M, O'Callaghan M, Osland E, Thibault R, Cuerda C, Jones L, Chapman B, Sahin P, Virgili NM, Lee ADW, Orlandoni P, Matysiak K, Di Caro S, Doitchinova-Simeonova M, Masconale L, Spaggiari C, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Petrina Jáuregui E, Zugasti Murillo A, Suárez-Llanos JP, Nardi E, Van Gossum A, Lal S. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure. Gut 2020; 69:1787-1795. [PMID: 31964752 DOI: 10.1136/gutjnl-2018-318172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 12/24/2018] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
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Affiliation(s)
- Loris Pironi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ezra Steiger
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisca Joly
- Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cecile Chambrier
- Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Umberto Aimasso
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | | | - Amelia Jukes
- University Hospital of Wales, Cardiff, Cardiff, UK
| | - Miriam Theilla
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
| | - Marek Kunecki
- Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
| | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mireille J Serlie
- Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Florian Poullenot
- Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene W Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriana Crivelli
- Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | | | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | | | - Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Nicola Wyer
- University Hospital Coventry, Coventry, Coventry, UK
| | | | - Marina Taus
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ronan Thibault
- Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brooke Chapman
- Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | | | - Núria M Virgili
- Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
| | - Andre Dong Won Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Konrad Matysiak
- Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
| | | | | | - Luisa Masconale
- Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
| | - Corrado Spaggiari
- Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
| | - Carmen Garde
- Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | | | - Gabriel Olveira
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | | | | | - José P Suárez-Llanos
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Elena Nardi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - André Van Gossum
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lal
- Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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15
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Narendra K, Kiss N, Margerison C, Johnston B, Chapman B. Impact of nutritional status/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study. J Hum Nutr Diet 2020; 33:587-597. [PMID: 32364298 DOI: 10.1111/jhn.12763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malnutrition is prevalent in patients undergoing gastrointestinal (GI) surgery and has been linked to adverse outcomes. The present study aimed to determine the association between early post-operative nutritional status/risk, post-operative nutritional management and clinical outcomes. METHODS A prospective observational study was conducted in GI surgical patients with a minimum 3-day post-operative length of stay (LOS). Data on patient demographics, nutritional status/risk, post-operative nutritional management and clinical outcomes were collected. Four markers of nutritional status and risk were assessed: preoperative weight loss, nutrition risk, malnutrition status and hand grip strength. Clinical outcomes included: post-operative LOS, complication and readmissions rates. Multivariate linear and logistic regression were used to test for associations with clinical outcomes. RESULTS One hundred and fifteen patients (55% female) with mean (SD) age of 60.8 (16.2) years were included. Median (IQR) post-operative LOS was 8.0 days (4.5-11.5), 37% of participants developed at least one complication post-operatively and 24% were readmitted within 30-days of discharge. Mean number of nil-by mouth (NBM) days post-operatively was 0.7 (1.2) and the average time to commence feeding was 3.3 (2.2) days after surgery. Poor nutritional status/risk between days 3-5 post-operatively assessed through all four markers was associated with longer post-operative LOS (all P < 0.05). No association was found between number of NBM days, time to feeding and clinical outcomes. CONCLUSION Poor early post-operative nutritional status/risk is associated with longer post-operative LOS in patients undergoing GI surgery, which may facilitate simple identification of patients at high priority for nutritional intervention. The present study highlights the heterogeneity in post-operative nutritional management practices.
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Affiliation(s)
- K Narendra
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - N Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - C Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - B Johnston
- Austin Health, Heidelberg, Victoria, Australia
| | - B Chapman
- Austin Health, Heidelberg, Victoria, Australia
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16
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Sinclair M, Chapman B, Hoermann R, Angus PW, Testro A, Scodellaro T, Gow PJ. Reply. Liver Transpl 2020; 26:309-310. [PMID: 31833637 DOI: 10.1002/lt.25700] [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] [Received: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Marie Sinclair
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Brooke Chapman
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Rudolf Hoermann
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Peter W Angus
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Thomas Scodellaro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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McClure T, Chapman B, Hey P, Testro A, Gow P. Long-term continuous terlipressin infusion in cirrhotic patients with hepatorenal syndrome or refractory ascites awaiting liver transplantation is associated with an increase in plasma sodium. United European Gastroenterol J 2019; 7:1271-1273. [PMID: 31700640 PMCID: PMC6826519 DOI: 10.1177/2050640619878996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/03/2023] Open
Affiliation(s)
- T McClure
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - B Chapman
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - P Hey
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - A Testro
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - P Gow
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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18
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Sinclair M, Chapman B, Hoermann R, Angus PW, Testro A, Scodellaro T, Gow PJ. Handgrip Strength Adds More Prognostic Value to the Model for End-Stage Liver Disease Score Than Imaging-Based Measures of Muscle Mass in Men With Cirrhosis. Liver Transpl 2019; 25:1480-1487. [PMID: 31282126 DOI: 10.1002/lt.25598] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 05/06/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022]
Abstract
Sarcopenia is associated with mortality in cirrhosis, but there is no gold standard for its diagnosis. The comparative utility of different diagnostic methods is unknown. This single-center observational cohort study followed 145 men referred for liver transplant evaluation between 2005 and 2012. Muscle mass was estimated by handgrip strength, dual energy X-ray absorptiometry (DEXA) lean mass, and single-slice computed tomography (CT) scan at the fourth lumbar vertebra. Recorded outcomes included time to death or liver transplantation. The median (interquartile range [IQR]) age was 54 years (47-59 years), and Model for End-Stage Liver Disease (MELD) score was 17 (14-23). Of 145 men, 56 died with a median (IQR) time to death of 7.44 months (3.48-14.16 months). In total, 79 men underwent transplantation with median (IQR) time to transplant of 7.20 months (3.96-12.84 months). The prevalence of sarcopenia differed between diagnostic modalities with 70.3% using CT muscle mass, 45.9% using handgrip strength, and 38.7% using DEXA. Muscle mass was inversely associated with wait-list mortality for measured CT muscle mass (hazard ratio [HR], 0.94; 95% confidence interval (CI), 0.90-0.98; P = 0.002), DEXA muscle mass (HR, 0.99; 95% CI, 0.99-0.99; P = 0.003), and handgrip strength (HR, 0.94; 95% CI, 0.91-0.98; P = 0.002). These results retained significance independent of the MELD score. In predicting mortality, the MELD-handgrip strength bivariate Cox model was superior to a MELD-CT muscle Cox model (P < 0.001). In conclusion, handgrip strength combined with MELD score was the superior predictive model in this novel study examining 3 commonly employed techniques to diagnose sarcopenia in cirrhosis. Handgrip strength has additional potential clinical benefits because it can be performed serially without the radiation dose, cost, and access issues attributable to CT and DEXA.
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Affiliation(s)
- Marie Sinclair
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Brooke Chapman
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter W Angus
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Scodellaro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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19
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Oatley G, S. W, Barnes GC, Clare J, Chapman B. Crime concentration in Perth CBD: a comparison of officer predicted hot spots, data derived hot spots and officer GPS patrol data. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1569141] [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: 10/27/2022]
Affiliation(s)
- G. Oatley
- Federation University, Melbourne, Australia
| | | | | | - J. Clare
- University of Western Australia, Perth, Australia
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20
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Sinclair M, Hoermann R, Peterson A, Testro A, Angus PW, Hey P, Chapman B, Gow PJ. Use of Dual X-ray Absorptiometry in men with advanced cirrhosis to predict sarcopenia-associated mortality risk. Liver Int 2019; 39:1089-1097. [PMID: 30746903 DOI: 10.1111/liv.14071] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 10/12/2018] [Revised: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Reduced muscle area on CT scan is an independent predictor of mortality in cirrhosis. We examine for the first time the relationship between dual energy x-ray absorptiometry (DEXA) lean mass parameters on outcomes in cirrhotic men awaiting liver transplantation. MATERIALS AND METHODS We retrospectively reviewed DEXA scans performed during transplant assessment between 2001 and 2016. Baseline data including the presence of ascites and MELD score were recorded. DEXA lean mass measures were adjusted for height. The primary outcome was 12-month wait-list mortality. RESULTS Four hundred twenty men with median age 55.4 years [interquartile range 49.2; 59.4] and MELD 16 [12; 20] were studied. Median follow-up was 58.5 [28.8; 109] months. 12-month wait-list mortality was 12.4%. Appendicular lean mass was inversely associated with mortality (HR 0.78 [0.62; 0.98], P = 0.03). Lean mass of arms (HR 0.37 [0.16; 0.83], P = 0.02) rather than legs (HR 0.77 [0.58; 1.03], P = 0.08) was responsible for this association. Upper limb lean mass showed a significant interaction with MELD score in predicting wait-list mortality, particularly within 4 months. Total lean mass was not associated with mortality but increased in conjunction with increasing ascites (OR for ascites 1.20 [1.15; 1.25], P < 0.001 for each unit increase in MELD). CONCLUSION Upper limb lean mass by DEXA is strongly associated with mortality in men awaiting liver transplantation. The superiority of upper limb lean mass probably relates to confounding of lower limb measures by fluid retention. This DEXA parameter represents a novel and reproducible measure of sarcopenia in cirrhosis.
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Affiliation(s)
- Marie Sinclair
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Rudolf Hoermann
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Adam Peterson
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia
| | - Adam Testro
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Peter W Angus
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope Hey
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Brooke Chapman
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- Austin Hospital Liver Transplant Unit, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Keighley C, Chen SCA, Marriott D, Pope A, Chapman B, Kennedy K, Bak N, Underwood N, Wilson HL, McDonald K, Darvall J, Halliday C, Kidd S, Nguyen Q, Hajkowicz K, Sorrell TC, Van Hal S, Slavin MA. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis 2019; 19:445. [PMID: 31113382 PMCID: PMC6528341 DOI: 10.1186/s12879-019-4065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/23/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model. Methods Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation. Results The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy (n = 20; 15%), and solid organ malignancy in (n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non-albicans Candida spp. accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source (p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset (n = 741). Conclusions Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia. .,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - D Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - A Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Mathematics and Statistics, University of NSW, Sydney, NSW, Australia
| | - B Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - N Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - H L Wilson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - K McDonald
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - J Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Q Nguyen
- National Centre for Clinical Excellence on Emerging Drugs of Concern (NCCRED), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - T C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - S Van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
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22
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Chapman B, Gow P, Sinclair M, Hanrahan T, Angus P, McClure T, Mills C, Terbah R, Testro A. Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant. JHEP Rep 2019; 1:107-113. [PMID: 32039358 PMCID: PMC7001556 DOI: 10.1016/j.jhepr.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/01/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background & Aims Portal hypertension contributes to the pathogenesis of malnutrition and sarcopenia in cirrhosis via multiple mechanisms. Terlipressin is a vasopressin analogue that we administer via continuous outpatient infusion, as a bridge to transplantation in patients with hepatorenal syndrome or refractory ascites. We describe, for the first time, the impact of outpatient terlipressin on nutritional and muscle parameters. Methods Nutrition (subjective global assessment), handgrip strength, dietary intake (energy, protein), frequency of paracentesis and severity of liver disease (model for end-stage liver disease score) were prospectively recorded at terlipressin commencement and follow-up (transplantation, cessation or census date). Results Nineteen patients were included (89% male, median age 59.6 years, median model for end-stage liver disease score 24), of whom 12 had hepatorenal syndrome and 7 had refractory ascites. All patients were malnourished at baseline, 63% (n = 12) had sarcopenic-range grip strength, and mean paracentesis frequency was 2.86 ± 1.62/month. Median duration of terlipressin was 51 days (interquartile range 29–222). Fourteen patients (74%) were transplanted, 2 delisted (10%) and 3 (16%) continued terlipressin. Energy and protein intake improved significantly following terlipressin, from 17.94 ± 5.43 kcal/kg to 27.70 ± 7.48 kcal/kg, and 0.74 ± 0.28 g/kg to 1.16 ± 0.31 g/kg, respectively (both p < 0.001). Handgrip strength increased from 25.36 ± 8.13 kg to 28.49 ± 7.63 kg (p = 0.001). Linear regression analysis demonstrated hand grip strength increased 0.075% for every 1-day of terlipressin (p = 0.005). The frequency of large-volume paracentesis reduced by 46%, to 1.57 ± 1.51/month (p = 0.001). Conclusion Continuous terlipressin infusion reduces the complications of portal hypertension and is associated with an improvement in nutritional and muscle parameters in patients on the liver transplant waiting list, in whom such characteristics usually demonstrate progressive decline. This validates both the aetiological role of portal hypertension in malnutrition and represents a promising new anabolic therapy. Lay summary Malnutrition and poor muscle strength are common in liver disease and often get worse while patients await liver transplant. Terlipressin is a medication used to treat portal hypertension in patients with hepatorenal syndrome. It is usually given for a few days or weeks in patients confined to hospital. Our centre provides outpatient terlipressin for weeks to months as a bridge to liver transplant. In patients treated with terlipressin at our hospital, we observed a substantial increase in their dietary intake and muscle strength, which may improve their quality of life and outcomes after liver transplant. Malnutrition and poor muscle strength are highly prevalent in cirrhotics with hepatorenal syndrome. Terlipressin infusion increased energy and protein intake in patients with hepatorenal syndrome. Handgrip strength continued to increase with every day of terlipressin therapy Medium to long-term terlipressin infusion was safe and efficacious as a bridge to liver transplant.
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Affiliation(s)
- Brooke Chapman
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Timothy Hanrahan
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Peter Angus
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Tess McClure
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Chris Mills
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Ryma Terbah
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
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23
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Ryan SF, Adamson NL, Aktipis A, Andersen LK, Austin R, Barnes L, Beasley MR, Bedell KD, Briggs S, Chapman B, Cooper CB, Corn JO, Creamer NG, Delborne JA, Domenico P, Driscoll E, Goodwin J, Hjarding A, Hulbert JM, Isard S, Just MG, Kar Gupta K, López-Uribe MM, O'Sullivan J, Landis EA, Madden AA, McKenney EA, Nichols LM, Reading BJ, Russell S, Sengupta N, Shapiro LR, Shell LK, Sheard JK, Shoemaker DD, Sorger DM, Starling C, Thakur S, Vatsavai RR, Weinstein M, Winfrey P, Dunn RR. The role of citizen science in addressing grand challenges in food and agriculture research. Proc Biol Sci 2018; 285:20181977. [PMID: 30464064 PMCID: PMC6253361 DOI: 10.1098/rspb.2018.1977] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 09/05/2018] [Accepted: 10/30/2018] [Indexed: 11/12/2022] Open
Abstract
The power of citizen science to contribute to both science and society is gaining increased recognition, particularly in physics and biology. Although there is a long history of public engagement in agriculture and food science, the term 'citizen science' has rarely been applied to these efforts. Similarly, in the emerging field of citizen science, most new citizen science projects do not focus on food or agriculture. Here, we convened thought leaders from a broad range of fields related to citizen science, agriculture, and food science to highlight key opportunities for bridging these overlapping yet disconnected communities/fields and identify ways to leverage their respective strengths. Specifically, we show that (i) citizen science projects are addressing many grand challenges facing our food systems, as outlined by the United States National Institute of Food and Agriculture, as well as broader Sustainable Development Goals set by the United Nations Development Programme, (ii) there exist emerging opportunities and unique challenges for citizen science in agriculture/food research, and (iii) the greatest opportunities for the development of citizen science projects in agriculture and food science will be gained by using the existing infrastructure and tools of Extension programmes and through the engagement of urban communities. Further, we argue there is no better time to foster greater collaboration between these fields given the trend of shrinking Extension programmes, the increasing need to apply innovative solutions to address rising demands on agricultural systems, and the exponential growth of the field of citizen science.
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Affiliation(s)
- S F Ryan
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Department of Entomology and Plant Pathology, University of Tennessee, Knoxville, TN, USA
| | - N L Adamson
- Xerces Society for Invertebrate Conservation/USDA NRCS ENTSC, Greensboro, NC, USA
| | - A Aktipis
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - L K Andersen
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - R Austin
- Department of Crop and Soil Sciences, NC State Extension, Raleigh, NC, USA
| | - L Barnes
- Lincoln Heights Environmental Connections Magnet Elementary School, Fuquay-Varina, NC, USA
| | - M R Beasley
- Knightdale High School of Collaborative Design, Knightdale, NC, USA
| | - K D Bedell
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Briggs
- NC Plant Sciences Initiative, College of Agriculture and Life Sciences, NC State Extension, Raleigh, NC, USA
| | - B Chapman
- Department of Agricultural and Human Sciences, NC State Extension, Raleigh, NC, USA
| | - C B Cooper
- Department of Forestry and Environmental Resources, NC State Extension, Raleigh, NC, USA
| | - J O Corn
- William and Ida Friday Institute for Educational Innovation, NC State Extension, Raleigh, NC, USA
| | - N G Creamer
- Department of Horticultural Science, NC State Extension, Raleigh, NC, USA
| | - J A Delborne
- Department of Forestry and Environmental Resources, NC State Extension, Raleigh, NC, USA
| | - P Domenico
- Curriculum Enhancement Programs at Wake County Public School System, Cary, NC, USA
| | - E Driscoll
- Department of Horticultural Science, NC State Extension, Raleigh, NC, USA
| | - J Goodwin
- Department of Communication, NC State Extension, Raleigh, NC, USA
| | - A Hjarding
- North Carolina Wildlife Federation, Charlotte, NC, USA
- The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J M Hulbert
- Forestry and Agricultural Biotechnology Institute, University of Pretoria, Pretoria, South Africa
| | - S Isard
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, State College, PA, USA
- Department of Meteorology and Atmospheric Sciences, Pennsylvania State University, State College, PA, USA
| | - M G Just
- Department of Entomology and Plant Pathology, NC State Extension, Raleigh, NC, USA
| | - K Kar Gupta
- Biodiversity Lab, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - M M López-Uribe
- Department of Entomology, Center for Pollinator Research, Pennsylvania State University, State College, PA, USA
| | - J O'Sullivan
- Center for Environmental Farming Systems, North Carolina A&T State University, Greensboro, NC, USA
| | - E A Landis
- Department of Biology, Tufts University, Medford, MA, USA
| | - A A Madden
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - E A McKenney
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - L M Nichols
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - B J Reading
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - S Russell
- Millbrook Environmental Connections Magnet Elementary School, Raleigh, NC, USA
| | - N Sengupta
- Consultant - Biodiversity Conservation & Sustainable Development, Auroville, Tamil Nadu, India
| | - L R Shapiro
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
| | - L K Shell
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - J K Sheard
- Center for Macroecology, Evolution and Climate, Natural History Museum of Denmark, Copenhagen University, Copenhagen, Denmark
| | - D D Shoemaker
- Department of Entomology and Plant Pathology, University of Tennessee, Knoxville, TN, USA
| | - D M Sorger
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
- Research and Collections, North Carolina Museum of Natural Sciences, Raleigh, NC, USA
| | - C Starling
- Heritage High School, Wake Forest, NC, USA
| | - S Thakur
- College of Veterinary Medicine, NC State Extension, Raleigh, NC, USA
| | - R R Vatsavai
- Department of Computer Science, NC State Extension, Raleigh, NC, USA
| | - M Weinstein
- Evaluation and Accountability Coordinator Extension Administration, NC State Extension, Raleigh, NC, USA
| | - P Winfrey
- Arizona State University Biodesign Institute, Tempe, AZ, USA
| | - R R Dunn
- Department of Applied Ecology, NC State Extension, Raleigh, NC, USA
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Chapman B, Huang A, Horner E, Peters K, Sempeles E, Roberts B, Lapham S. INTERNAL REPLICATION STRATEGIES FOR (MODERATELY) LARGE SAMPLES: CROSS-VALIDATION TECHNIQUES IN PROJECT TALENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2911] [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: 11/14/2022] Open
Affiliation(s)
- B Chapman
- Departments of Psychiatry and Public Health Sciences, URMC, Rochester, New York, United States
| | - A Huang
- American Institutes for Research, Washington, DC, USA
| | - E Horner
- American Institutes for Research, Washington, DC, USA
| | - K Peters
- American Institutes for Research, Washington, DC, USA
| | - E Sempeles
- American Institutes for Research, Washington, DC, USA
| | - B Roberts
- University of Illinois, Champaign, IL, USA
| | - S Lapham
- American Institutes for Research, Washington, DC, USA
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25
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Chapman B, Rebok GW. INTEREST GROUP SESSION - ALZHEIMER’S DISEASE RESEARCH: HOW EARLY CAN WE PREDICT AD? EVIDENCE FROM THE 53-YEAR PROJECT TALENT-MEDICARE STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2046] [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: 11/12/2022] Open
Affiliation(s)
- B Chapman
- Departments of Psychiatry and Public Health Sciences, URMC, Rochester, New York
| | - G W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
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Ochoukov R, Bobkov V, Chapman B, Dendy R, Dunne M, Faugel H, García-Muñoz M, Geiger B, Hennequin P, McClements KG, Moseev D, Nielsen S, Rasmussen J, Schneider P, Weiland M, Noterdaeme JM. Observations of core ion cyclotron emission on ASDEX Upgrade tokamak. Rev Sci Instrum 2018; 89:10J101. [PMID: 30399687 DOI: 10.1063/1.5035180] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The B-dot probe diagnostic suite on the ASDEX Upgrade tokamak has recently been upgraded with a new 125 MHz, 14 bit resolution digitizer to study ion cyclotron emission (ICE). While classic edge emission from the low field side plasma is often observed, we also measure waves originating from the core with fast fusion protons or beam injected deuterons being a possible emission driver. Comparing the measured frequency values with ion cyclotron harmonics present in the plasma places the origin of this emission on the magnetic axis, with the fundamental hydrogen/second deuterium cyclotron harmonic matching the observed values. The actual values range from ∼27 MHz at the on-axis toroidal field BT = -1.79 T to ∼40 MHz at BT = -2.62 T. When the magnetic axis position evolves during this emission, the measured frequency values track the changes in the estimated on-axis cyclotron frequency values. Core ICE is usually a transient event lasting ∼100 ms during the neutral beam startup phase. However, in some cases, core emission occurs in steady-state plasmas and lasts for longer than 1 s. These observations suggest an attractive possibility of using a non-perturbing ICE-based diagnostic to passively monitor fusion alpha particles at the location of their birth in the plasma core, in deuterium-tritium burning devices such as ITER and DEMO.
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Affiliation(s)
- R Ochoukov
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - V Bobkov
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - B Chapman
- Centre for Fusion, Space and Astrophysics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - R Dendy
- Centre for Fusion, Space and Astrophysics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - M Dunne
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - H Faugel
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - M García-Muñoz
- FAMN Department, Faculty of Physics, University of Seville, 41012 Seville, Spain
| | - B Geiger
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - P Hennequin
- Laboratoire de Physique des Plasmas, Ecole Polytechnique, 91128 Palaiseau, France
| | - K G McClements
- CCFE, Culham Science Center, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D Moseev
- Max Planck Institute for Plasma Physics, Wendelsteinstr. 1, 17491 Greifswald, Germany
| | - S Nielsen
- Department of Physics, Technical University of Denmark, Fysikvej, b. 309, DK-2800 Kongens Lyngby, Denmark
| | - J Rasmussen
- Department of Physics, Technical University of Denmark, Fysikvej, b. 309, DK-2800 Kongens Lyngby, Denmark
| | - P Schneider
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - M Weiland
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
| | - J-M Noterdaeme
- Max Planck Institute for Plasma Physics, Boltzmannstr. 2, D-85748 Garching, Germany
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Chapman B, Pintar K, Smith BA. Multi-Exposure Pathway Model to Compare Escherichia coli O157 Risks and Interventions. Risk Anal 2018; 38:392-409. [PMID: 28471504 DOI: 10.1111/risa.12826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
The relative contributions of exposure pathways associated with cattle-manure-borne Escherichia coli O157:H7 on public health have yet to be fully characterized. A stochastic, quantitative microbial risk assessment (QMRA) model was developed to describe a hypothetical cattle farm in order to compare the relative importance of five routes of exposure, including aquatic recreation downstream of the farm, consumption of contaminated ground beef processed with limited interventions, consumption of leafy greens, direct animal contact, and the recreational use of a cattle pasture. To accommodate diverse environmental and hydrological pathways, existing QMRAs were integrated with novel and simplistic climate and field-level submodels. The model indicated that direct animal contact presents the greatest risk of illness per exposure event during the high pathogen shedding period. However, when accounting for the frequency of exposure, using a high-risk exposure-receptor profile, consumption of ground beef was associated with the greatest risk of illness. Additionally, the model was used to evaluate the efficacy of hypothetical interventions affecting one or more exposure routes; concurrent evaluation of multiple routes allowed for the assessment of the combined effect of preharvest interventions across exposure pathways-which may have been previously underestimated-as well as the assessment of the effect of additional downstream interventions. This analysis represents a step towards a full evaluation of the risks associated with multiple exposure pathways; future incorporation of variability associated with environmental parameters and human behaviors would allow for a comprehensive assessment of the relative contribution of exposure pathways at the population level.
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Affiliation(s)
- B Chapman
- Public Health Agency of Canada, Guelph, ON, Canada
- University of Guelph, Guelph, ON, Canada
| | - K Pintar
- Public Health Agency of Canada, Guelph, ON, Canada
| | - B A Smith
- Public Health Agency of Canada, Guelph, ON, Canada
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Pironi L, Konrad D, Brandt C, Joly F, Wanten G, Agostini F, Chambrier C, Aimasso U, Zeraschi S, Kelly D, Szczepanek K, Jukes A, Di Caro S, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Wu J, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Pagano MC, Hughes SJ, Guglielmi FW, Kozjek NR, Schneider SM, Gillanders L, Ellegard L, Thibault R, Matras P, Zmarzly A, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Sahin P, Jones L, Lee ADW, Bertasi V, Orlandoni P, Izbéki F, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui EP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Shaffer J, Lal S. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr 2017; 37:728-738. [PMID: 28483328 DOI: 10.1016/j.clnu.2017.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Denise Konrad
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Federica Agostini
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | | | - Sarah Zeraschi
- Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | | | | | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | | | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jian Wu
- Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Sarah-Jane Hughes
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Lyn Gillanders
- National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anna Zmarzly
- Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospital, Coventry, United Kingdom
| | - Marina Taus
- Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy
| | - Nuria M Virgili
- Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D W Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Marta Bueno Díez
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Carmen Garde
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Chapman B, De Cruz P, Jones R, Hardikar W, Testro A. Intestinal Failure and Transplant: The Australian Experience (2009 to 2014). Transplant Proc 2017; 48:463-7. [PMID: 27109979 DOI: 10.1016/j.transproceed.2015.09.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/24/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND A joint adult and pediatric intestinal transplant (ITx) program for Australia was developed in 2009 to provide life-saving ITx to patients with irreversible intestinal failure (IF). We aimed to analyze the outcomes of patients treated by our service over the past 5 years. METHODS A retrospective medical record review was conducted on all IF patients referred to our service. Patient demographics, underlying disease, nutrition support, TPN complications, and current transplant program status were evaluated. RESULTS Fifty-seven patients (35 adults, 40.4 ± 12.4 years; 22 children, 6.3 ± 4.3 years) throughout Australia and New Zealand have been referred. Leading causes of IF were short bowel syndrome followed by pseudo-obstruction. Forty patients (70%) exhibited at least 1 life-threatening complication of PN at referral: liver failure, impending loss of venous access, and/or recurrent line sepsis. Three patients have undergone ITx with 100% survival (median follow-up, 1161 days). Four patients (8%) are listed for transplant, 6 patients (12%) are awaiting transplant assessment, and 4 patients (8%) have died (2 while awaiting transplantation, 2 during assessment period). Causes of death included sepsis and intracranial bleed. Two-thirds of all referred patients (n = 40) were deferred or rejected from wait-listing. CONCLUSIONS After 5 years of establishing the first dedicated ITx program in Australia and New Zealand, early results indicate that ITx is an available and life-saving option for IF patients in these countries. Current barriers to ITx in Australia include a shortage of appropriate donors and a high rate of donor-specific antibodies among potential recipients. Growing awareness of the service and early referral to assist appropriate patient selection will aid in the program's success.
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Affiliation(s)
- B Chapman
- Nutrition and Dietetics Department, Austin Health, Melbourne, Australia.
| | - P De Cruz
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Australia
| | - R Jones
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Australia
| | - W Hardikar
- Liver and Intestinal Transplant Unit, Royal Children's Hospital, Melbourne, Australia
| | - A Testro
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Australia
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Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A, Marriott DJ, Chapman B, Halliday CL, Hajkowicz K, Athan E, Bak N, Cheong E, Heath CH, Morrissey CO, Kidd S, Beresford R, Blyth C, Korman TM, Robinson JO, Meyer W, Chen SCA. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clin Microbiol Infect 2016; 22:775-781. [PMID: 26806139 DOI: 10.1016/j.cmi.2016.01.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/30/2015] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
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Affiliation(s)
- K J Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
| | - K Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - S J van Hal
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - T C Sorrell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - A Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - D J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - B Chapman
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - C L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - E Cheong
- Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, Australia
| | - C H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - C O Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | - R Beresford
- Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia
| | - C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Australia
| | - T M Korman
- Monash Infectious Diseases and Monash University, Melbourne, Australia
| | - J O Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Biomedical Sciences, Curtin University, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - W Meyer
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology, The University of Sydney, Sydney, Australia
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Beltrame L, Di Marino M, Fruscio R, Calura E, Chapman B, Clivio L, Sina F, Mele C, Iatropoulos P, Grassi T, Fotia V, Romualdi C, Martini P, Noris M, Paracchini L, Craparotta I, Petrillo M, Milani R, Perego P, Ravaggi A, Zambelli A, Ronchetti E, D'Incalci M, Marchini S. Profiling cancer gene mutations in longitudinal epithelial ovarian cancer biopsies by targeted next-generation sequencing: a retrospective study. Ann Oncol 2015; 26:1363-71. [PMID: 25846551 DOI: 10.1093/annonc/mdv164] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 09/02/2014] [Accepted: 03/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The majority of patients with stage III-IV epithelial ovarian cancer (EOC) relapse after initially responding to platinum-based chemotherapy, and develop resistance. The genomic features involved in drug resistance are unknown. To unravel some of these features, we investigated the mutational profile of genes involved in pathways related to drug sensitivity in a cohort of matched tumors obtained at first surgery (Ft-S) and second surgery (Sd-S). PATIENTS AND METHODS Matched biopsies (33) taken at Ft-S and Sd-S were selected from the 'Pandora' tumor tissue collection. DNA libraries for 65 genes were generated using the TruSeq Custom Amplicon kit and sequenced on MiSeq (Illumina). Data were analyzed using a high-performance cluster computing platform (Cloud4CARE project) and independently validated. RESULTS A total of 2270 somatic mutations were identified (89.85% base substitutions 8.19% indels, and 1.92% unknown). Homologous recombination (HR) genes and TP53 were mutated in the majority of Ft-S, while ATM, ATR, TOP2A and TOP2B were mutated in the entire dataset. Only 2% of mutations were conserved between matched Ft-S and Sd-S. Mutations detected at second surgery clustered patients in two groups characterized by different mutational profiles in genes associated with HR, PI3K, miRNA biogenesis and signal transduction. CONCLUSIONS There was a low level of concordance between Ft-S and Sd-S in terms of mutations in genes involved in key processes of tumor growth and drug resistance. This result suggests the importance of future longitudinal analyses to improve the clinical management of relapsed EOC.
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Affiliation(s)
- L Beltrame
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - M Di Marino
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - E Calura
- Department of Biology, University of Padova, Padova, Italy
| | - B Chapman
- Bioinformatics Core, Harvard School of Public Health, Boston, USA
| | - L Clivio
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - F Sina
- Clinic of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - C Mele
- Department of Molecular Medicine Laboratory, Immunology and Genetic of Rare Diseases and Organ Transplantation, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - P Iatropoulos
- Department of Molecular Medicine Laboratory, Immunology and Genetic of Rare Diseases and Organ Transplantation, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - T Grassi
- Clinic of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - V Fotia
- PhD Program in Experimental Medicine, University of Pavia, Pavia
| | - C Romualdi
- Department of Biology, University of Padova, Padova, Italy
| | - P Martini
- Department of Biology, University of Padova, Padova, Italy
| | - M Noris
- Department of Molecular Medicine Laboratory, Immunology and Genetic of Rare Diseases and Organ Transplantation, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - L Paracchini
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - I Craparotta
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - M Petrillo
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome
| | - R Milani
- Clinic of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - P Perego
- Department of Pathology, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - A Ravaggi
- Division of Gynecologic Oncology, 'Angelo Nocivelli' Institute of Molecular Medicine, University of Brescia, Brescia
| | - A Zambelli
- Unit of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - E Ronchetti
- Laboratory of Experimental Oncology and Pharmacogenomics, IRCCS Salvatore Maugeri Foundation, Pavia, Italy
| | - M D'Incalci
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
| | - S Marchini
- Department of Oncology, Centro di Ricerche Cliniche per le Malattie Rare 'ALDO e CELE DACCO'', IRCCS 'Mario Negri' Institute for Pharmacological Research, Milano
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Baugh AD, Wooten W, Chapman B, Drake AF, Vaughn BV. Sleep characteristics in Goldenhar Syndrome. Int J Pediatr Otorhinolaryngol 2015; 79:356-8. [PMID: 25636665 DOI: 10.1016/j.ijporl.2014.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 10/06/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the characteristics of sleep in patients with Goldenhar Syndrome. DESIGN Retrospective review of all polysomnography studies conducted at the University of North Carolina Hospitals between 2003 and 2013 on patients carrying the diagnosis of Goldenhar's Syndrome. RESULTS A preponderance of patients demonstrated severe obstructive sleep apnea and hypercapnia. CONCLUSIONS Patients with Goldenhar Syndrome should be screened for sleep apnea and hypercapnia.
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Affiliation(s)
- A D Baugh
- Department of Surgery, Michigan State University, United States
| | - W Wooten
- Pediatric Specialty Care, East Carolina University, United States
| | - B Chapman
- Department of Neurology, The Ohio State University, United States
| | - A F Drake
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - B V Vaughn
- Division of Sleep and Epilepsy, Department of Neurology, University of North Carolina School of Medicine, United States
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Olivier S, Smith R, Bull M, Chapman B, Knoerzer K. Apparatus for the simultaneous processing of mesophilic spores by heat-only and by high pressure and heat in a high pressure vessel to investigate synergistic spore inactivation. INNOV FOOD SCI EMERG 2015. [DOI: 10.1016/j.ifset.2014.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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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Collins G, Chapman B, Crowe T. OP013: Weight Gain and Obesity After Orthotopic Liver Transplantation at Austin Health. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50013-1] [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: 11/27/2022]
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Merriman T, Phipps-Green A, Topless R, Merriman M, Franklin C, Jones G, van Rij A, Montgomery G, Chapman B, White D, Stamp L, Dalbeth N. THU0492 Association Analysis of 18 Recently Discovered Serum Urate Loci with Gout. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4679] [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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Erdozain G, KuKanich K, Chapman B, Powell D. Best Practices for Planning Events Encouraging Human-Animal Interactions. Zoonoses Public Health 2014; 62:90-9. [DOI: 10.1111/zph.12117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- G. Erdozain
- College of Veterinary Medicine; Kansas State University; Manhattan KS USA
| | - K. KuKanich
- Department of Clinical Sciences; Kansas State University; Manhattan KS USA
| | - B. Chapman
- Department of 4-H Youth Development and Family & Consumer Sciences; North Carolina State University; Raleigh NC USA
| | - D. Powell
- Powell food safety; Brisbane QLD Australia
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Lutsiv O, Pullenayegum E, Foster G, Vera C, Giglia L, Chapman B, Fusch C, McDonald SD. Women's intentions to breastfeed: a population-based cohort study. BJOG 2013; 120:1490-8. [DOI: 10.1111/1471-0528.12376] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
Affiliation(s)
- O Lutsiv
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - E Pullenayegum
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Centre for Evaluation of Medicines; St Joseph's Healthcare; Hamilton ON Canada
| | - G Foster
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Biostatistics Unit; Father Sean O'Sullivan Research Centre; St Joseph's Healthcare; Hamilton ON Canada
| | - C Vera
- Departmento de Obstetricia y Ginecologia; Escuela de Medicina; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - L Giglia
- Division of General Pediatrics; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - B Chapman
- Better Outcomes Registry and Network (BORN) Ontario (formerly OPSS); Ottawa ON Canada
| | - C Fusch
- Division of Neonatology; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - SD McDonald
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Division of Maternal-Fetal Medicine; Departments of Obstetrics & Gynecology and Diagnostic Imaging; McMaster University; Hamilton ON Canada
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Olivier S, Bull M, Chapman B. Bacillus spp. spores produced at lower temperatures are more resistant to high pressure thermal processes but mineralization does not predict relative resistance. INNOV FOOD SCI EMERG 2012. [DOI: 10.1016/j.ifset.2012.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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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Erdozain G, KuKanich K, Chapman B, Powell D. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos--2010-2011. Zoonoses Public Health 2012; 60:304-10. [PMID: 22846186 DOI: 10.1111/j.1863-2378.2012.01531.x] [Citation(s) in RCA: 24] [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: 11/30/2022]
Abstract
Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This study details an observational study of hand hygiene tool availability and recommendations; frequency of risky behaviour; and handwashing attempts by visitors in Kansas (9) and Missouri (4), USA, petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos, respectively. Risky behaviours were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviours were as follows: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children's and adults' hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n = 214) of individuals attempted some type of hand hygiene, with male adults, female adults and children attempting at similar rates (32%, 40% and 37%, respectively). Visitors were 4.8× more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; P < 0.001, OR = 4.863, 95% CI = 3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3× more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals' yard for contact (26/114, 22.8%; P < 0.001, OR = 2.339, 95% CI = 1.454-3.763). Inconsistencies existed in tool availability, signage and supervision of animal contact. Risk communication was poor, with few petting zoos outlining risks associated with animal contact, or providing recommendations for precautions to be taken to reduce these risks.
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Affiliation(s)
- G Erdozain
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
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Allen DG, Clugston E, Petersen Y, Röder IV, Chapman B, Rudolf R. Interactions between intracellular calcium and phosphate in intact mouse muscle during fatigue. J Appl Physiol (1985) 2011; 111:358-66. [DOI: 10.1152/japplphysiol.01404.2010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fatigue was studied in intact tibialis anterior muscle of anesthetized mice. The distal tendon was detached and connected to a force transducer while blood flow continued normally. The muscle was stimulated with electrodes applied directly to the muscle surface and fatigued by repeated (1 per 4 s), brief (0.4 s), maximal (100-Hz stimulation frequency) tetani. Force declined monotonically to 49 ± 5% of the initial value with a half time of 36 ± 5 s and recovered to 86 ± 4% after 4 min. Intracellular phosphate concentration ([Pi]) was measured by 31P-NMR on perchloric acid extracts of muscles. [Pi] increased during fatigue from 7.6 ± 1.7 to 16.0 ± 1.6 mmol/kg muscle wet wt and returned to control during recovery. Intracellular Ca2+ was measured with cameleons whose plasmids had been transfected in the muscle 2 wk before the experiment. Yellow cameleon 2 was used to measure myoplasmic Ca2+, and D1ER was used to measure sarcoplasmic reticulum (SR) Ca2+. The myoplasmic Ca2+ during tetani declined steadily during the period of fatigue and showed complete recovery over 4 min. The SR Ca2+ also declined monotonically during fatigue and showed a partial recovery with rest. These results show that the initial phase of force decline is accompanied by a rise in [Pi] and a reduction in the tetanic myoplasmic Ca2+. We suggest that both changes contribute to the fatigue. A likely cause of the decline in tetanic myoplasmic Ca2+ is precipitation of CaPi in the SR.
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Affiliation(s)
- D. G. Allen
- School of Medical Sciences and Bosch Institute and
| | - E. Clugston
- School of Medical Sciences and Bosch Institute and
| | - Y. Petersen
- Institute for Toxicology and Genetics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - I. V. Röder
- Institute for Toxicology and Genetics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - B. Chapman
- School of Molecular Bioscience, University of Sydney, Sydney, New South Wales, Australia; and
| | - R. Rudolf
- Institute for Toxicology and Genetics, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Bull M, Steele R, Kelly M, Olivier S, Chapman B. Packaging under pressure: Effects of high pressure, high temperature processing on the barrier properties of commonly available packaging materials. INNOV FOOD SCI EMERG 2010. [DOI: 10.1016/j.ifset.2010.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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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Chapman B, Scurrah KJ, Ross T. Contemporary formulation and distribution practices for cold-filled acid products: Australian industry survey and modeling of published pathogen inactivation data. J Food Prot 2010; 73:895-906. [PMID: 20501041 DOI: 10.4315/0362-028x-73.5.895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A survey of 12 Australian manufacturers indicated that mild-tasting acids and preservatives are used to partially replace acetic acid in cold-filled acid dressings and sauces. In contrast to traditional ambient temperature distribution practices, some manufacturers indicated that they supply the food service sector with cold-filled acid products prechilled for incorporation into ready-to-eat foods. The Comité des Industries des Mayonnaises et Sauces Condimentaires de la Communauté Economique Européenne (CIMSCEE) Code, a formulation guideline used by the industry to predict the safety of cold-filled acid formulations with respect to Salmonella enterica and Escherichia coli, does not extend to the use of acids and preservatives other than acetic acid nor does it consider the effects of chill distribution. We found insufficient data in the published literature to comprehensively model the response of S. enterica and E. coli to all of the predictor variables (i.e., pH, acetic acid, NaCl, sugars, other acids, preservatives, and storage temperature) of relevance for contemporary cold-filled acid products in Australia. In particular, we noted a lack of inactivation data for S. enterica at aqueous-phase NaCl concentrations of >3% (wt/wt). However, our simple models clearly identified pH and 1/absolute temperature of storage as the most important variables generally determining inactivation. To develop robust models to predict the effect of contemporary formulation and storage variables on product safety, additional empirical data are required. Until such models are available, our results support challenge testing of cold-filled acid products to ascertain their safety, as suggested by the CIMSCEE, but suggest consideration of challenging with both E. coli and S. enterica at incubation temperatures relevant to intended product distribution temperatures.
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Affiliation(s)
- B Chapman
- CSIRO Division of Food and Nutritional Sciences, P.O. Box 52, North Ryde 1670, New South Wales, Australia.
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Grieve S, Kuchel P, Chapman B, Figtree G. Tracking Cardiac Myofibrils by Magnetic Resonance Diffusion Tensor Imaging at High Field. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.486] [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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Stone G, Chapman B, Lovell D. Development of a log-quadratic model to describe microbial inactivation, illustrated by thermal inactivation of Clostridium botulinum. Appl Environ Microbiol 2009; 75:6998-7005. [PMID: 19767461 PMCID: PMC2786541 DOI: 10.1128/aem.01067-09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 09/10/2009] [Indexed: 11/20/2022] Open
Abstract
In the commercial food industry, demonstration of microbiological safety and thermal process equivalence often involves a mathematical framework that assumes log-linear inactivation kinetics and invokes concepts of decimal reduction time (D(T)), z values, and accumulated lethality. However, many microbes, particularly spores, exhibit inactivation kinetics that are not log linear. This has led to alternative modeling approaches, such as the biphasic and Weibull models, that relax strong log-linear assumptions. Using a statistical framework, we developed a novel log-quadratic model, which approximates the biphasic and Weibull models and provides additional physiological interpretability. As a statistical linear model, the log-quadratic model is relatively simple to fit and straightforwardly provides confidence intervals for its fitted values. It allows a D(T)-like value to be derived, even from data that exhibit obvious "tailing." We also showed how existing models of non-log-linear microbial inactivation, such as the Weibull model, can fit into a statistical linear model framework that dramatically simplifies their solution. We applied the log-quadratic model to thermal inactivation data for the spore-forming bacterium Clostridium botulinum and evaluated its merits compared with those of popular previously described approaches. The log-quadratic model was used as the basis of a secondary model that can capture the dependence of microbial inactivation kinetics on temperature. This model, in turn, was linked to models of spore inactivation of Sapru et al. and Rodriguez et al. that posit different physiological states for spores within a population. We believe that the log-quadratic model provides a useful framework in which to test vitalistic and mechanistic hypotheses of inactivation by thermal and other processes.
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Affiliation(s)
- G Stone
- CSIRO Division of Food and Nutritional Sciences, Building E6B, Macquarie University, P.O. Box 52, North Ryde, NSW 1670, Australia.
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Chapman B, Ross T. Escherichia coli and Salmonella enterica are protected against acetic acid, but not hydrochloric acid, by hypertonicity. Appl Environ Microbiol 2009; 75:3605-10. [PMID: 19346344 PMCID: PMC2687272 DOI: 10.1128/aem.02462-08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 03/29/2009] [Indexed: 11/20/2022] Open
Abstract
Chapman et al. (B. Chapman, N. Jensen, T Ross, and M. B. Cole, Appl. Environ. Microbiol. 72:5165-5172, 2006) demonstrated that an increased NaCl concentration prolongs survival of Escherichia coli O157 SERL 2 in a broth model simulating the aqueous phase of a food dressing or sauce containing acetic acid. We examined the responses of five other E. coli strains and four Salmonella enterica strains to increasing concentrations of NaCl under conditions of lethal acidity and observed that the average "lag" time prior to inactivation decreases in the presence of hydrochloric acid but not in the presence of acetic acid. For E. coli in the presence of acetic acid, the lag time increased with increasing NaCl concentrations up to 2 to 4% at pH 4.0, up to 4 to 6% at pH 3.8, and up to 4 to 7% (wt/wt of water) NaCl at pH 3.6. Salmonella was inactivated more rapidly by combined acetic acid and NaCl stresses than E. coli, but increasing NaCl concentrations still decreased the lag time prior to inactivation in the presence of acetic acid; at pH 4.0 up to 1 to 4% NaCl was protective, and at pH 3.8 up to 1 to 2% NaCl delayed the onset of inactivation. Sublethal injury kinetics suggest that this complex response is a balance between the lethal effects of acetic acid, against which NaCl is apparently protective, and the lethal effects of the NaCl itself. Compared against 3% NaCl, 10% (wt/wt of water) sucrose with 0.5% NaCl (which has similar osmotic potential) was found to be equally protective against adverse acetic acid conditions. We propose that hypertonicity may directly affect the rate of diffusion of acetic acid into cells and hence cell survival.
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Affiliation(s)
- B Chapman
- Food Science Australia, North Ryde, NSW, Australia.
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Bull MK, Olivier SA, van Diepenbeek RJ, Kormelink F, Chapman B. Synergistic inactivation of spores of proteolytic Clostridium botulinum strains by high pressure and heat is strain and product dependent. Appl Environ Microbiol 2009; 75:434-45. [PMID: 19011055 PMCID: PMC2620695 DOI: 10.1128/aem.01426-08] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/05/2008] [Indexed: 11/20/2022] Open
Abstract
The combined high pressure and heat resistances of spores of five proteolytic Clostridium botulinum strains and of the nonpathogenic surrogate strain Clostridium sporogenes PA3679 were compared with their heat-only resistances on the basis of equivalent accumulated thermal lethality, expressed as equivalent minutes at a reference temperature of 105 degrees C (F(105 degrees C). Comparisons were made with three model (i.e., diluted) products, namely, 30% (wt/wt) Bolognese sauce, 50% (wt/wt) cream sauce, and rice water agar. Pressure was determined to act synergistically with heat during high-pressure thermal (HPT) processing for C. botulinum FRRB 2802 (NCTC 7273) and C. botulinum FRRB 2804 (NCTC 3805 and 62A) in the Bolognese and cream sauces and for C. botulinum FRRB 2807 (213B) in the Bolognese sauce only. No synergy was observed for C. botulinum FRRB 2803 (NCTC 2916) or FRRB 2806 (62A) or C. sporogenes FRRB 2790 (NCTC 8594 and PA3679) in any of the model products. No significant protective effect of pressure against spore inactivation was determined for any Clostridium strain in any product. Because synergy was not consistently observed among strains of C. botulinum or among products, the prediction of inactivation of C. botulinum spores by HPT sterilization (HPTS) for the present must assume a complete lack of synergy. Therefore, any HPTS process for low-acid shelf-stable foods must be at least thermally equivalent to an F(0) process of 2.8 min, in line with current good manufacturing practices. The results of this study suggest that the use of C. sporogenes PA3679 as a surrogate organism may risk overestimating inactivation of C. botulinum by HPT processing.
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Affiliation(s)
- M K Bull
- Food Science Australia, P.O. Box 52, North Ryde, NSW 1670, Australia
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Mathys A, Chapman B, Bull M, Heinz V, Knorr D. Flow cytometric assessment of Bacillus spore response to high pressure and heat. INNOV FOOD SCI EMERG 2007. [DOI: 10.1016/j.ifset.2007.06.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chapman B, Winley E, Fong A, Hocking A, Stewart C, Buckle K. Ascospore inactivation and germination by high pressure processing is affected by ascospore age. INNOV FOOD SCI EMERG 2007. [DOI: 10.1016/j.ifset.2007.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haywood B, Chapman B, Mansfield P. Model gradient coil employing active acoustic control for MRI. MAGMA 2007; 20:223-31. [PMID: 18004601 PMCID: PMC2798026 DOI: 10.1007/s10334-007-0086-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 09/04/2007] [Accepted: 10/08/2007] [Indexed: 11/17/2022]
Abstract
Results are presented for a model three-axis gradient coil incorporating active acoustic control which is applied to the switched read gradient during a single-shot rapid echo-planar imaging (EPI) sequence at a field strength of 3.0 T. The total imaging acquisition time was 10.6 ms. Substantial noise reduction is achieved both within the magnet bore and outside the magnet. Typical internal noise reduction over the specimen area is 40 dBA whereas outside the acoustic chamber the noise level is reduced by 60–77 dBA. However these results are relative to a control winding which is switched in phase, adding 6 dBA in its non-optimized mode, which is included in the quoted figures.
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Affiliation(s)
- B Haywood
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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Chapman B, Jensen N, Ross T, Cole M. Salt, alone or in combination with sucrose, can improve the survival of Escherichia coli O157 (SERL 2) in model acidic sauces. Appl Environ Microbiol 2006; 72:5165-72. [PMID: 16885261 PMCID: PMC1538705 DOI: 10.1128/aem.02522-05] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 05/09/2006] [Indexed: 11/20/2022] Open
Abstract
The commercial production of microbiologically safe and stable sauces containing acetic acid is guided by the Comité des Industries des Mayonnaises et Sauces Condimentaires de la Communauté Economique Européenne's (CIMSCEE) code. The CIMSCEE safety value is calculated using a linear regression equation combining weighted contributions of pH and aqueous-phase concentrations of undissociated acetic acid, NaCl, and sugars. By implication, the CIMSCEE safety equation predicts that increasing concentrations of hurdles will always increase inactivation of the target pathogen. In this study, the time to achieve a 3-log10 reduction of an acid-resistant, acid-adapted, Shiga toxin-producing Escherichia coli (STEC) O157 isolate was determined experimentally for 81 formulations at various pHs and acetic acid, NaCl, and sucrose concentrations in a broth model. The combinations were intended to simulate the aqueous phase of acidic sauces and dressings. Experimental data were fitted to the log logistic model to estimate the time to 3-log10 reduction (t3D). Comparison of fitted t3D estimates with CIMSCEE values showed agreement in predicting safety (as defined by CIMSCEE) for the majority of formulations. However, CIMSCEE safety predictions were "fail dangerous" for 13 of 81 formulations. Among these formulations and others, the observed E. coli t3D initially increased and then decreased with increasing osmolalities (NaCl and sucrose). Relative protection increased with exposure time where the protective effect of NaCl predominated. While commercial acidic sauces are not considered high-risk vehicles for STEC, interactions among hurdles that decrease their combined effectiveness are deserving of further investigation because they may reveal mechanisms of broader relevance in the inactivation of pathogens in foods.
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Affiliation(s)
- B Chapman
- Australian Food Safety Centre of Excellence, Food Science Australia, New South Wales, Australia.
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