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Kim-Muller JY, Song L, LaCarubba Paulhus B, Pashos E, Li X, Rinaldi A, Joaquim S, Stansfield JC, Zhang J, Robertson A, Pang J, Opsahl A, Boucher M, Breen D, Hales K, Sheikh A, Wu Z, Zhang BB. GDF15 neutralization restores muscle function and physical performance in a mouse model of cancer cachexia. Cell Rep 2023; 42:111947. [PMID: 36640326 DOI: 10.1016/j.celrep.2022.111947] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 05/16/2022] [Revised: 10/06/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Cancer cachexia is a disorder characterized by involuntary weight loss and impaired physical performance. Decline in physical performance of patients with cachexia is associated with poor quality of life, and currently there are no effective pharmacological interventions that restore physical performance. Here we examine the effect of GDF15 neutralization in a mouse model of cancer-induced cachexia (TOV21G) that manifests weight loss and muscle function impairments. With comprehensive assessments, our results demonstrate that cachectic mice treated with the anti-GDF15 antibody mAB2 exhibit body weight gain with near-complete restoration of muscle mass and markedly improved muscle function and physical performance. Mechanistically, the improvements induced by GDF15 neutralization are primarily attributed to increased caloric intake, while altered gene expression in cachectic muscles is restored in caloric-intake-dependent and -independent manners. The findings indicate potential of GDF15 neutralization as an effective therapy to enhance physical performance of patients with cachexia.
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Affiliation(s)
- Ja Young Kim-Muller
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - LouJin Song
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Brianna LaCarubba Paulhus
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Evanthia Pashos
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Xiangping Li
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Anthony Rinaldi
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Stephanie Joaquim
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - John C Stansfield
- Biostatistics, Early Clinical Development, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Jiangwei Zhang
- Drug Safety Research & Development, Pfizer Worldwide Research, Development & Medical, 10777 Science Center Dr., San Diego, CA, USA
| | - Andrew Robertson
- Drug Safety Research & Development, Pfizer Worldwide Research, Development & Medical, 445 Eastern Point Rd., Groton, CT, USA
| | - Jincheng Pang
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Alan Opsahl
- Drug Safety Research & Development, Pfizer Worldwide Research, Development & Medical, 445 Eastern Point Rd., Groton, CT, USA
| | - Magalie Boucher
- Drug Safety Research & Development, Pfizer Worldwide Research, Development & Medical, 445 Eastern Point Rd., Groton, CT, USA
| | - Danna Breen
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Katherine Hales
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Abdul Sheikh
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Zhidan Wu
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA
| | - Bei B Zhang
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, 1 Portland St., Cambridge, MA, USA.
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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Brennan M, Phelan S, Breen D. 90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients
Methods
A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged >65 years
Results
In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p<0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.
Conclusion
LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.
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Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Phelan
- Galway University Hospital , Galway, Ireland
| | - D Breen
- Galway University Hospital , Galway, Ireland
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4
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Chan VWS, Keeley F, Lagerveld B, Breen D, King A, Nielsen T, van Strijen M, Garnon J, Alcorn D, Graumann O, de Kerviler E, Zondervan P, Walkden M, Lughezzani G, Wah TM. 455 The Changing Trends of Image Guided Biopsy of Small Renal Masses Before Intervention- an Analysis of European Multinational Prospective EuRECA Registry. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing up take on histological results of treated SMRs.
Method
From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic or open cryoablation from 14 European institutions within the European Registry For Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results and the factors influencing use of pre-cryoablation biopsy.
Results
871 patients (Median [IQR] age, 69[14], 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p<0.001). Patients treated for a benign histology are significantly more likely to have presented later in the trend, where pre-cryoablation biopsy is more prevalent (OR: 0.64, 95% CI 0.51–0.81, p<0.001). Patients treated for undiagnosed histology are also significantly less likely to have presented in 2018 compared to 2016 (OR 0.31, 95% CI 0.10–0.97, p=0.044). Patients aged 70+ are less likely to be biopsies pre-cryoablation (p<0.05). R.E.N.A.L. nephrometry score of 10+ and a Charlson Comorbidity Index >1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p<0.05).
Conclusion
An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology is more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments.
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Affiliation(s)
- VWS Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds , Leeds , United Kingdom
- Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London , London , United Kingdom
| | - F Keeley
- Bristol Urological Institute, North Bristol NHS Trust , Bristol , United Kingdom
| | - B Lagerveld
- Department of Urology, OLVG , Amsterdam , Netherlands
| | - D Breen
- Department of Radiology, Southampton University Hospitals , Southampton , United Kingdom
| | - A King
- Department of Radiology, Southampton University Hospitals , Southampton , United Kingdom
| | - T Nielsen
- Department of Urology, Aarhus University Hospital , Aarhus , Denmark
| | - M van Strijen
- Department of Radiology, St Antonius Hospital , Nieuwegein , Netherlands
| | - J Garnon
- Department of Interventional Radiology , Nouvel Hôpital Civil, 1 place de l’Hôpital 67000 Strasbourg , France
| | - D Alcorn
- Department of Interventional Radiology, Gartnavel General Hospital , Glasgow , United Kingdom
| | - O Graumann
- Department of Radiology, Odense University Hospital , Odense , Denmark
| | - E de Kerviler
- Radiology Department, Saint-Louis Hospital , Paris , France
| | - P Zondervan
- Department of Urology , 26066 Amsterdam UMC, , Amsterdam , Netherlands
- University of Amsterdam , 26066 Amsterdam UMC, , Amsterdam , Netherlands
| | - M Walkden
- Department of Imaging, University College London Hospitals NHS Foundation Trust , London , United Kingdom
| | - G Lughezzani
- Vita-Salute San Raffaele University, Department of Urology , Milan , Italy
| | - TM Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, Leeds Teaching Hospitals Trust, St James’s University Hospital , Leeds , United Kingdom
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Fung E, Kang L, Sapashnik D, Benard S, Sievers A, Liu Y, Yan G, Zhou J, Rodriguez L, Ma W, Stochaj WR, LaVallie E, Wroblewska L, Kelleher K, Tam A, Bezy O, Breen D, Chabot JR, He T, Lin L, Wu Z, Mosyak L. Fc-GDF15 glyco-engineering and receptor binding affinity optimization for body weight regulation. Sci Rep 2021; 11:8921. [PMID: 33903632 PMCID: PMC8076310 DOI: 10.1038/s41598-021-87959-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/30/2021] [Indexed: 12/14/2022] Open
Abstract
GDF15 is a distant TGF-β family member that induces anorexia and weight loss. Due to its function, GDF15 has attracted attention as a potential therapeutic for the treatment of obesity and its associated metabolic diseases. However, the pharmacokinetic and physicochemical properties of GDF15 present several challenges for its development as a therapeutic, including a short half-life, high aggregation propensity, and protease susceptibility in serum. Here, we report the design, characterization and optimization of GDF15 in an Fc-fusion protein format with improved therapeutic properties. Using a structure-based engineering approach, we combined knob-into-hole Fc technology and N-linked glycosylation site mutagenesis for half-life extension, improved solubility and protease resistance. In addition, we identified a set of mutations at the receptor binding site of GDF15 that show increased GFRAL binding affinity and led to significant half-life extension. We also identified a single point mutation that increases p-ERK signaling activity and results in improved weight loss efficacy in vivo. Taken together, our findings allowed us to develop GDF15 in a new therapeutic format that demonstrates better efficacy and potential for improved manufacturability.
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Affiliation(s)
- Ella Fung
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Liya Kang
- Internal Medicine Research Unit, Pfizer Inc., 1 Portland Street, Cambridge, MA, USA
| | - Diana Sapashnik
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Susan Benard
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Annette Sievers
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Yan Liu
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Guoying Yan
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Jing Zhou
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Linette Rodriguez
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Weijun Ma
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA.,Sanofi Research and Development, Sanofi North America, Framingham, MA, USA
| | - Wayne R Stochaj
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Edward LaVallie
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | | | - Kerry Kelleher
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Amy Tam
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Olivier Bezy
- Internal Medicine Research Unit, Pfizer Inc., 1 Portland Street, Cambridge, MA, USA.,Cellarity, Cambridge, MA, USA
| | - Danna Breen
- Internal Medicine Research Unit, Pfizer Inc., 1 Portland Street, Cambridge, MA, USA
| | - Jeffrey R Chabot
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Tao He
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA.,JOINN Biologics US Inc, Richmond, CA, USA
| | - Laura Lin
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA
| | - Zhidan Wu
- Internal Medicine Research Unit, Pfizer Inc., 1 Portland Street, Cambridge, MA, USA
| | - Lidia Mosyak
- BioMedicine Design, Pfizer Inc., 610 N Main Street, Cambridge, MA, USA.
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6
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Wu Z, Bennett D, Brosnan J, Calle R, Collins S, Esquejo R, Joaquim S, Joyce A, Kim H, LaCarubba B, Lin L, Kim-Muller J, Peloquin M, Pettersen B, Qiao S, Rossulek M, Weber G, Zhang B, Birnbaum M, Breen D. 2O Growth differentiation factor 15 (GDF-15) neutralization reverses cancer cachexia, restores physical performance and mitigates emesis associated with platinum-based chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.155] [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] Open
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7
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Cullivan S, Ahmed M, Weedle R, Bruzzi J, Phelan S, Da Costa M, Soo A, Breen D. The Role of Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer. Ir Med J 2020; 113:122. [PMID: 35575042] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim The aim of this study is to assess the impact of EBUS on the concordance of clinical and pathological NSCLC staging in our center. Methods Data was collected retrospectively from the hospital database regarding patients who underwent surgical resection for early stage NSCLC between 2012 and 2017. Results A total of 251 patients were included. The mean age was 67 (±9), 55% (n=137) were male and 83% (n=209) were current/former smokers. In group A (n=154, 61%) clinical nodal stage (cN) was established from a combination of CT, PET CT and mediastinoscopy. Group B underwent additional EBUS (n=97, 39%). cN and pathological nodal staging (pN) were concordant in 78% (n=120) in group A versus 62% (n=60) in group B (p=0.009). Conclusion This study demonstrated higher rates of nodal discordance in patients who underwent EBUS which contrasts existing data that demonstrates improved concordance with EBUS. We describe these findings and potential explanations further in this study.
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Affiliation(s)
- S Cullivan
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - M Ahmed
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - R Weedle
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - J Bruzzi
- Department of Radiology, Galway University Hospital - Galway, Ireland
| | - S Phelan
- Department of Histopathology, Galway University Hospital - Galway, Ireland
| | - M Da Costa
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - A Soo
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - D Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
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8
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Breen D, Bennett D, Jagarlapudi S, Joaquim S, Zou C, Patel A, Wu Z, Seeley R, Zhang BB, Bezy O. Effect of growth differentiation factor 15 (GDF-15) inhibition on energy balance in cancer cachexia and in lipopolysaccharide (LPS)-induced sepsis mouse models. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24153 Background: Growth differentiation factor 15 (GDF-15) is a cytokine that induces anorexia, weight loss and has been reported to be associated with cachexia and poor survival in illnesses characterized by inflammation such as cancer cachexia and heart failure. In preclinical cancer cachexia models, GDF-15 inhibition has been demonstrated to reverse cachexia and improve survival. Circulating GDF-15 is also elevated in patients with sepsis and is associated with increased complications and poor survival. However, the role of infection- and sepsis-induced GDF-15 in mouse models is controversial based on published reports. Methods: In this study, we examined the effect of GDF-15 inhibition on tumor and lipopolysaccharide (LPS)-induced anorexia, weight loss, and survival using a GDF-15 neutralizing antibody (mAB2) and GDF-15 knockout mice. Results: mAB2 efficacy was confirmed by reversing AAV-GDF-15-induced weight loss in wildtype mice. A cachectic (anorexia and weight loss) mouse tumor model was established with subcutaneous implantation of mouse renal cell carcinoma (RENCA) cells. The chemotherapy sorafenib was administered to slow tumor progression. Plasma GDF-15 was increased to ~2 ng/mL, similar to levels in cancer patients. Treatment with mAB2 rapidly reversed both anorexia and weight loss in the tumor-bearing mice. LPS injection (intraperitoneal, 5 mg/kg) increased circulating GDF-15 in wildtype mice reaching concentrations like that reported in septic patients within 90 minutes and remaining elevated after 48 hours (~1 ng/mL). LPS decreased food intake, body weight, and increased mortality (~20%). Different from the tumor model, GDF-15 neutralization with mAB2 did not prevent or exacerbate any of the effects of LPS. There were no observed detrimental effects of mAB2 treatment in either model. Similarly, in GDF-15 knockout mice the LPS effect on energy balance and survival was comparable to that observed in wildtype controls. Plasma GDF-15 was undetectable in the GDF-15 knockout mice. Conclusions: Taken together, these data suggest that GDF-15 is a critical regulator of energy balance and survival in selective pathophysiological states associated with weight loss.
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9
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Breen D, Beaumont K, Bennett D, Brosnan J, Calle RA, Chabot J, Collins S, Esquejo R, Joaquim S, Joyce A, Kim H, Lin L, Pettersen BA, Qiao S, Rossulek MI, Walters K, Weber G, Wu Z, Zhang BB, Birnbaum MJ. Growth differentiation factor 15 (GDF-15) as a key regulator of cachexia induced by platinum-based chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24162 Background: Platinum-based drug use in cancer treatment is restricted by dose-limiting side effects, including nausea/emesis, anorexia and weight loss that reduce patient quality of life and limit treatment adherence. Cisplatin increases GDF-15, a cytokine that induces aversion, anorexia and weight loss in preclinical models. GDF-15 signals through the hindbrain receptor glial cell-derived neurotrophic factor receptor alpha-like (GFRAL) and cisplatin-induced weight loss was attenuated in a GFRAL knockout mouse. Methods: In the current study, using mouse and/or nonhuman primate models, we examined whether GDF-15 inhibition via a potent and selective monoclonal antibody (mAB1) prevents platinum-induced emesis, anorexia, weight loss, with increased survival. Results: Circulating GDF-15 levels in NSCLC and colorectal cancer were higher (~1.5 fold) in patients on platinum therapy compared to non-platinum-based therapy. Higher levels of circulating GDF-15 were also associated with greater weight loss in colorectal cancer patients prior to receiving FOLFOX as part of cancer treatment. In wildtype mice, cisplatin, oxaliplatin and carboplatin each increased circulating GDF-15 (≥ 5-fold) and induced anorexia, skeletal muscle wasting, and weight loss. These effects were prevented in GDF-15 knockout mice, however only a partial blockade of carboplatin was observed. The GDF-15 neutralizing efficacy of mAB1 was confirmed by reversing AAV-GDF-15-induced weight loss in wildtype mice. In nonhuman primates, cisplatin treatment for 5 days (96% of the daily recommended clinical dose) also increased circulating GDF-15 ( > 5-fold), and induced anorexia and emesis. Treatment with mAB1 resulted in no detectable circulating levels of free GDF-15 and attenuated both cisplatin-induced anorexia and emesis. In a mouse cachectic tumor model (subcutaneous; NSCLC patient derived xenograft), cisplatin inhibited tumor growth; however, GDF-15 levels remained elevated and additional weight loss occurred compared to control. When mAB1 was given in combination with cisplatin, weight loss was reversed and tumor growth inhibition was maintained, resulting in greater survival compared to cisplatin alone. Conclusions: Taken together, these data support that GDF-15 inhibition with mAB1 holds the potential as an effective therapeutic approach to alleviate GDF-15 mediated emesis, anorexia and weight loss, with the aim to enable optimal cancer treatment as well as to improve patient quality of life and potentially survival.
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Peloquin M, LaCarubba B, Joaqium S, Weber G, Stansfield J, Bezy O, Kim-Muller JY, Breen D, Wu Z, Zhang BB. Growth differentiation factor 15 (GDF-15) inhibition to increase muscle mass and function in cancer cachexia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15633 Background: Almost half of cancer deaths are attributed to cancers most frequently associated with cachexia. Cachexia is a complex metabolic disease characterized by anorexia and unintentional weight loss. Skeletal muscle depletion has been recognized as a key feature of the disease, however muscle anabolic therapies have not been successful, suggesting that treatments that target multiple aspects of the disease will be most effective. Growth differentiation factor 15 (GDF-15) is a cytokine that induces anorexia and weight loss and is associated with cachexia in cancer patients. In preclinical cancer cachexia models, GDF-15 inhibition is sufficient to normalize food intake and body weight, including skeletal muscle mass. However, it remains to be determined whether the increased skeletal muscle mass also results in restoration of muscle function. Therefore, we examined the effect of GDF-15 inhibition on muscle mass and function in mouse models of cancer cachexia in comparison with myostatin inhibition, an established muscle anabolic pathway. Methods: Cachectic mouse tumor models were established with subcutaneous implantation of tumor cell lines reported to be GDF-15-dependent; mouse renal cell carcinoma (RENCA) and human ovarian cancer (TOV-21G) cell lines. Mice were treated with anti-GDF-15 (mAB2) or anti-myostatin (RK35) monoclonal antibodies and skeletal muscle function was assessed in vivo via maximum force, maximum rate of contraction and half relax time. In the RENCA tumor model, GDF-15 inhibition fully restored body weight and skeletal muscle mass whereas myostatin inhibition showed only a modest effect. Results: Consistent with the muscle mass improvement, GDF-15 inhibition dramatically increased functional muscle endpoints compared to the partial effect of myostatin inhibition. Interestingly, in the TOV-21G tumor model GDF-15 inhibition only partially restored body weight, however skeletal muscle mass and muscle function were completely normalized. Consistent with the functional assessment, GDF-15 inhibition in the RENCA tumor model decreased the expression of several catabolic genes (i.e. Trim63, Fbxo32, Myh7 and Myh2). The GDF-15 effect is likely to be secondary to the reversal of anorexia since wildtype mice pair-fed to Fc-GDF-15-treated mice demonstrated equivalent muscle mass loss. Conclusions: Taken together these data suggest that GDF-15 inhibition holds potential as an effective therapeutic approach to alleviate multiple aspects of cachexia.
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Patel S, Alvarez-Guaita A, Melvin A, Rimmington D, Dattilo A, Miedzybrodzka EL, Cimino I, Maurin AC, Roberts GP, Meek CL, Virtue S, Sparks LM, Parsons SA, Redman LM, Bray GA, Liou AP, Woods RM, Parry SA, Jeppesen PB, Kolnes AJ, Harding HP, Ron D, Vidal-Puig A, Reimann F, Gribble FM, Hulston CJ, Farooqi IS, Fafournoux P, Smith SR, Jensen J, Breen D, Wu Z, Zhang BB, Coll AP, Savage DB, O'Rahilly S. GDF15 Provides an Endocrine Signal of Nutritional Stress in Mice and Humans. Cell Metab 2019; 29:707-718.e8. [PMID: 30639358 PMCID: PMC6408327 DOI: 10.1016/j.cmet.2018.12.016] [Citation(s) in RCA: 244] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/10/2018] [Accepted: 12/17/2018] [Indexed: 01/07/2023]
Abstract
GDF15 is an established biomarker of cellular stress. The fact that it signals via a specific hindbrain receptor, GFRAL, and that mice lacking GDF15 manifest diet-induced obesity suggest that GDF15 may play a physiological role in energy balance. We performed experiments in humans, mice, and cells to determine if and how nutritional perturbations modify GDF15 expression. Circulating GDF15 levels manifest very modest changes in response to moderate caloric surpluses or deficits in mice or humans, differentiating it from classical intestinally derived satiety hormones and leptin. However, GDF15 levels do increase following sustained high-fat feeding or dietary amino acid imbalance in mice. We demonstrate that GDF15 expression is regulated by the integrated stress response and is induced in selected tissues in mice in these settings. Finally, we show that pharmacological GDF15 administration to mice can trigger conditioned taste aversion, suggesting that GDF15 may induce an aversive response to nutritional stress.
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Affiliation(s)
- Satish Patel
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Anna Alvarez-Guaita
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Audrey Melvin
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Debra Rimmington
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Alessia Dattilo
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Emily L Miedzybrodzka
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Irene Cimino
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Anne-Catherine Maurin
- INRA, Unité de Nutrition Humaine, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Geoffrey P Roberts
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Claire L Meek
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Samuel Virtue
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, USA
| | - Stephanie A Parsons
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, USA
| | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alice P Liou
- Internal Medicine Research Unit, Pfizer Global R&D, 1 Portland Street, Cambridge, MA, USA
| | - Rachel M Woods
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK
| | - Sion A Parry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK
| | - Per B Jeppesen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Anders J Kolnes
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Heather P Harding
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; Cambridge Institute for Medical Research, Cambridge University, Cambridge CB2 0XY, UK
| | - David Ron
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; Cambridge Institute for Medical Research, Cambridge University, Cambridge CB2 0XY, UK
| | - Antonio Vidal-Puig
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Frank Reimann
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Fiona M Gribble
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Carl J Hulston
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK
| | - I Sadaf Farooqi
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Pierre Fafournoux
- INRA, Unité de Nutrition Humaine, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, USA
| | - Jorgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Danna Breen
- Internal Medicine Research Unit, Pfizer Global R&D, 1 Portland Street, Cambridge, MA, USA
| | - Zhidan Wu
- Internal Medicine Research Unit, Pfizer Global R&D, 1 Portland Street, Cambridge, MA, USA
| | - Bei B Zhang
- Internal Medicine Research Unit, Pfizer Global R&D, 1 Portland Street, Cambridge, MA, USA
| | - Anthony P Coll
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - David B Savage
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK.
| | - Stephen O'Rahilly
- Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK.
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McDonnell MJ, O’Mahony M, Breen D, Gilmartin JJ, O’Regan A, Rutherford RM. P267 Dlco predicts disease severity and mortality in bronchiectasis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.410] [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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Smyth R, Brennan V, Breen D. 42 Determinants of intra-procedure hypoxia during EBUS for cancer. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30059-9] [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: 10/22/2022]
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Khan L, Breen D, Zhang L, Balogh J, Czarnota G, Lee J, Tsao MN, Barnes EA. Predictors of recurrence after radiotherapy for non-melanoma skin cancer. ACTA ACUST UNITED AC 2014; 21:e326-9. [PMID: 24764714 DOI: 10.3747/co.21.1727] [Citation(s) in RCA: 20] [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: 02/06/2023]
Abstract
Predictive factors of recurrence were examined in 448 non-melanoma skin cancers (72% basal cell carcinoma, 28% squamous cell carcinoma) treated with radiotherapy. The overall recurrence rate was 15.8% at a median follow-up of 18.4 months. In multivariate analysis, significant factors for recurrence were age (p = 0.0197), tumour size 2 cm or greater (p = 0.0095), immunosuppression (p = 0.0082), and treatment modality (p = 0.0009).
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Affiliation(s)
- L Khan
- University of Toronto, Toronto, ON
| | - D Breen
- University of Toronto, Toronto, ON
| | - L Zhang
- University of Toronto, Toronto, ON
| | - J Balogh
- University of Toronto, Toronto, ON
| | | | - J Lee
- University of Toronto, Toronto, ON
| | - M N Tsao
- University of Toronto, Toronto, ON
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Gorecka M, Scott J, Casey R, Breen D. The journey of mesothelioma: from postmortem to FNA. BMJ Case Rep 2014; 2014:bcr-2013-203013. [PMID: 24515241 DOI: 10.1136/bcr-2013-203013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 73-year-old man, non-smoker presented with an 8-week history of left-sided chest pain and shortness of breath on exertion. He had no significant medical history. He worked in construction for 40 years, but denied definite asbestos exposure. His initial chest X-ray demonstrated a large left-sided pleural effusion. Subsequent CT thorax revealed circumferential thickening of the pleura with associated pleural plaques and calcification. A provisional diagnosis of mesothelioma was made. Initial ultrasound-guided thoracocentesis revealed a transudate with negative cytology. In addition, thoracoscopy and CT-guided pleural biopsy failed to obtain a definitive diagnosis. A surgical biopsy was planned, but at the time of admission, the patient developed unilateral neck swelling. Ultrasound-guided fine-needle aspiration (FNA) and core biopsies of the lymph node were diagnostic for pleural mesothelioma. Treatment with palliative chemotherapy was planned, but the patient's clinical status rapidly deteriorated and he passed away prior to the beginning of therapy.
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Affiliation(s)
- M Gorecka
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
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Fitzgerald A, Breen D. Difference in physiological parameters between sitting out of bed into a chair or sitting up on an electric bed in the adult ICU. Crit Care 2014. [PMCID: PMC4069374 DOI: 10.1186/cc13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Edgeworth D, Brohan J, O'Neill S, Maher M, Breen D, Murphy D. Pulmonary sequelae of severe H1N1 infection treated with high frequency oscillatory ventilation. Ir Med J 2013; 106:249-252. [PMID: 24282900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
During the recent influenza A (H1N1) pandemic, due to severe respiratory failure many patients required treatment with alternative ventilator modalities including High Frequency Oscillatory Ventilation (HFOV). We present four such patients treated with HFOV at an academic, tertiary referral hospital in Ireland. We detail outcomes of clinical examination, pulmonary function testing, quality of life assessment and radiographic appearance on CT Thorax at follow-up at 6 months. Further clinical assessment and pulmonary function testing were performed at median 19 months (range 18-21 months) post-discharge. At initial review all patients were found to have reduced gas transfer (median predicted DLCO 74%) with preservation of lung volumes and normal spirometrical values at 6 months (median FVC 5.42L [101% predicted] and FEV14.5L [101.2% predicted] respectively), with improvements in gas transfer (median predicted DLCO 83%)at subsequent testing. Post-inflammatory changes on CT thorax at 6 months were seen in all 4 cases. To our knowledge this is the first report to document the long-term effects of severe H1N1 infection requiring high frequency oscillation on respiratory function. We conclude that the effects on respiratory function and pulmonary radiological appearance are similar to those observed following conventional treatment of Acute Respiratory Distress Syndrome [ARDS].
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Johnston R, Kaliaperumal C, Wyse G, Fanning N, Breen D, Kaar G. Brain Dead or Not? Diagnostic Dilemma Following Severe Traumatic Brain Injury. J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rehman S, Tangri A, Shin J, Mehta V, Moore A, Breen D, Black E. 187 Endobronchial intervention at Oxford – two year experience and outcomes. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70188-5] [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: 10/14/2022]
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Khan L, Choo R, Breen D, Assaad D, Fialkov J, Antonyshyn O, McKenzie D, Toni W, Zhang L, Barnes E. Recommendations for CTV Margins in Radiotherapy Planning for Nonmelanoma Skin Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.241] [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: 10/15/2022]
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Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A, Czarnota G, Pang J, De Angelis C. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. ACTA ACUST UNITED AC 2011; 17:94-112. [PMID: 20697521 DOI: 10.3747/co.v17i4.493] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [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: 11/15/2022]
Abstract
Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-severe skin reaction. Acute radiation-induced skin reactions often lead to itching and pain, delays in treatment, and diminished aesthetic appearance-and subsequently to a decrease in quality of life. Surveys have demonstrated that a wide variety of topical, oral, and intravenous agents are used to prevent or to treat radiation-induced skin reactions. We conducted a literature review to identify trials that investigated products for the prophylaxis and management of acute radiation dermatitis. Thirty-nine studies met the pre-defined criteria, with thirty-three being categorized as prophylactic trials and six as management trials.For objective evaluation of skin reactions, the Radiation Therapy Oncology Group criteria and the U.S. National Cancer Institute Common Toxicity Criteria were the most commonly used tools (65% of the studies). Topical corticosteroid agents were found to significantly reduce the severity of skin reactions; however, the trials of corticosteroids evaluated various agents, and no clear indication about a preferred corticosteroid has emerged. Amifostine and oral enzymes were somewhat effective in preventing radiation-induced skin reactions in phase II and phase III trials respectively; further large randomized controlled trials should be undertaken to better investigate those products. Biafine cream (Ortho-McNeil Pharmaceuticals, Titusville, NJ, U.S.A.) was found not to be superior to standard regimes in the prevention of radiation-induced skin reactions (n = 6).In conclusion, the evidence is insufficient to support the use of a particular agent for the prevention and management of acute radiation-induced skin reactions. Future trials should focus on comparing agents and approaches that, in phase I and II trials, suggest efficacy. These future phase III randomized controlled trials must clearly distinguish between preventive and management strategies for radiation-induced dermatitis. Only then can evidence-based guidelines be developed, with the hope of standardizing the approach across centres and of improving the prevention and management of radiation-induced dermatitis.
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Affiliation(s)
- N Salvo
- Department of Pharmacy, Edmond Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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Abstract
BACKGROUND There is a need for a procedure-specific means of assessment of clinical performance in anaesthesia. The aim of this study was to devise a tool for assessing the performance of spinal anaesthesia, which has both content and construct validity. METHODS The clinical assessment tool was generated using a focus group discussion of practicing anaesthetists. The tool comprised three components: a checklist of 11 pre-defined errors, two time intervals and a six-item global rating scale (GRS). Thirty-one anaesthetists at three different levels of experience underwent testing using the clinical assessment tool: novice (n=10), intermediate (n=10) and expert (n=11). RESULTS The error checklist and GRS scores but not the time intervals were significantly different between the three groups (P<0.005). CONCLUSION The error checklist and GRS form the basis for a procedure-specific assessment tool for spinal anaesthesia.
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Affiliation(s)
- D Breen
- Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland.
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Pang J, Assaad D, Breen D, Fialkov J, Antonyshyn O, Balogh J, Tsao M, Kamra J, Czarnota G, Barnes EA. Extramammary Paget disease: review of patients seen in a non-melanoma skin cancer clinic. ACTA ACUST UNITED AC 2010; 17:43-5. [PMID: 20975878 DOI: 10.3747/co.v17i5.588] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extramammary Paget disease (EMPD) is a rare skin disease commonly found in the anogenital region. In this study, we aimed to identify EMPD patients seen in the non-melanoma skin cancer clinic at Odette Cancer Centre and to describe the treatments delivered and outcomes achieved. From 2000 to 2009, 14 patients were seen. Initial treatment recommendations included imiquimod and surgical excision, although half the patients required more than one treatment modality, highlighting the difficulty of achieving complete eradication of this disease.
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Affiliation(s)
- J Pang
- Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
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Barnes EA, Breen D, Culleton S, Zhang L, Kamra J, Tsao M, Balogh J. Palliative radiotherapy for non-melanoma skin cancer. Clin Oncol (R Coll Radiol) 2010; 22:844-9. [PMID: 20716481 DOI: 10.1016/j.clon.2010.07.014] [Citation(s) in RCA: 28] [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] [Received: 11/21/2009] [Revised: 05/17/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Abstract
AIMS The primary objective of this study was to assess the rate of tumour response to the palliative radiotherapy regimen used at our centre (8 Gy/fraction on days 0, 7, 21) for non-melanoma skin cancer. The secondary objective was to evaluate symptom palliation. MATERIALS AND METHODS A retrospective chart review identified patients treated with this palliative radiotherapy regimen from August 2003 to December 2008. Patient age, gender, tumour histology, location, size, presenting symptoms and radiation treatment factors were recorded at baseline. The tumour size and tumour-related symptoms were recorded at each fraction and follow-up visit. The results were analysed on an intent to treat basis. RESULTS Twenty-eight patients received 31 courses of palliative radiation for basal cell (five) or squamous cell (26) carcinoma of the skin. Twenty-one patients with 23 tumours attended at least one follow-up visit, and seven patients had incomplete follow-up data. At the time of last follow-up (median 17 weeks), the response rate was 58.1% (complete response 15/31; partial response 3/31). A complete response to treatment was correlated with a smaller tumour size at day 21 (P=0.0143). Presenting symptoms were alleviated in 61.3% (19/31) of symptomatic sites. No severe late toxicities were seen. CONCLUSIONS This palliative regimen offers impressive response rates and effective symptom palliation for patients with non-melanoma skin cancer.
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Affiliation(s)
- E A Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada.
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Pravinkumar SJ, Edwards G, Lindsay D, Redmond S, Stirling J, House R, Kerr J, Anderson E, Breen D, Blatchford O, McDonald E, Brown A. A cluster of Legionnaires' disease caused by Legionella longbeachae linked to potting compost in Scotland, 2008-2009. ACTA ACUST UNITED AC 2010; 15:19496. [PMID: 20197024 DOI: 10.2807/ese.15.08.19496-en] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three cases of Legionnaires disease caused by Legionella longbeachae Sg 1 associated with potting compost have been reported in Scotland between 2008 and 2009. The exact method of transmission is still not fully understood as Legionnaires disease is thought to be acquired by droplet inhalation. The linked cases associated with compost exposure call for an introduction of compost labelling, as is already in place in other countries where L. longbeachae outbreaks have been reported.
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Affiliation(s)
- S J Pravinkumar
- National Health Service Lanarkshire, Hamilton, United Kingdom.
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Abstract
Patients with chronic lymphocytic leukemia (cll) are at a significantly increased risk of developing cutaneous squamous cell carcinoma (scc), in part because of their impaired immunosurveillance. Here, we report the cases of 4 patients with cll who had locally aggressive cutaneous scc managed with radiotherapy for local recurrence following surgical excision. All tumours were located in the head-and-neck region. All patients initially achieved complete regression of disease; however, 2 had local recurrence a mean of 8 months after treatment completion. One patient died from progressive scc. Our findings agree with the high rates reported in literature of multiple tumours, local recurrence, metastases, and mortality from scc in patients with cll. Radiotherapy plays an important role in patient management, and it is the recommended treatment modality when complete surgical excision of disease would result in anatomic and functional defects. Radiotherapy is often used in the case of local recurrence after one or more attempts at surgical excision. Dose escalation through intensity-modulated radiotherapy, hyperfractionation, or novel treatment techniques such as high-intensity focused ultrasound may be explored to improve local control of scc lesions. To optimize patient outcomes, cutaneous scc arising in patients with a history of cll should be managed and followed in a multidisciplinary clinic, with regular skin surveillance and prompt treatment.
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Affiliation(s)
- J Wong
- Department of Radiation Oncology, University of Toronto, Faculty of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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Barnes E, Breen D, Culleton S, Pang J, Balogh J, Tsao M, Kamra J, Czarnota G, Antonyshyn O, Fialkov J, Assaad D. 80 FIVE YEAR REVIEW OF THE NON MELANOMA SKIN CANCER CLINIC AT THE ODETTE CANCER CENTRE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72467-2] [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: 10/27/2022]
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Pang J, Nguyen J, Salvo N, Culleton S, Breen D, Giotis A, Barnes T, DeAngelis C. 155 CURRENT PRACTICE FOR THE PROPHYLAXIS AND MANAGEMENT OF RADIATION INDUCED SKIN REACTIONS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72542-2] [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: 10/27/2022]
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Pinot D, Breen D, Peloni JM, Gaubert JY, Dutau H, Vervloet D. An incidental finding in a 34-year-old male under investigation for haemoptysis. Diagnosis: The radiological and endoscopic images demonstrate a complex defect along the posterior tracheal wall consistent with acquired tracheal diverticulum. Eur Respir J 2009; 33:1227-9. [PMID: 19407058 DOI: 10.1183/09031936.00131908] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D Pinot
- Respiratory Department, Sainte Marguerite University Hospital, Marseille, France.
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Brook BS, Murphy CM, Breen D, Miles AW, Tilley DG, Wilson AJ. Theoretical Models for the Quantification of Lung Injury Using Ventilation and Perfusion Distributions. Computational and Mathematical Methods in Medicine 2009. [DOI: 10.1080/17486700802201592] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper describes two approaches to modelling lung disease: one based on a multi-compartment statistical model with a log normal distribution of ventilation perfusion ratio (V˙/Q˙) values; and the other on a bifurcating tree which emulates the anatomical structure of the lung. In the statistical model, the distribution becomes bimodal, when theV˙/Q˙values of a randomly selected number of compartments are reduced by 85% to simulate lung disease. For the bifurcating tree model a difference in flow to the left and right branches coupled with a small random variation in flow ratio between generations results in a log normal distribution of flows in the terminal branches. Restricting flow through branches within the tree to simulate lung disease transforms this log normal distribution to a bi-modal one. These results are compatible with those obtained from experiments using the multiple inert gas elimination technique, where log normal distributions ofV˙/Q˙ratio become bimodal in the presence of lung disease.
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Affiliation(s)
- B. S. Brook
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - C. M. Murphy
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - D. Breen
- Department of Anaesthesthetics, Royal Hallamshire Hospital, Sheffield, UK
| | - A. W. Miles
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - D. G. Tilley
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - A. J. Wilson
- Department of Physics, University of Warwick, Coventry, UK
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Abstract
INTRODUCTION Stridor in the post extubation period occurs frequently and is most commonly caused by laryngeal oedema. During this period, the trachea can also be obstructed by pseudomembranes. CASE REPORT We report the case of a 59 year old woman who required re-intubation, 15 days after extubation because of the acute onset of severe respiratory distress secondary to pseudomembranes in her trachea. CONCLUSION It is essential that physicians who care for patients during the post extubation period are aware of this severe and life threatening cause of stridor. Definitive treatment with the rigid bronchoscope allows for rapid recanalisation of the airway.
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Affiliation(s)
- Y Gernez
- Unité d'Endoscopie thoracique, Pôle Cardiovasculaire et Thoracique, Hôpital Sainte Marguerite, Marseille.
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Breen D, Fraticelli A, Greillier L, Mallawathantri S, Astoul P. Redo medical thoracoscopy is feasible in patients with pleural diseases - a series. Interact Cardiovasc Thorac Surg 2008; 8:330-3. [DOI: 10.1510/icvts.2008.188730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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O'Callaghan D, Breen D, Young V. Angiosarcoma of the Right Atrium Masquerading as Recurrent Pulmonary Embolism. Thorac Cardiovasc Surg 2008; 56:488-90. [PMID: 19012217 DOI: 10.1055/s-2007-989292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- J Groarke
- Department of Respiratory Medicine, CResT Directorate, St James's Hospital, Dublin 8, Ireland
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Brook BS, Murphy CM, Breen D, Miles AW, Tilley DG, Wilson AJ. Quantification of lung injury using ventilation and perfusion distributions obtained from gamma scintigraphy. Physiol Meas 2007; 28:1451-64. [PMID: 18057511 DOI: 10.1088/0967-3334/28/12/001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
This paper explores the potential of isotope V/Q lung scans to quantify lung disease. Areas of restricted perfusion in subjects with a pulmonary embolus (PE) were identified in 3D reconstructions of V/Q images achieved using anatomical data from the Visible Human Project. From these, the extent of lung damage was quantified. Significant differences in the values of both LogSD V and LogSD Q (p > 0.05) obtained from plots of V and Q against Log(V/Q) were found between normal subjects and subjects with a PE, but no correlation was found between either of these parameters and the degree of lung damage in subjects with a PE (p > 0.05). Whilst V/Q values were log normally distributed, the V/Q distributions from the subjects with a PE failed to show the bimodal distribution predicted from theoretical considerations and MIGET measurements previously reported. There was a statistically significant difference in the mean and standard deviation values of the V/Q distributions between normal subject and subjects with a PE (p < 0.05) but not in the median values (p > 0.05). There was no correlation between the mean, median and standard deviation of the distributions from the subjects with a PE and the percentage of damage present (p > 0.05).
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Affiliation(s)
- B S Brook
- School of Mathematical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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Nassiri AH, Dutau H, Breen D, Colchen A, Quiot JJ, Nguyen B, Vergnon JM. A multicenter retrospective study investigating the role of interventional bronchoscopic techniques in the management of endobronchial lipomas. Respiration 2007; 75:79-84. [PMID: 17923776 DOI: 10.1159/000109709] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 07/16/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary lipomas are rare benign tumors that are usually found endobronchially. Undiagnosed, they can lead to the serious late sequelae associated with endobronchial obstruction. In the majority of cases, they are located in the first three subdivisions of the tracheobronchial tree, and therefore, they are amenable to endoscopic techniques for diagnostic and therapeutic purposes. OBJECTIVES It was our aim to retrospectively study the bronchoscopic management and follow-up of a large series of endobronchial lipomas, as well as defining the demographic and endoscopic characteristics of patients. METHODS A retrospective multicenter study was performed to identify all cases of lipomas that were treated endoscopically in 4 institutions in the period from 1981 to 2002. Demographic, radiological, endoscopic and histological data were collected. RESULTS Thirty-eight patients were included in the study; 81.6% of cases were males and the average age was 63.5 +/- 15.2 years. The majority of the patients were symptomatic (63.2%). Lipomas were located proximally in 18 cases (47.4%) and distally in 20 subjects (52.6%). Specimens obtained by rigid bronchoscopy were diagnostic in all cases. Thirty-six out of 38 patients underwent therapeutic rigid bronchoscopy. Laser and mechanical debulking was performed in 29 cases (76.3%), cryotherapy and mechanical debulking in 7 subjects (18.4%), and mechanical debulking alone in 2 cases (5.3%). No cases of recurrence occurred during the follow-up period. CONCLUSIONS This study demonstrates that endoscopic techniques are effective for the diagnosis and treatment of endobronchial lipomas when there is no evidence of severe distal bronchiectasis. This should be the treatment of choice after a full clinicoradiological evaluation.
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Affiliation(s)
- A H Nassiri
- Department of Chest Diseases and Thoracic Oncology, Hôpital Nord, Hôpitaux Universitaires de Saint-Etienne, Saint-Etienne, France
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Abstract
Airway inflammation is central to the pathogenesis of both airway remodelling and parenchymal destruction in chronic obstructive pulmonary disease (COPD). Neutrophils, macrophages, and CD8+ T lymphocytes have been implicated in a number of studies, but a detailed profile of disease-phenotype specific inflammation has yet to emerge. The heterogeneity of the disease has hindered data interpretation while extrapolation of the results of relatively non-invasive studies to the actual pathology found in the distal lung is difficult. Moreover, prominent studies have had frequently conflicting results. Further investigations are needed to marry the different clinical phenotypes of COPD to their respective inflammatory profiles in the airways and thus improve our understanding of the pathogenesis of the disease as a whole.
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Affiliation(s)
- R O'Donnell
- Respiratory Cell and Molecular Biology, Division of Infection, Inflammation and Repair, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Choo R, Woo T, Barnes E, Assaad D, Antonyshyn O, Mckenzie D, Fialkov J, Breen D, Mamedov A. What is the Microscopic Tumor Extent beyond Clinically Delineated Gross Tumor Boundary in Nonmelanoma Skin Cancers? Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.087] [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: 11/17/2022]
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41
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Choo R, Woo T, Barnes E, Assaad D, Antonyshyn O, Mckenzie D, Fialkov J, Breen D, Mamedov A. 42 Evaluation of the Microscopic Tumor Extent Beyond Clinically Delineated Gross Tumor Boundary in Nonmelanoma Skin Cancers. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80203-8] [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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42
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Ramage JK, Davies AHG, Ardill J, Bax N, Caplin M, Grossman A, Hawkins R, McNicol AM, Reed N, Sutton R, Thakker R, Aylwin S, Breen D, Britton K, Buchanan K, Corrie P, Gillams A, Lewington V, McCance D, Meeran K, Watkinson A. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 2005; 54 Suppl 4:iv1-16. [PMID: 15888809 PMCID: PMC1867801 DOI: 10.1136/gut.2004.053314] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J K Ramage
- North Hampshire Hospital, Aldermaston Road, Basingstoke, Hants, UK.
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Pitsiu M, Wilmer A, Bodenham A, Breen D, Bach V, Bonde J, Kessler P, Albrecht S, Fisher G, Kirkham A. Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment †. Br J Anaesth 2004; 92:493-503. [PMID: 14766712 DOI: 10.1093/bja/aeh086] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The pharmacokinetics of remifentanil, an opioid analgesic metabolized by non-specific esterases, and its principal metabolite, remifentanil acid (RA), which is excreted via the kidneys, were assessed as part of an open-label safety study in intensive care unit (ICU) patients with varying degrees of renal impairment. METHODS Forty adult ICU patients with normal/mildly impaired renal function (creatinine clearance [CL(cr)] 62.9 (sd) 14.5 ml min(-1); n=10) or moderate/severe renal impairment (CL(cr) 14.7 (15.7) ml min(-1); n=30) were included. Remifentanil was infused for up to 72 h, at a starting rate of 6-9 microg kg(-1) h(-1) titrated to achieve a target sedation level, with additional propofol (0.5 mg kg(-1) h(-1)) if required. Intensive arterial sampling was performed for up to 72 h after infusion. Pharmacokinetic parameters obtained by simultaneous modelling of remifentanil and RA data were statistically compared between the two groups. RESULTS Remifentanil pharmacokinetics were not significantly affected by renal status. RA clearance in the moderate/severe group was reduced to about 25% that of the normal/mild group (41 (29) vs 176 (49) ml kg(-1) h(-1), P<0.0001). Metabolic ratio, a predictor of the ratio of RA to remifentanil concentrations at steady state, was approximately eight-fold higher in the moderate/severe group relative to the normal/mild group (116 (110) vs 15 (4), P<0.0001). Maximum RA levels approached 700 ng ml(-1) in the moderate/severe group. CONCLUSIONS Although RA accumulates in patients with moderate/severe renal impairment, pharmacokinetic modelling predicts that RA concentrations during a 9 microg kg(-1) h(-1) remifentanil infusion for up to 15 days would not exceed those reported in the present study, for which no associated prolongation of mu-opioid effects was observed.
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Affiliation(s)
- M Pitsiu
- Medeval Ltd, Skelton House, Manchester Science Park, Lloyd Street North, Manchester M15 6SH, UK.
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Karabinis A, Malbrain M, Bakker J, Jensen T, Germann P, Breen D, Parkinson P. Crit Care 2004; 8:P237. [DOI: 10.1186/cc2704] [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: 11/10/2022] Open
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Breen D. Pneumococcal vaccination programme in over 65s and at-risk groups: the Dumfries and Galloway experience. Commun Dis Public Health 2003; 6:228-30. [PMID: 14708273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Implementation of a systematic pneumococcal vaccination campaign in over 65s and at-risk groups is described for Dumfries and Galloway, South West Scotland. A successful programme is achievable in health boards and health authorities with a modes degree of effort. Problems are few, costs are manageable if the campaign is combined with the flu vaccination campaign, and acceptability to and uptake by the population is high. The lessons learned have implications for all regions of the United Kingdom as pneumococcal vaccination programmes are scheduled for introduction over the next three years.
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Affiliation(s)
- D Breen
- NHS Dumfries and Galloway, Grierson House, The Crichton, Bankend Road, Dumfries DG1 4ZG.
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Breen D, Churches T, Hawker F, Torzillo PJ. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax 2002; 57:29-33. [PMID: 11809986 PMCID: PMC1746171 DOI: 10.1136/thorax.57.1.29] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Traditionally, patients with acute respiratory failure due to chronic obstructive pulmonary disease (COPD) admitted to the intensive care unit (ICU) are believed to have a poor outcome. A study was undertaken to explore both hospital and long term outcome in this group and to identify clinical predictors. METHODS A retrospective review was carried out of consecutive admissions to a tertiary referral ICU over a 6 year period. This group was then followed prospectively for a minimum of 3 years following ICU admission. RESULTS A total of 74 patients were admitted to the ICU with acute respiratory failure due to COPD during the study period. Mean forced expiratory volume in 1 second (FEV1) was 0.74 (0.34) l. Eighty five per cent of the group underwent invasive mechanical ventilation for a median of 2 days (range 1-17). The median duration of stay in the ICU was 3 days (range 2-17). Survival to hospital discharge was 79.7%. Admission arterial carbon dioxide tension (PaCO2) and APACHE II score were independent predictors of hospital mortality on multiple regression analysis. Mortality at 6 months, 1, 2, and 3 years was 40.5%, 48.6%, 58.1%, and 63.5%, respectively. There were no independent predictors of mortality in the long term. CONCLUSIONS Despite the need for invasive mechanical ventilation in most of the study group, good early survival was observed. Mortality in the long term was significant but acceptable, given the degree of chronic respiratory impairment of the group.
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Affiliation(s)
- D Breen
- Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, Australia
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48
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Wilmer A, Bodenham A, Breen D, Bach V, Bonde J, Kessler P, Albrecht S, Shaikh S. An investigation of the offset of pharmacodynamic effects of remifentanil following prolonged infusion in ICU patients with varying degrees of renal dysfunction: preliminary results. Crit Care 2001. [PMCID: PMC3333387 DOI: 10.1186/cc1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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49
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Evans CJ, Cowden JM, Breen D, Thomson-Carter F. Investigation and management of sporadic gastrointestinal infections with potentially Vero cytotoxin producing Escherichia coli in Scotland. Commun Dis Public Health 2000; 3:201-7. [PMID: 11014036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Recognition of the potential of Escherichia coli O157 and other Vero cytotoxin producing E. coli (VTEC) organisms to cause serious disease led to the recommendation that all diarrhoeal stool specimens be examined for E. coli O157. National guidelines exist for the testing and exclusion of cases and contacts of VTEC infection. A survey was conducted to discover the extent to which these recommendations are followed in Scotland by asking about current practices for public health management of identified cases and laboratory investigation of E. coli infection. About two thirds of Scottish health boards followed national guidelines for testing and exclusion of cases and contacts of VTEC O157 infection. Most laboratories tested all diarrhoeal stools for E. coli O157 but detection methods varied and a minority tested selected stools for non-O157 E. coli serogroups. Standardisation of policies for laboratory testing of VTEC infection would improve national surveillance. Adherence to evidence based guidelines would standardise public health management of VTEC infections in Scotland.
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Affiliation(s)
- C J Evans
- Scottish Centre for Infection and Environmental Health, Glasgow
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50
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Abstract
Pasteurella multocida is a normal oral commensal in animals. Animal bites are often complicated by severe wound infection due to P. multocida, but systemic infection is rare. We report a patient with bacteremic pneumonia successfully treated with ceftriaxone and ciprofloxacin. We also review the clinical isolates of P. multocida reported by a major teaching hospital laboratory over a 10-year period. There were 23 patients, comprising the present case, 17 patients with wound infections following animal bites, one case of neonatal meningitis and associated maternal vaginal carriage of P. multocida, and three sputum isolates of doubtful significance.
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Affiliation(s)
- D Breen
- St. George Hospital, Sydney, Australia.
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