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Nicolson C, Burke A, Gardiner D, Harvey D, Munshi L, Shaw M, Tsanas A, Lone N, Puxty K. Predicting time to asystole following withdrawal of life-sustaining treatment: a systematic review. Anaesthesia 2024; 79:638-649. [PMID: 38301032 DOI: 10.1111/anae.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
The planned withdrawal of life-sustaining treatment is a common practice in the intensive care unit for patients where ongoing organ support is recognised to be futile. Predicting the time to asystole following withdrawal of life-sustaining treatment is crucial for setting expectations, resource utilisation and identifying patients suitable for organ donation after circulatory death. This systematic review evaluates the literature for variables associated with, and predictive models for, time to asystole in patients managed on intensive care units. We conducted a comprehensive structured search of the MEDLINE and Embase databases. Studies evaluating patients managed on adult intensive care units undergoing withdrawal of life-sustaining treatment with recorded time to asystole were included. Data extraction and PROBAST quality assessment were performed and a narrative summary of the literature was provided. Twenty-three studies (7387 patients) met the inclusion criteria. Variables associated with imminent asystole (<60 min) included: deteriorating oxygenation; absence of corneal reflexes; absence of a cough reflex; blood pressure; use of vasopressors; and use of comfort medications. We identified a total of 20 unique predictive models using a wide range of variables and techniques. Many of these models also underwent secondary validation in further studies or were adapted to develop new models. This review identifies variables associated with time to asystole following withdrawal of life-sustaining treatment and summarises existing predictive models. Although several predictive models have been developed, their generalisability and performance varied. Further research and validation are needed to improve the accuracy and widespread adoption of predictive models for patients managed in intensive care units who may be eligible to donate organs following their diagnosis of death by circulatory criteria.
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Affiliation(s)
- C Nicolson
- Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - A Burke
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - D Gardiner
- Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NHS Blood and Transplant, Watford, UK
| | - D Harvey
- Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NHS Blood and Transplant, Watford, UK
| | - L Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - M Shaw
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - A Tsanas
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - N Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Critical Care, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K Puxty
- Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Chen SY, Forero L, Davy J, Stackhouse J, Harvey D, Abdelfattah E, Maier G. Factors associated with perceived Anaplasma marginale infection and clinical anaplasmosis cases on beef operations in California. Ticks Tick Borne Dis 2024; 15:102346. [PMID: 38643720 DOI: 10.1016/j.ttbdis.2024.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024]
Abstract
Bovine anaplasmosis is a tick-borne disease caused by Anaplasma marginale in the United States. The objective of this study was to use a survey tool to generate information for beef operations in California on anaplasmosis prevention and control management, including to what extent management activities were informed by perceived herd-level exposure to A. marginale infection or occurrence of clinical anaplasmosis cases. We mailed 2,621 questionnaires with questions on Anaplasma status, herd demographics, anaplasmosis control and prevention measures, and environmental factors to beef ranchers in California in October 2020. Survey-weighted chi-square tests were used to compare management differences according to perceived Anaplasma infection status. Generalized estimating equations (GEEs) were used to analyze whether region of California, management practices, or environmental factors were associated with reported clinical cases of anaplasmosis in the previous five years. A total of 466 questionnaires describing 749 herds were obtained and used in this study. Use of management measures, including deliberate exposure of calves to ticks, vaccination for Anaplasma, infection control through antibiotics in feed, maintaining a completely closed herd, blood testing for Anaplasma on all herd additions, and taking no anaplasmosis control and prevention measures, were significantly different between herds with or without perceived A. marginale infection based on producers' self-declared status. The overall perceived prevalence for Anaplasma infection and reported clinical cases of anaplasmosis at the herd level was 26.0 % (95 % CI: 24.3-27.7 %) and 17.1 % (95 % CI: 15.6-18.6 %) respectively, with the highest perceived infection and case numbers reported in the Central Coast region. In the GEE model, higher odds of reporting clinical cases of anaplasmosis in the previous five years were observed in cattle located in the Central Coast region, cattle within a large herd, cattle that are treated with tick/fly control, cattle in a completely closed herd, and cattle receiving Anaplasma vaccine. Anaplasma infection and bovine anaplasmosis status may be underestimated in beef herds in California based on previous study results. Changing needles between cattle after injections and conducting blood testing for Anaplasma on herd additions are important Anaplasma management measures that are infrequently implemented in beef herds in California. The results show a need for producer education to improve producers' awareness of bovine anaplasmosis and implement proper measures for disease control and prevention.
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Affiliation(s)
- S Y Chen
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, United States
| | - L Forero
- University of California Cooperative Extension, Agriculture and Natural Resources, Redding, CA, 96002, United States
| | - J Davy
- University of California Cooperative Extension, Agriculture and Natural Resources, Red Bluff, CA, 96080, United States
| | - J Stackhouse
- University of California Cooperative Extension, Agriculture and Natural Resources, Eureka, CA, 95503, United States
| | - D Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, 95616, United States
| | - E Abdelfattah
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, United States; Department of Animal Hygiene, and Veterinary Management, Faculty of Veterinary Medicine, Benha University, Moshtohor 13736, Egypt
| | - G Maier
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, United States.
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Torres-Espin A, Rabadaugh H, Fitzsimons S, Harvey D, Chou A, Lindberg C, Casaletto KB, Goldberger L, Staffaroni AM, Maillard P, Miller BL, DeCarli C, Hinman JD, Ferguson AR, Kramer JH, Elahi FM. Sexually dimorphic differences in angiogenesis markers predict brain aging trajectories. bioRxiv 2023:2023.07.16.549192. [PMID: 37503183 PMCID: PMC10370093 DOI: 10.1101/2023.07.16.549192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Aberrant angiogenesis could contribute to cognitive impairment, representing a therapeutic target for preventing dementia. However, most angiogenesis studies focus on model organisms. To test the relevance of angiogenesis to human cognitive aging, we evaluated associations of circulating blood markers of angiogenesis with brain aging trajectories in two deeply phenotyped human cohorts (n=435, age 74 + 9) with longitudinal cognitive assessments, biospecimens, structural brain imaging, and clinical data. Machine learning and traditional statistics revealed sex dimorphic associations of plasma angiogenic growth factors with brain aging outcomes. Specifically, angiogenesis is associated with higher executive function and less brain atrophy in younger women (not men), a directionality of association that reverses around age 75. Higher levels of basic fibroblast growth factor, known for pleiotropic effects on multiple cell types, predicted favorable cognitive trajectories. This work demonstrates the relevance of angiogenesis to brain aging with important therapeutic implications for vascular cognitive impairment and dementia.
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Pham C, Nguyen M, Cooper M, Pierce B, Harvey D, Yau S, Youssef J, Goodarzi A, Nguyen D, Graviss E, Huang H. Use of a Medication Questionnaire to Identify Lung Transplant Recipients Benefiting from Pharmacist Prioritization in Clinic. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1046] [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] Open
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Banerjee S, Harvey D. Marijuana use versus suicidal ideation in the context of broadening legalization. Ann Epidemiol 2021. [DOI: 10.1016/j.annepidem.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Montgomery J, Stokes-Lampard HJ, Griffiths MD, Gardiner D, Harvey D, Suntharalingam G. Assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges during a pandemic: An Intensive Care Society clinical guideline. J Intensive Care Soc 2021; 22:204-210. [PMID: 34422102 DOI: 10.1177/1751143720948537] [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] [Indexed: 11/16/2022] Open
Abstract
This national professional society guidance lays out operational and ethical principles for decision-making during a pandemic, in the immediate context of COVID-19 in the early 2020 surge iteration but with potential ongoing relevance. It identifies the different phases of a pandemic and the implications for capacity and mutual aid within a national healthcare system, and introduces a revised CRITCON-PANDEMIC framework for shared operational responsibilities and clinical decision-making. Usual legal and ethical frameworks should continue to apply while capacity and mutual aid are available (CRITCON-PANDEMIC levels 0-3); clinicians should focus on current clinical needs and should not treat patients differently because of anticipated future pressures. In conditions of resource limitation (CRITCON-PANDEMIC 4), a structured and equitable approach is necessary and an objective Decision Support Aid is proposed. In producing this guidance, we emphasise that all patients must be treated with respect and without discrimination, because everyone is of equal value. The guidance has been put together with input from patient and public groups and aims to provide standards that are fair to everyone. We acknowledge that COVID-19 is a new disease with a partial and evolving knowledge base, and aim to provide an objective clinical decision-making framework based on the best available information. It is recognised that a factual assessment of likely benefit may take into account age, frailty and comorbidities, but the guidance emphasises that every assessment must be individualised on a balanced, case by case, basis and may inform clinical judgement but not replace it. The effects of a comorbidity on someone's ability to benefit from critical care should be individually assessed. Measures of frailty should be used with care, and should not disadvantage those with stable disability.
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Affiliation(s)
| | - H J Stokes-Lampard
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - M D Griffiths
- National Heart & Lung Institute, Imperial College London, London, UK
| | - D Gardiner
- Nottingham University Hospitals, Nottingham, UK
| | - D Harvey
- Nottingham University Hospitals, Nottingham, UK
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Curtis RMK, Manara AR, Madden S, Brown C, Duncalf S, Harvey D, Tridente A, Gardiner D. Validation of the factors influencing family consent for organ donation in the UK. Anaesthesia 2021; 76:1625-1634. [PMID: 33860929 DOI: 10.1111/anae.15485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47-1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23-0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22-0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.
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Affiliation(s)
- R M K Curtis
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - A R Manara
- NHS Blood and Transplant and Consultant, Southmead Hospital, Bristol, UK
| | - S Madden
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - C Brown
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - S Duncalf
- North West and Yorkshire Organ Donation Service and NHS Blood and Transplant, Leeds, UK
| | - D Harvey
- NHS Blood and Transplant and Consultant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Tridente
- St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - D Gardiner
- NHS Blood and Transplant and Consultant, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Bera KD, Shah A, English MR, Harvey D, Ploeg RJ. Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions. Anaesthesia 2020; 75:1191-1204. [PMID: 32430910 DOI: 10.1111/anae.15037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/16/2022]
Abstract
Mortality remains high for patients on the waiting list for organ transplantation. A marked imbalance between the number of available organs and recipients that need to be transplanted persists. Organs from deceased donors are often declined due to perceived and actual suboptimal quality. Adequate donor management offers an opportunity to reduce organ injury and maximise the number of organs than can be offered in order to respect the donor's altruistic gift. The cornerstones of management include: correction of hypovolaemia; maintenance of organ perfusion; prompt treatment of diabetes insipidus; corticosteroid therapy; and lung protective ventilation. The interventions used to deliver these goals are largely based on pathophysiological rationale or extrapolations from general critical care patients. There is currently insufficient high-quality evidence that has assessed whether any interventions in the donor after brain death may actually improve immediate post-transplant function and long-term graft survival or recipient survival after transplantation. Improvements in our understanding of the underlying mechanisms following brain death, in particular the role of immunological and metabolic changes in donors, offer promising future therapeutic opportunities to increase organ utilisation. Establishing a UK donor management research programme involves consideration of ethical, logistical and legal issues that will benefit transplanted patients while respecting the wishes of donors and their families.
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Affiliation(s)
- K D Bera
- Oxford Biomedical Research Centre and Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - M R English
- University of Oxford Medical School, Oxford, UK
| | - D Harvey
- Department of Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R J Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, UK
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Cooper J, Harvey D, Gardiner D. Examining consent for interventional research in potential deceased organ donors: a narrative review. Anaesthesia 2020; 75:1229-1235. [PMID: 32329902 DOI: 10.1111/anae.15039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/04/2023]
Abstract
In the last decade, research in transplant medicine has focused on developing interventions in the management of the deceased organ donor to improve the quality and quantity of transplantable organs. Despite the promise of interventional donor research, there remain debates about the ethics of this research, specifically regarding gaining research consent. Here, we examine the concerns and ambiguities around consent for interventional donor research, which incorporate questions about who should consent for interventional donor research and what people are being asked to consent for. We highlight the US and UK policy responses to these concerns and argue that, whereas guidance in this area has done much to clarify these ambiguities, there is little consideration of the nature, practicalities and context around consent in this area, particularly regarding organ donors and their families. We review wider studies of consent in critical care research and social science studies of consent in medical research, to gain a broader view of consent in this area as a relational and contextual process. We contend a lack of consideration has been given to: what it might mean to consent to interventional donor research; how families, patients and health professionals might experience providing and seeking this consent; who is best placed to have these discussions; and the socio-institutional contexts affecting these processes. Further, empirical research is required to establish an ethical and sensitive model for consent in interventional donor research, ensuring the principles enshrined in research ethics are met and public trust in organ donation is maintained.
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Affiliation(s)
- J Cooper
- School of Health Sciences, City, University of London, UK
| | - D Harvey
- Department of Intensive Care Medicine, Nottingham University NHS Trust, Nottingham, UK
| | - D Gardiner
- Department of Intensive Care Medicine, Nottingham University NHS Trust, Nottingham, UK
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Ingiosi A, Hayworth C, Harvey D, Singletary K, Rempe M, Wisor J, Frank M. A role for astroglial calcium activity in sleep and sleep homeostasis. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.462] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rivero-Rodriguez JF, Garcia-Munoz M, Martin R, Galdon-Quiroga J, Ayllon-Guerola J, Akers RJ, Buchanan J, Croft D, Garcia-Vallejo D, Gonzalez-Martin J, Harvey D, McClements KG, Rodriguez-Ramos M, Sanchis L. A rotary and reciprocating scintillator based fast-ion loss detector for the MAST-U tokamak. Rev Sci Instrum 2018; 89:10I112. [PMID: 30399654 DOI: 10.1063/1.5039311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
The design and unique feature of the first fast-ion loss detector (FILD) for the Mega Amp Spherical Tokamak - Upgrade (MAST-U) is presented here. The MAST-U FILD head is mounted on an axially and angularly actuated mechanism that makes it possible to independently adapt the orientation [0°, 90°] and radial position [1.40 m, 1.60 m] of the FILD head, i.e., its collimator, thus maximizing the detector velocity-space coverage in a broad range of plasma scenarios with different q95. The 3D geometry of the detector has been optimized to detect fast-ion losses from the neutral beam injectors. Orbit simulations are used to calculate the strike map and predict the expected signals. The results show a velocity-space range of [4 cm, 13 cm] in gyroradius and [30°, 85°] in pitch angle, covering the entire neutral beam ion energy range. The optical system will provide direct sight of the scintillator and simultaneous detection with two cameras, giving high spatial and temporal resolution. The MAST-U FILD will shed light on the dominant fast-ion transport mechanisms in one of the world's two largest spherical tokamaks through absolute measurements of fast-ion losses.
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Affiliation(s)
- J F Rivero-Rodriguez
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - M Garcia-Munoz
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, CSIC, Junta de Andalucia, Seville, Spain
| | - R Martin
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - J Galdon-Quiroga
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, CSIC, Junta de Andalucia, Seville, Spain
| | - J Ayllon-Guerola
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - R J Akers
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - J Buchanan
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - D Croft
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - D Garcia-Vallejo
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - J Gonzalez-Martin
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - D Harvey
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - K G McClements
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - M Rodriguez-Ramos
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, CSIC, Junta de Andalucia, Seville, Spain
| | - L Sanchis
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, CSIC, Junta de Andalucia, Seville, Spain
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Makki D, Abdalla S, El Gamal TA, Harvey D, Jackson G, Platt S. Is it necessary to change instruments between sampling sites when taking multiple tissue specimens in musculoskeletal infections? Ann R Coll Surg Engl 2018; 100:563-565. [PMID: 29909681 DOI: 10.1308/rcsann.2018.0097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction Surgical debridement of orthopaedic infections allows biopsy for microbiology and facilitates successful treatment. It is recommended that biopsy instruments are changed when taking multiple samples. This study compared assessed cross-contamination between biopsy sites when using same instruments to take tissue samples from multiple sites. Materials and methods During the surgical debridement, we defined five sampling sites and marked them with diathermy. Two sampling techniques were performed on same patient to minimise any potential bias arising from the type of host and the severity of infection. First, fresh instruments were used for each biopsy site. Titleond, the instruments used in the first sampling site were reused to take samples from the remaining sites. By comparing the microbiology results of the samples taken by each technique for each site we determined cross-contamination with microorganisms. Results Fifteen patients with foot and ankle infections (mean age 56 years) were included. Ten patients were diabetic and five had neuropathies. Cross-contamination between sampling sites occurred in eight cases when the same instruments were used to take biopsies (P = 0.002, Fisher's exact test). One or more microorganisms were involved in cross-contamination and the latter always occurred between two consecutive sites rather than sites that were further apart. Conclusion It is important to use fresh instruments for each biopsy site when taking multiple samples in musculoskeletal infection as cross-contamination might occur otherwise and affect microbiological studies.
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Affiliation(s)
- D Makki
- Stepping Hill Hospital, Orthopaedics , Stockport , UK
| | - S Abdalla
- Aintree University Hospitals NHS Foundation Trust, Trauma & Orthopaedics , Liverpool , UK
| | | | | | | | - S Platt
- Wirral University Teaching Hospital NHS Foundation Trust, Trauma and Orthopaedics , Wirral, Merseyside , UK
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Harvey D, Butler J, Groves J, Manara A, Menon D, Thomas E, Wilson M. Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations. Br J Anaesth 2018; 120:138-145. [DOI: 10.1016/j.bja.2017.10.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/20/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022] Open
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Makki D, Elgamal T, Evans P, Harvey D, Jackson G, Platt S. The orthopaedic manifestation and outcomes of methicillin-sensitive Staphylococcus aureus septicaemia. Bone Joint J 2017; 99-B:1545-1551. [PMID: 29092997 DOI: 10.1302/0301-620x.99b11.bjj-2016-1093.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/30/2017] [Accepted: 05/19/2017] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia. PATIENTS AND METHODS A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement. RESULTS The most common site of infection was the spine, which occurred in 28 patients (58%), and was associated with abscess formation in 16. Back pain was the presenting symptom in these patients, with a positive predictive value of 100%. A total of 24 patients had a total of 42 arthroplasties of the hip or knee in situ. Prosthetic joint infection occurred in six of these patients (25%). In five patients, the infection originated outside the musculoskeletal system. Three patients (6%) with MSSA septicaemia from a musculoskeletal sources died. CONCLUSION Amongst the musculoskeletal sources of MSSA septicaemia, the spine was the most commonly involved. We recommend an MRI scan of the whole spine and pelvis in patients with MSSA septicaemia with back pain, when the primary source of infection has not been identified or clinical examination is unreliable. Cite this article: Bone Joint J 2017;99-B:1545-51.
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Affiliation(s)
- D Makki
- Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
| | - T Elgamal
- Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
| | - P Evans
- Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
| | - D Harvey
- Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
| | - G Jackson
- Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
| | - S Platt
- Department of Trauma and Orthopaedics Wirral University Teaching Hospital NHS Trust , Arrowe Park Road, Upton, Wirral CH49 5PE, UK
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Loh E, Guy SD, Mehta S, Moulin DE, Bryce TN, Middleton JW, Siddall PJ, Hitzig SL, Widerström-Noga E, Finnerup NB, Kras-Dupuis A, Casalino A, Craven BC, Lau B, Côté I, Harvey D, O'Connell C, Orenczuk S, Parrent AG, Potter P, Short C, Teasell R, Townson A, Truchon C, Bradbury CL, Wolfe D. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: introduction, methodology and recommendation overview. Spinal Cord 2017; 54 Suppl 1:S1-6. [PMID: 27444714 DOI: 10.1038/sc.2016.88] [Citation(s) in RCA: 14] [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: 01/05/2023]
Abstract
STUDY DESIGN Clinical practice guidelines. OBJECTIVES The objective was to develop the first Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. METHODS The guidelines were developed in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS The Working Group developed 12 recommendations for screening and diagnosis, 12 recommendations for treatment and 5 recommendations for models of care. Important clinical considerations accompany each recommendation. CONCLUSIONS The Working Group recommendations for the management of neuropathic pain after SCI should be used to inform practice.
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Affiliation(s)
- E Loh
- Lawson Health Research Institute, London, Ontario, Canada.,St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S D Guy
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S Mehta
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - D E Moulin
- St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - T N Bryce
- Mount Sinai Hospital, New York, NY, USA
| | - J W Middleton
- The University of Sydney, Sydney, New South Wales, Australia
| | - P J Siddall
- The University of Sydney, Sydney, New South Wales, Australia
| | - S L Hitzig
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | | | | | - A Casalino
- Parkwood Institute, London, Ontario, Canada
| | - B C Craven
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - B Lau
- University of British Columbia, Vancouver, British Columbia, Canada
| | - I Côté
- Center interdisciplinaire de reserche en réadaptation et integration sociale, Quebec City, Quebec
| | - D Harvey
- Spinal Cord Injury Ontario, Ontario, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
| | - S Orenczuk
- Parkwood Institute, London, Ontario, Canada
| | - A G Parrent
- Western University, London, Ontario, Canada.,London Health Sciences Center, London, Ontario, Canada
| | - P Potter
- Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - C Short
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Teasell
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - A Townson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - C Truchon
- Institut National d'Excellence en Santé et Services Sociaux, Montreal, Quebec
| | - C L Bradbury
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - D Wolfe
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
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Jayne Z, Lungley J, Harvey D, Nair D. A positive experience but a negative result in screening for familial hyypercholesterolaemia (FH) in primary care. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.09.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lungley J, Jayne Z, Harvey D, Nair D. Early identification of familial hypercholesterolaemIa (FH): The prevention of Cardiovascular disease (CVD). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.09.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Menear M, Gervais M, Careau E, Chouinard MC, Cloutier G, Delorme A, Dogba MJ, Dugas M, Gagnon MP, Gilbert M, Harvey D, Houle J, Kates N, Knowles S, Martin N, Nease D, Pluye P, Samson E, Zomahoun HTV, Légaré F. Strategies and impacts of patient and family engagement in collaborative mental healthcare: protocol for a systematic and realist review. BMJ Open 2016; 6:e012949. [PMID: 27678546 PMCID: PMC5051434 DOI: 10.1136/bmjopen-2016-012949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Collaborative mental healthcare (CMHC) has garnered worldwide interest as an effective, team-based approach to managing common mental disorders in primary care. However, questions remain about how CMHC works and why it works in some circumstances but not others. In this study, we will review the evidence on one understudied but potentially critical component of CMHC, namely the engagement of patients and families in care. Our aims are to describe the strategies used to engage people with depression or anxiety disorders and their families in CMHC and understand how these strategies work, for whom and in what circumstances. METHODS AND ANALYSIS We are conducting a review with systematic and realist review components. Review part 1 seeks to identify and describe the patient and family engagement strategies featured in CMHC interventions based on systematic searches and descriptive analysis of these interventions. We will use a 2012 Cochrane review of CMHC as a starting point and perform new searches in multiple databases and trial registers to retrieve more recent CMHC intervention studies. In review part 2, we will build and refine programme theories for each of these engagement strategies. Initial theory building will proceed iteratively through content expert consultations, electronic searches for theoretical literature and review team brainstorming sessions. Cluster searches will then retrieve additional data on contexts, mechanisms and outcomes associated with engagement strategies, and pairs of review authors will analyse and synthesise the evidence and adjust initial programme theories. ETHICS AND DISSEMINATION Our review follows a participatory approach with multiple knowledge users and persons with lived experience of mental illness. These partners will help us develop and tailor project outputs, including publications, policy briefs, training materials and guidance on how to make CMHC more patient-centred and family-centred. PROSPERO REGISTRATION NUMBER CRD42015025522.
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Affiliation(s)
- Matthew Menear
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
| | | | - Emmanuelle Careau
- Department of Rehabilitation, Laval University, Quebec, Quebec, Canada
| | | | - Guylaine Cloutier
- Association québecoise pour la réadaptation psychosociale, Quebec, Quebec, Canada
| | - André Delorme
- Quebec Ministry of Health and Social Services, Quebec, Quebec, Canada
| | - Maman Joyce Dogba
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
| | - Michèle Dugas
- CHU de Québec Research Centre, Quebec, Quebec, Canada
| | | | - Michel Gilbert
- National Centre for Excellence in Mental Health, Montreal, Quebec, Canada
| | - Diane Harvey
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sara Knowles
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Neasa Martin
- Neasa Martin and Associates, Toronto, Ontario, Canada
| | - Donald Nease
- Department of Family Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Esther Samson
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | | | - France Légaré
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
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Gilhooly KJ, Gilhooly ML, Phillips LH, Harvey D, Murray A, Hanlon P. Cognitive Aging: Activity Patterns and Maintenance Intentions. Int J Aging Hum Dev 2016; 65:259-80. [DOI: 10.2190/ag.65.3.d] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined relationships between cognitive functioning in older people and 1) levels of mental, physical and social activities, and 2) intentions regarding maintenance of cognitive functioning. Participants ( N = 145) were 70–91 years of age, varied in health status and socio-economic backgrounds. Current cognitive functioning was assessed by psychometric tests and real world problem solving tasks. Crystallized ability was indexed by the National Adult Reading Test (NART). Degree of involvement in mentally demanding activities was positively related to a fluid cognitive factor after effects of age, prior functioning, gender, health, and socio-economic status were accounted for. Social and physical activities were not related to the cognitive measures. Age effects on cognitive functioning were reduced among participants who reported undertaking activities intentionally to maintain cognitive functioning.
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Affiliation(s)
| | | | | | - D. Harvey
- MRC Social and Public Health Services Unit, Glasgow
| | - A. Murray
- Glasgow City Council, Social Work Services
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Abstract
Disturbances of the natural balance between procoagulant and anticoagulant mechanisms can result in bleeding or thrombotic tendencies. Factor V, on activation by thrombin to factor Va, forms an essential component of the prothrombinase complex, in which it demonstrates its cofactor activity for factor Xa. Down-regulation of factor Va by activated protein C (APC) occurs through cleavage of specific peptide bonds in the heavy chain of the molecule. Factor V Leiden (FV Leiden) is a mutation of factor V that renders factor Va resistant to APC, due to loss of one of these cleavage sites. This mutation predisposes the patient to thrombosis. Prevalence of FV Leiden varies; however, heterozygosity for the FV Leiden mutation is recognised as the most common heritable thrombophilic defect in Caucasian populations. The association this inherited thrombophilia has with venous thromboembolism (VTE) is well established. Pregnancy is notably an acquired hypercoagulable state, due in part to physiological changes that occur in the coagulation system. This seems to have potential for interaction with FV Leiden to cause adverse experiences. A role has been suggested for FV Leiden in VTE events during pregnancy. At present only selected women are screened for FV Leiden. Pregnant women with a history of VTE or with a family history of the mutation are investigated. Whether or not the introduction of a routine screening plan for this mutation is justified remains a matter for debate.
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Affiliation(s)
- D Harvey
- Department of Haematology, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE
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Rao N, Jain A, Harvey D, Persaud J, Nair D. Lipoprotein phospholipase A2, high sensitivity C reactive protein and carotid intima media thickness in cardiovascular risk assessment for a South Asian population. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sharifi M, Gallivan A, Harvey D, Li KW, Futema M, Cooper J, Humphries S, Nair D. Atherosclerosis in monogenic Familial Hypercholesterolaemia versus polygenic hypercholesterolaemia. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oh W, Devonald M, Gardner D, Mahajan R, Harvey D, Sharman A, Mafrici B, Rigby M, Welham S. Micronutrient loss in renal replacement therapy for acute kidney injury. Crit Care 2015. [PMCID: PMC4471419 DOI: 10.1186/cc14380] [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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25
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Shakeshaft M, Cunniffe J, Harvey D. Response to Dawson S, 'Blood culture contaminants', J Hosp Infect 2014, vol. 87, pp. 1-10. J Hosp Infect 2014; 88:120. [PMID: 25218657 DOI: 10.1016/j.jhin.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- M Shakeshaft
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
| | - J Cunniffe
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - D Harvey
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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Neves FMDO, Leite TT, Meneses GC, Araujo De Souza NH, Martins AMC, Parahyba MC, Queiroz REB, Liborio A, Liu Y, Li Y, Li X, Chen L, Zulkarnaev A, Vatazin A, Nikolaj S, Stadler T, Raddatz A, Hubner W, Poppleton A, Fliser D, Klingele M, Castellano G, Intini A, Stasi A, Divella C, Pontrelli P, Gigante M, Zito A, Pertosa GB, Gesualdo L, Grandaliano G, Powell TC, Donnelly JP, Wang HE, Warnock DG, De Loor J, Hoste E, Herck I, Francois K, Decrop L, Clauwaert C, Bracke S, Vermeiren D, Demeyere K, Meyer E, Mitra P, Rahim MA, Gupta RD, Samdani TS, Rahman SA, Enam SF, Mursalin G, E-Khoda MM, Haque WMM, Iqbal S, Mansur MA, Guglielmetti G, Cena T, Musetti C, Quaglia M, Battista M, Radin E, Airoldi A, Izzo C, Stratta P, Haase-Fielitz A, Albert C, Westphal S, Hoffmann J, Mertens PR, Plass M, Westerman M, Bellomo R, Maisel A, Ronco C, Haase M, Wu PC, Wu VC, Prasad B, Wong B, St.Onge JR, Rungta R, Das P, Ray DS, Gupta S, De Gracia MDC, Osuna A, Quesada A, Manzano F, Montoro S, Jimenez MDM, Wangensteen R, Strunk AK, Schmidt J, Schmidt B, Bode-Boger S, Martens-Lobenhoffer J, Welte T, Kielstein JT, Wang AY, Bellomo R, Cass A, Myburgh J, Finfer S, Gatta D, Chadban S, Jardine M, Lo S, Barzi F, Gallagher M, Marn-Pernat A, Benedik M, Bren A, Buturovic-Ponikvar J, Gubensek J, Knap B, Premru V, Ponikvar R, Koba L, Teixeira M, Macedo E, Altunoren O, Balli M, Tasolar H, Eren N, Arpaci A, Caglayan CE, Yavuz YC, Sahin M, Gliga ML, Gliga PM, Frigy A, Bandea A, Magdas AM, Dogaru G, Mergulhao C, Pinheiro H, Vidal E, Sette L, Amorim G, Fernandes G, Valente L, Hornum M, Penninga L, Rasmussen A, Plagborg UB, Oturai P, Feldt-Rasmussen B, Hillingso JG, Klimenko A, Villevalde S, Kobalava Z, Arias Cabrales C, Rodriguez E, Bermejo S, Sierra A, Pascual J, Huang TM, Wu VC, Oh WC, Rigby M, Mafrici B, Sharman A, Harvey D, Welham S, Mahajan R, Gardner D, Devonald M, Wu VC, Lin MC, Wu PC, Wu CH, Nagaraja P, Clark A, Brisk R, Jennings V, Jones H, Hashmi M, Parker C, Mikhail A, Schraut J, Keller F, Mertens T, Duprel JB, Quercia AD, Cantaluppi V, Dellepiane S, Pacitti A, Biancone L, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Quercia AD, Cantaluppi V, Dellepiane S, Medica D, Besso L, Gai M, Leonardi G, Guarena C, Biancone L, Obrencevic K, Jovanovic D, Petrovic M, Ignjatovic L, Tadic J, Mijuskovic M, Maksic D, Vavic N, Pilcevic D, Mistry HD, Bramham K, Seed PT, Lynham S, Ward MA, Poston L, Chappell LC. CLINICAL ACUTE KIDNEY INJURY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rialland P, Otis C, de Courval ML, Mulon PY, Harvey D, Bichot S, Gauvin D, Livingston A, Beaudry F, Hélie P, Frank D, del Castillo J, Troncy E. Assessing experimental visceral pain in dairy cattle: A pilot, prospective, blinded, randomized, and controlled study focusing on spinal pain proteomics. J Dairy Sci 2014; 97:2118-34. [DOI: 10.3168/jds.2013-7142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/21/2013] [Indexed: 12/23/2022]
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Sharma M, Jain A, Musalhi K, Harvey D, Persaud J, Mikhailidis D, Defesche J, Nair D. Severe hypertriglyceridaemia revisited. Atherosclerosis 2013. [DOI: 10.1016/j.atherosclerosis.2013.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tiwari D, Horan J, Langston A, Qayed M, Carr J, Renfroe H, Couture C, Khoury HJ, Robertson J, Harvey D, Mehta A, Waller EK, Kean LS. A First-in-Disease Trial of in Vivo Costimulation Blockade for GVHD Prevention: The Addition of Abatacept to Standard GVHD Prophylaxis Controls Early CD4+ T Cell Proliferation and is Associated with Low Rates of Severe Acute GVHD. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maillard P, Carmichael O, Harvey D, Fletcher E, Reed B, Mungas D, DeCarli C. FLAIR and diffusion MRI signals are independent predictors of white matter hyperintensities. AJNR Am J Neuroradiol 2012; 34:54-61. [PMID: 22700749 DOI: 10.3174/ajnr.a3146] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [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
BACKGROUND AND PURPOSE WMH, associated with cognitive decline and cardiovascular risk factors, may represent only the extreme end of a more widespread continuous WM injury process that progresses during aging and is poorly understood. We investigated the ability of FLAIR and DTI to characterize the longitudinal course of WMH development. MATERIALS AND METHODS One hundred nineteen participants (mean age, 74.5 ± 7.4), including cognitively healthy elders and subjects diagnosed with Alzheimer disease and mild cognitive impairment, received a comprehensive clinical evaluation and brain MR imaging, including FLAIR and DTI on 2 dates. The risk for each baseline normal-appearing WM voxel to convert into WMH was modeled as a function of baseline FA (model M1) and both baseline FA and standardized FLAIR (M2). Sensitivity, specificity, accuracy, and AUC for predicting conversion to WMH were compared between models. RESULTS Independent of clinical diagnosis, lower baseline FA (P < .001, both models) and higher baseline FLAIR intensity (P < .001, M2) were independently associated with increased risk for conversion from normal WM to WMH. M1 exhibited higher sensitivity but lower specificity, accuracy, and AUC compared with M2. CONCLUSIONS These findings provide further evidence that WMH result from a continuous process of WM degeneration with time. Stepwise decreases in WM integrity as measured by both DTI and FLAIR were independently associated with stepwise increases in WMH risk, emphasizing that these modalities may provide complementary information for understanding the time course of aging-associated WM degeneration.
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Affiliation(s)
- P Maillard
- Imaging of Dementia and Aging Laboratory, University of California, Davis, Davis, California, USA
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Kaur B, Harvey D, Tong E, Hofstetter CR, DeCarli C, Olichney J. The Relationship of Smoking History and Vascular Risk Factors to Motor Parkinsonism in Dementia (P04.202). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.202] [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: 11/15/2022] Open
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Rao N, Eastwood SV, Jain A, Shah M, Leurent B, Harvey D, Robertson L, Walters K, Persaud JW, Mikhailidis DP, Nair DR. Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study. Int J Clin Pract 2012; 66:262-9. [PMID: 22151579 DOI: 10.1111/j.1742-1241.2011.02773.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. METHODS A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. RESULTS At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). CONCLUSIONS A high prevalence of modifiable risk factors for CVD was detected in the population screened.
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Affiliation(s)
- N Rao
- Department of Clinical Biochemistry, Royal Free Hospital, Pond Street, London, NW3 UK
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Karaderi T, Pointon JJ, Wordsworth TWH, Harvey D, Appleton LH, Cohen CJ, Farrar C, Harin A, Brown MA, Wordsworth BP. Evidence of genetic association between TNFRSF1A encoding the p55 tumour necrosis factor receptor, and ankylosing spondylitis in UK Caucasians. Clin Exp Rheumatol 2012; 30:110-113. [PMID: 22272576] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/20/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To replicate the possible genetic association between ankylosing spondylitis (AS) and TNFRSF1A. METHODS TNFRSF1A was re-sequenced in 48 individuals with AS to identify novel polymorphisms. Nine single nucleotide polymorphisms (SNPs) in TNFRSF1A and 5 SNPs in the neighbouring gene SCNN1A were genotyped in 1604 UK Caucasian individuals with AS and 1019 matched controls. An extended study was implemented using additional genotype data on 8 of these SNPs from 1400 historical controls from the 1958 British Birth Cohort. A meta-analysis of previously published results was also undertaken. RESULTS One novel variant in intron 6 was identified but no new coding variants. No definite associations were seen in the initial study but in the extended study there were weak associations with rs4149576 (p=0.04) and rs4149577 (p=0.007). In the meta-analysis consistent, somewhat stronger associations were seen with rs4149577 (p=0.002) and rs4149578 (p=0.006). CONCLUSIONS These studies confirm the weak genetic associations between AS and TNFRSF1A. In view of the previously reported associations of TNFRSF1A with AS, in Caucasians and Chinese, and the biological plausibility of this candidate gene, replication of this finding in well powered studies is clearly indicated.
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Affiliation(s)
- T Karaderi
- National Institute for Health Research Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK
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Jain A, Harvey D, Robertson L, Mikhailidis DP, Nair DR. Gender-based cardiometabolic risk evaluation in minority and non-minority men grading the evidence of non-traditional determinants of cardiovascular risk. Int J Clin Pract 2011; 65:715-6. [PMID: 21564448 DOI: 10.1111/j.1742-1241.2011.02674.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Nair D, Jain A, Persaud J, Harvey D, Robertson L, Mikhailidis D. 578 CVD SCREENING IN A FAITH BASED SETTING IMPROVES ACCESS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70579-7] [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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Pointon JJ, Harvey D, Karaderi T, Appleton LH, Farrar C, Stone MA, Sturrock RD, Brown MA, Wordsworth BP. Erratum: Elucidating the chromosome 9 association with AS; CARD9 is a candidate gene. Genes Immun 2011. [DOI: 10.1038/gene.2011.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pointon JJ, Harvey D, Karaderi T, Appleton LH, Farrar C, Wordsworth BP. The histone demethylase JARID1A is associated with susceptibility to ankylosing spondylitis. Genes Immun 2011; 12:395-8. [DOI: 10.1038/gene.2011.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gilhooly ML, Gilhooly KJ, Phillips LH, Harvey D, Brady A, Hanlon P. Real-world problem solving and quality of life in older people. Br J Health Psychol 2010; 12:587-600. [DOI: 10.1348/135910706x154477] [Citation(s) in RCA: 14] [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: 11/12/2022]
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Harvey D, Booth C, Buckley H, Bunker N, Jones N, Sim M, Sarkar S. Testing of incapacitated patients for blood-borne disease is ethical. Anaesthesia 2010; 65:1227-8. [DOI: 10.1111/j.1365-2044.2010.06546.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Harvey D, Foley A, Cooke R. P20.04 Crusted scabies – lessons from a recent outbreak. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60203-4] [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: 11/30/2022]
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Harvey D. Understanding infection prevention and control. J Hosp Infect 2010. [DOI: 10.1016/j.jhin.2010.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Landau SM, Harvey D, Madison CM, Reiman EM, Foster NL, Aisen PS, Petersen RC, Shaw LM, Trojanowski JQ, Jack CR, Weiner MW, Jagust WJ. Comparing predictors of conversion and decline in mild cognitive impairment. Neurology 2010; 75:230-8. [PMID: 20592257 DOI: 10.1212/wnl.0b013e3181e8e8b8] [Citation(s) in RCA: 427] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE A variety of measurements have been individually linked to decline in mild cognitive impairment (MCI), but the identification of optimal markers for predicting disease progression remains unresolved. The goal of this study was to evaluate the prognostic ability of genetic, CSF, neuroimaging, and cognitive measurements obtained in the same participants. METHODS APOE epsilon4 allele frequency, CSF proteins (Abeta(1-42), total tau, hyperphosphorylated tau [p-tau(181p)]), glucose metabolism (FDG-PET), hippocampal volume, and episodic memory performance were evaluated at baseline in patients with amnestic MCI (n = 85), using data from a large multisite study (Alzheimer's Disease Neuroimaging Initiative). Patients were classified as normal or abnormal on each predictor variable based on externally derived cutoffs, and then variables were evaluated as predictors of subsequent conversion to Alzheimer disease (AD) and cognitive decline (Alzheimer's Disease Assessment Scale-Cognitive Subscale) during a variable follow-up period (1.9 +/- 0.4 years). RESULTS Patients with MCI converted to AD at an annual rate of 17.2%. Subjects with MCI who had abnormal results on both FDG-PET and episodic memory were 11.7 times more likely to convert to AD than subjects who had normal results on both measures (p <or= 0.02). In addition, the CSF ratio p-tau(181p)/Abeta(1-42) (beta = 1.10 +/- 0.53; p = 0.04) and, marginally, FDG-PET predicted cognitive decline. CONCLUSIONS Baseline FDG-PET and episodic memory predict conversion to AD, whereas p-tau(181p)/Abeta(1-42) and, marginally, FDG-PET predict longitudinal cognitive decline. Complementary information provided by these biomarkers may aid in future selection of patients for clinical trials or identification of patients likely to benefit from a therapeutic intervention.
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Affiliation(s)
- S M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley 94720-3190, USA.
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Nettiksimmons J, Harvey D, Brewer J, Carmichael O, DeCarli C, Jack CR, Petersen R, Shaw LM, Trojanowski JQ, Weiner MW, Beckett L. Subtypes based on cerebrospinal fluid and magnetic resonance imaging markers in normal elderly predict cognitive decline. Neurobiol Aging 2010; 31:1419-28. [PMID: 20542598 DOI: 10.1016/j.neurobiolaging.2010.04.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 04/19/2010] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
Cerebrospinal fluid (CSF) and structural magnetic resonance imaging (MRI) show patterns of change in Alzheimer's disease (AD) that precede dementia. The Alzheimer's Disease Neuroimaging Initiative (ADNI) studied normal controls (NC), subjects with mild cognitive impairment (MCI), and subjects with AD to identify patterns of biomarkers to aid in early diagnosis and effective treatment of AD. Two hundred twenty-two NC underwent baseline MRI and clinical examination at baseline and at least one follow-up. One hundred twelve also provided CSF at baseline. Unsupervised clustering based on initial CSF and MRI measures was used to identify clusters of participants with similar profiles. Repeated measures regression modeling assessed the relationship of individual measures, and of cluster membership, to cognitive change over 3 years. Most individuals showed little cognitive change. Individual biomarkers had limited predictive value for cognitive decline, but membership in the cluster with the most extreme profile was associated with more rapid decline in ADAS-cog. Subtypes among NC based on multiple biomarkers may represent the earliest stages of subclinical cognitive decline and AD.
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Affiliation(s)
- J Nettiksimmons
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA 95616, USA
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Pointon JJ, Harvey D, Karaderi T, Appleton LH, Farrar C, Stone MA, Sturrock RD, Brown MA, Wordsworth BP. Elucidating the chromosome 9 association with AS; CARD9 is a candidate gene. Genes Immun 2010; 11:490-6. [PMID: 20463747 PMCID: PMC2933507 DOI: 10.1038/gene.2010.17] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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] [Indexed: 11/24/2022]
Abstract
Ankylosing spondylitis (AS) is polygenic with contributions from the immunologically relevant genes HLA-B*27, ERAP1 and IL23R. A recent genome-wide association study (GWAS) identified associations (p~0.005) with the non-synonymous single nucleotide polymorphisms (nsSNPs), rs4077515 and rs3812571, in CARD9 and SNAPC4 on chromosome 9q that had previously been linked to AS. We replicated these associations in a study of 730 AS patients compared to 2879 historic disease controls, (rs4077515 p = 0.0004 odds ratio (OR) (95% confidence interval) = 1.2 (1.1-1.4); rs3812571 p = 0.0003 OR = 1.2 (1.1-1.4)). Meta-analysis revealed strong associations of both SNPs with AS, rs4077515 p = 0.000005 OR = 1.2 (1.1-1.3) and rs3812571 p = 0.000006 OR = 1.2 (1.1-1.3). We then typed 1604 AS cases and 1020 controls for 13 tagging SNPs; 6 showed at least nominal association, 5 of which were in CARD9. We imputed genotypes for 13 additional SNPs but none was more strongly associated with AS than the tagging SNPs. Finally, interrogation of an mRNA expression database revealed that the SNPs most strongly associated AS (or in strong linkage disequilibrium) were those most associated with CARD9 expression. CARD9 is a plausible candidate for AS given its central role in the innate immune response.
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Affiliation(s)
- J J Pointon
- NIHR Oxford Musculoskeletal Biomedical Research Unit and Botnar Research Centre, Oxford, UK.
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McCappin J, Harvey D, Wordsworth BP, Middleton D. No association of KIR3DL1 or KIR3DS1 or their alleles with ankylosing spondylitis. ACTA ACUST UNITED AC 2010; 75:68-73. [DOI: 10.1111/j.1399-0039.2009.01392.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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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Rao N, Johri N, Robertson L, Harvey D, Persaud B, Mikhailidis D, Thomas M, Nair D. COMPARISON OF A POINT OF CARE CHOLESTEROL DEVICE AND LABORATORY ANALYSIS IN THE PREDICTION OF CARDIOVASCULAR DISEASE. Atherosclerosis 2009. [DOI: 10.1016/j.atherosclerosis.2009.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lonial S, Francis D, Karanes C, Trudel S, Dollard A, Harvey D, Kaufman J. A phase I MMRC clinical trial testing the combination of bortezomib and tipifarnib in relapsed/refractory multiple myeloma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8597] [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
8597 Background: Preclinical work from our group has demonstrated that the combination of a farnesyl transferase inhibitor and bortezomib results in enhanced plasma cell apoptosis, and more recently, we have suggested that the mechanism for this synergy is due to inhibition of HDAC6, and inhibition of the proteasome and aggresome pathway. Methods: Patients with relapsed or refractory myeloma were treated with bortezomib at 1.0 or 1.3 mg/m2 on a standard schedule in conjunction with escalating doses of tipifarnib (100–400mg/BID) given on days 2–15 every 21 days. Dose escalation was accomplished using an adaptive phase I design (Escalation With Overdose Control). Results: 22 patients have been enrolled, of which 18 are evaluable, into respective tipifarnib dose levels 100 mg (n=6), 200mg (n=5) and 300mg (n=5) and 400mg (n=2). Median age for the enrolled patients is 59 and median time from myeloma diagnosis was 4.7 years. The average number of prior therapies was 4.5. Among these patients with advanced myeloma and refractory disease, stabilization of disease or better was seen among 8/10 patients with 2 of the 8 achieving an MR. Among the patients achieving clinical benefit, 1 patient had a stable M-protein, but experienced an 80% reduction in circulating plasma cells while on therapy, and another has had a 75% reduction in the free light chain assay. The most common drug related side effect was was Gr2 diarrhea (23.5%). Hematologic toxicities were difficult to ascertain as patients had advanced myeloma and many were entered onto study with platelet counts between 25 and 50. Additional grade 3 toxicities included renal insufficiency (related to PD), pneumonia and altered mental status which were all considered not related to study drug but to progression of disease. There were no Grade 3-5 drug related toxicities. One patient experienced grade 2 peripheral neuropathy who did not have pre existing PN at baseline. Conclusions: The combination of bortezomib and tipifarnib is supported by preclinical rationale and has produced stable disease or better among 10 of 18 patients with refractory myeloma. Optimal dose of tipifarnib and bortezomib have yet to be defined, and additional patients are being enrolled with 1.3mg/m2 of bortezomib, and escalating doses of tipifarnib. [Table: see text]
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Affiliation(s)
- S. Lonial
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - D. Francis
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - C. Karanes
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - S. Trudel
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - A. Dollard
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - D. Harvey
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
| | - J. Kaufman
- Emory University School of Medicine, Atlanta, GA; City of Hope Comprehensive Cancer Center, Duarte, CA; University Health Network, Toronto, ON, Canada; Multiple Myeloma Research Consortium, Norwalk, CT
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