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White B, Ng SM, Agwu JC, Barrett TG, Birchmore N, Kershaw M, Drew J, Kavvoura F, Law J, Moudiotis C, Procter E, Paul P, Regan F, Reilly P, Sachdev P, Sakremath R, Semple C, Sharples K, Skae M, Timmis A, Williams E, Wright N, Soni A. A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus. BMC Med 2024; 22:144. [PMID: 38561783 PMCID: PMC10986054 DOI: 10.1186/s12916-024-03349-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
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Affiliation(s)
- Billy White
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S M Ng
- Mersey And West Lancashire Teaching Hospitals NHS Trust, Ormskirk, UK
| | - J C Agwu
- Wye Valley NHS Trust, Hereford, UK
| | - T G Barrett
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - N Birchmore
- Great Ormond Street Hospital For Children, NHS Foundation Trust, London, UK
| | - M Kershaw
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - J Drew
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - F Kavvoura
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Law
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - C Moudiotis
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E Procter
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - P Paul
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - F Regan
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - P Reilly
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - P Sachdev
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - R Sakremath
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - C Semple
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - M Skae
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - A Timmis
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - E Williams
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - N Wright
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK
| | - A Soni
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK.
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Shillitoe B, Cowie CJA, Misgar H, Pareja-Cebrian L, Williams E. Spontaneous Clostridium perfringens Meningitis and Brain Abscess in a Neonate. Pediatr Infect Dis J 2023; 42:1121-1123. [PMID: 37725822 DOI: 10.1097/inf.0000000000004116] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
This case describes a neonate who presented with spontaneous Clostridium perfringens meningitis and brain abscess. The abscess was drained, and the infant completed a 6-week course of antibiotics. Throughout this time the infant remained well with no need for intensive care. C. perfringens central nervous system infections are associated with trauma and poor outcomes. This case highlights that the spectrum of disease can include spontaneous infection with a relatively mildly clinical course demonstrating the importance of 16s polymerase chain reaction in culture-negative cases and its role in detecting rare causes of central nervous system infections such as C. perfringens .
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Affiliation(s)
- Ben Shillitoe
- From the Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Christopher J A Cowie
- Department of Neurosurgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Hilal Misgar
- Department of Paediatrics, University Hospital of North Durham, Durham, United Kingdom
| | - Lucia Pareja-Cebrian
- Department of Microbiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Eleri Williams
- From the Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Mehta P, Tsilifis C, Lum SH, Slatter MA, Hambleton S, Owens S, Williams E, Flood T, Gennery AR, Nademi Z. Outcome of Second Allogeneic HSCT for Patients with Inborn Errors of Immunity: Retrospective Study of 20 Years' Experience. J Clin Immunol 2023; 43:1812-1826. [PMID: 37452206 DOI: 10.1007/s10875-023-01549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
A significant complication of HSCT is graft failure, although few studies focus on this problem in patients with inborn errors of immunity (IE). We explored outcome of second HSCT for IEI by a retrospective, single-centre study between 2002 and 2022. Four hundred ninety-three patients underwent allogeneic HSCT for severe combined immunodeficiency (SCID; n = 113, 22.9%) or non-SCID IEI (n = 380, 77.1%). Thirty patients (6.0%) required second HSCT. Unconditioned infusion or no serotherapy at first HSCT was more common in patients who required second transplant. Median interval between first and second HSCT was 0.97 years (range: 0.19-8.60 years); a different donor was selected for second HSCT in 24/30 (80.0%) patients. Conditioning regimens for second HSCT were predominately treosulfan-based (with thiotepa: n = 18, 60.0%; without, n = 6, 20.0%). Patients received grafts from peripheral blood stem cell (n = 25, 83.3%) or bone marrow (n = 5, 16.7%) with median stem cell dose 9.5 × 106 CD34 + cells/kilogram (range: 1.4-32.3). Median follow-up was 1.92 years (0.22-16.0). Overall survival was 80.8% and event-free survival was 64.7%. Four patients died, two of early-transplant related complications, and two of late sepsis post-second HSCT. Three patients required third HSCT; all are alive with 100% donor chimerism. Cumulative incidence of acute graft-versus-host disease was 28.4%, (all grade I-II). Viral reactivation was seen in 13/30 (43.3%) patients, including HHV6 (n = 6), CMV (n = 4), and adenovirus (n = 2). At latest follow-up, 25/26 surviving patients have donor chimerism ≥ 90% and 16/25 (64.0%) have discontinued immunoglobulin replacement. Second HSCT offers IEI patients with graft failure curative treatment with good overall survival and immunological recovery.
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Affiliation(s)
- Priti Mehta
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Christo Tsilifis
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK.
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Su Han Lum
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Mary A Slatter
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Sophie Hambleton
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Stephen Owens
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Eleri Williams
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Terry Flood
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Andrew R Gennery
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Zohreh Nademi
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
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Ramanathan S, Lum SH, Nademi Z, Carruthers K, Watson H, Flood T, Owens S, Williams E, Hambleton S, Gennery AR, Slatter M. CD3+TCRαβ/CD19+ depleted mismatched family or unrelated donor salvage stem cell transplantation for graft dysfunction in inborn errors of immunity. Transplant Cell Ther 2023:S2666-6367(23)01321-0. [PMID: 37279857 DOI: 10.1016/j.jtct.2023.05.019] [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] [Received: 04/01/2023] [Revised: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND A minority of children experience significant graft dysfunction after an allogeneic hematopoietic stem cell transplant (HSCT) for inborn errors of immunity (IEI). The optimal approach to salvage HSCT is unclear with respect to conditioning regimen and stem cell source. This single-centre retrospective case series reports the outcomes of salvage CD3+TCRαβ/CD19 depleted mismatched family or unrelated donor stem cell transplantation (TCRαβ-SCT) between 2013 - 2022 for graft dysfunction in 12 children with IEI. OBJECTIVES Outcomes of interest were overall survival (OS), event free survival (EFS), graft-versus-host disease (GvHD)-free and event-free survival (GEFS), toxicities, GvHD, viremia and long-term graft function. STUDY DESIGN A retrospective audit of patients who underwent second CD3+TCRαβ/CD19 depleted mismatched donor graft using Treosulfan-based reduced toxicity myeloablative conditioning. RESULTS Median age at first HSCT was 8.76 months (range, 2.5 months - 6 years) and at second TCRαβ-SCT was 3.6 years (1.2 - 11 years). Median interval between first and second HSCT was 1.7 years (3 months - 9 years). The primary diagnoses were: severe combined immunodeficiency (SCID) (n=5) and non-SCID IEI (n=7). The indications for second HSCT were: primary aplasia (n=1), secondary autologous reconstitution (n=6), refractory aGVHD (n=3) and secondary leukemia (n=1). Donors were either haploidentical parental donors (n=10) or mismatched unrelated donors (n=2). All received TCRαβ/CD19-depleted-PBSC with a median CD34+ cell dose of 9.3 × 106/kg (2.8-32.3 × 106/kg) and a median TCRαβ+ cell dose of 4 × 104/kg (1.3-19.2 × 104/kg). All engrafted with median days to neutrophil and platelet recovery of 15 (12-24) and 12 (9-19). One developed secondary aplasia and one had secondary autologous reconstitution, but both underwent a successful third HSCT. Four (33%) had grade II aGvHD and none had grade III-IV aGvHD. None had cGvHD but one developed extensive cutaneous cGVHD after third HSCT using PBSC and ATG. Nine (75%) were noted to have at least one episode of blood viremia with HHV6 (n=6, 50%), adenovirus (n=6, 50%), EBV (n=3, 25%) or CMV (n=3; 25%). Median duration of follow-up was 2.3 years (range: 0.5 - 10 years) and the 2-year OS, EFS and GEFS were 100% (95% confidence interval, 0-100%), 73% (37-90%) and 73% (37%-90%) respectively. CONCLUSIONS TCRαβ-SCT from mismatched family or unrelated donors, using a chemotherapy only regimen, is a safe alternative donor salvage transplant strategy for second HSCT in patients without a suitably matched donor.
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Affiliation(s)
- Subramaniam Ramanathan
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Su Han Lum
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Zohreh Nademi
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Kayleigh Carruthers
- Newcastle Advanced Therapies, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Helen Watson
- Blood Sciences, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Terence Flood
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Stephen Owens
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Eleri Williams
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Sophie Hambleton
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Andrew R Gennery
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Mary Slatter
- Department of Paediatric Hematopoietic Stem Cell Transplant, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, United Kingdom.
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Rose M, Wilson N, Williams E, Letner H, Bettinger R, Bouchendouka A, Batagower J, Kaspar J. Growth with Commensal Streptococci Alters Streptococcus mutans Behaviors. J Dent Res 2023; 102:450-458. [PMID: 36688378 PMCID: PMC10154915 DOI: 10.1177/00220345221145906] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As oral bacteria grow and persist within biofilms attached to the tooth's surface, they interact with other species to form synergistic or antagonistic exchanges that govern homeostasis for the overall population. One example are the interactions between the cariogenic species Streptococcus mutans and oral commensal streptococci. Previously, we showed that the cell-cell signaling pathways of S. mutans were inhibited during coculture with other oral streptococci species, leading us to posit that the S. mutans transcriptome and behaviors are broadly altered during growth with these species. To test this hypothesis, we performed whole transcriptome sequencing (RNA-seq) on cocultures of S. mutans with either Streptococcus gordonii, Streptococcus sanguinis, or Streptococcus oralis and a quadculture containing all 4 species in comparison to S. mutans grown alone. Our results reveal that in addition to species-dependent changes to the S. mutans transcriptome, a conserved response to oral streptococci in general can be observed. We monitored the behavior of S. mutans by both microscopy imaging of biofilms and in a bacteriocin overlay assay and verified that S. mutans acts similarly with each of these species but noted divergences in phenotypes when cocultured with another cariogenic Streptococcus (Streptococcus sobrinus) or with oral nonstreptococci species. RNA-seq with oral nonstreptococci showed lack of a consistent gene expression profile and overlap of differentially expressed genes found with commensal streptococci. Finally, we investigated the role of upregulated S. mutans genes within our data sets to determine if they provided a fitness benefit during interspecies interactions. Eleven total genes were studied, and we found that a majority impacted the fitness of S. mutans in various assays, highlighted by increased biomass of commensal streptococci in mixed-species biofilms. These results confirm a common, species-independent modification of S. mutans behaviors with oral commensal streptococci that emphasizes the need to further evaluate oral bacteria within multispecies settings.
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Affiliation(s)
- M. Rose
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - N. Wilson
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - E. Williams
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - H. Letner
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - R. Bettinger
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - A. Bouchendouka
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - J. Batagower
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
| | - J.R. Kaspar
- Division of Biosciences, The Ohio State
University College of Dentistry, Columbus, OH, USA
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Ramanathan S, Veramendi-Espinoza L, Shillitoe B, Flinn A, Owens S, Williams E, Emonts M, Hambleton S, Burton-Fanning S, Waugh S, Flood T, Gennery AR, Slatter M, Nademi Z. Haploidentical CD3 + TCR αβ/CD19 +-depleted HSCT for MHC class II deficiency and persistent SARS-CoV-2 pneumonitis. J Allergy Clin Immunol Glob 2023; 2:101-104. [PMID: 36210925 PMCID: PMC9531933 DOI: 10.1016/j.jacig.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to coronavirus disease 2019 (COVID-19), which can range from a mild illness to a severe phenotype characterized by acute respiratory distress needing mechanical ventilation. Children with combined immunodeficiencies might be unable to mount a sufficient cellular and humoral immune response against COVID-19 and have persistent disease. Objective Our aim was to describe a child with combined immunodeficiency and a favorable post-hematopoietic stem cell transplant (HSCT) course following a haploidentical HSCT in the presence of persistent SARS-CoV-2 infection. Methods A 13-month-old girl with MHC class II deficiency developed persistent pre-HSCT SARS-CoV-2 infection. Faced with a significant challenge of balancing the risk of progressive infection due to an incompetent immune system with the danger of inflammatory pneumonitis peri-immune reconstitution after HSCT, the patient's physicians performed a maternal (with a recent history of COVID-19 infection) haploidentical HSCT. The patient received regdanvimab (after stem cell infusion) and remdesivir (before and after stem cell infusion). Results The patient exhibited a gradual increase in her cycle threshold values, implying a reduction in viral RNA with concomitant expansion in the CD3 lymphocyte subset and clinical and radiologic improvement. Conclusions Combination of adoptive transfer of maternal CD45RO+ memory addback T lymphocytes after haploidentical HSCT and use of regdanvimab (a SARS-CoV-2-neutralizing mAb) and remdesivir may have led to the successful outcome in our patient with severe immunodeficiency after she had undergone HSCT. This case highlights the role of novel antiviral strategies (mAbs and CD45RO+ memory T lymphocytes) in contributing to viral clearance in a challenging clinical scenario.
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Affiliation(s)
- Subramaniam Ramanathan
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Liz Veramendi-Espinoza
- Immunology and Allergy Division. Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Benjamin Shillitoe
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Aisling Flinn
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Eleri Williams
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shirelle Burton-Fanning
- Department of Microbiology and Virology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sheila Waugh
- Department of Microbiology and Virology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Terence Flood
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Andrew R. Gennery
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mary Slatter
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Zohreh Nademi
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom,Corresponding author: Zohreh Nademi, PhD, Children's Haematopoietic Stem Cell Transplant, Great Noth Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
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9
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Aggarwal R, Sidnam-Mauch E, Neffa-Creech D, Plant A, Williams E, Shami E, Menon U, George S, Langbaum JB. Development of a Mobile-First Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies. J Prev Alzheimers Dis 2023; 10:857-864. [PMID: 37874108 PMCID: PMC10884078 DOI: 10.14283/jpad.2023.86] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Web-based participant recruitment registries can be useful tools for accelerating enrollment into studies, but existing Alzheimer's disease (AD)-focused recruitment registries have had limited success enrolling individuals from underrepresented racial and ethnic groups. Designing these registries to meet the needs of individuals from these communities, including designing mobile-first, may facilitate improvement in the enrollment of underrepresented groups. OBJECTIVES Evaluate the usability of a prototype mobile-first participant recruitment registry for AD prevention studies; assess users' perceptions of and willingness to sign up for the registry. DESIGN AND SETTING Quantitative usability testing and an online survey; online setting. PARTICIPANTS We recruited 1,358 adults ages 45-75 who self-reported not having a diagnosis of mild cognitive impairment, AD, or other forms of dementia (Study 1: n=589, Study 2: n=769). Black/African American and Hispanic/Latino participants were specifically recruited, including those with lower health literacy. METHODS AND MEASUREMENTS Study 1 measures the prototype's usability through observed task success rates, task completion times, and responses to the System Usability Scale. Study 2 uses an online survey to collect data on perceptions of and willingness to sign up for the mobile-first registry. RESULTS Study 1 findings show the prototype mobile-first recruitment registry website demonstrates high usability and is equally usable for Black / African American, Hispanic/Latino, and White user groups. Survey results from Study 2 indicate that users from underrepresented communities understand the registry's purpose and content and express willingness to sign up for the registry on a mobile device. CONCLUSIONS Designing mobile-first participant recruitment registries based on feedback from underrepresented communities may result in more sign-ups by individuals from minoritized communities.
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Affiliation(s)
- R Aggarwal
- Jessica Langbaum, Banner Alzheimer's Institute, 901 E. Willetta Street, Phoenix, AZ 85006,
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10
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Cleland J, Bill V, Williams E, Shelton C. Retained desflurane in decommissioned vaporisers: a national problem? Anaesthesia 2022; 78:651-652. [PMID: 36437774 DOI: 10.1111/anae.15930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- J Cleland
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - V Bill
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - E Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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11
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Macken WL, Falabella M, McKittrick C, Pizzamiglio C, Ellmers R, Eggleton K, Woodward CE, Patel Y, Labrum R, Phadke R, Reilly MM, DeVile C, Sarkozy A, Footitt E, Davison J, Rahman S, Houlden H, Bugiardini E, Quinlivan R, Hanna MG, Vandrovcova J, Pitceathly RDS, Hubbard TJP, Jackson R, Jones LJ, Kasperaviciute D, Kayikci M, Kousathanas A, Lahnstein L, Lakey A, Leigh SEA, Leong IUS, Lopez FJ, Maleady-Crowe F, McEntagart M, Minneci F, Mitchell J, Moutsianas L, Mueller M, Murugaesu N, Need AC, O’Donovan P, Odhams CA, Patch C, Perez-Gil D, Pereira MB, Pullinger J, Rahim T, Rendon A, Rogers T, Savage K, Sawant K, Scott RH, Siddiq A, Sieghart A, Smith SC, Sosinsky A, Stuckey A, Tanguy M, Taylor Tavares AL, Thomas ERA, Thompson SR, Tucci A, Welland MJ, Williams E, Witkowska K, Wood SM, Zarowiecki M, Phadke R, Reilly MM, DeVile C, Sarkozy A, Footitt E, Davison J, Rahman S, Houlden H, Bugiardini E, Quinlivan R, Hanna MG, Vandrovcova J, Pitceathly RDS. Specialist multidisciplinary input maximises rare disease diagnoses from whole genome sequencing. Nat Commun 2022; 13:6324. [PMID: 36344503 PMCID: PMC9640711 DOI: 10.1038/s41467-022-32908-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
Diagnostic whole genome sequencing (WGS) is increasingly used in rare diseases. However, standard, semi-automated WGS analysis may overlook diagnoses in complex disorders. Here, we show that specialist multidisciplinary analysis of WGS, following an initial 'no primary findings' (NPF) report, improves diagnostic rates and alters management. We undertook WGS in 102 adults with diagnostically challenging primary mitochondrial disease phenotypes. NPF cases were reviewed by a genomic medicine team, thus enabling bespoke informatic approaches, co-ordinated phenotypic validation, and functional work. We enhanced the diagnostic rate from 16.7% to 31.4%, with management implications for all new diagnoses, and detected strong candidate disease-causing variants in a further 3.9% of patients. This approach presents a standardised model of care that supports mainstream clinicians and enhances diagnostic equity for complex disorders, thereby facilitating access to the potential benefits of genomic healthcare. This research was made possible through access to the data and findings generated by the 100,000 Genomes Project: http://www.genomicsengland.co.uk .
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Affiliation(s)
- William L. Macken
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Micol Falabella
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Caroline McKittrick
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Chiara Pizzamiglio
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Rebecca Ellmers
- Neurogenetics Unit, Rare and Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Kelly Eggleton
- Neurogenetics Unit, Rare and Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Cathy E. Woodward
- grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK ,Neurogenetics Unit, Rare and Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Yogen Patel
- Neurogenetics Unit, Rare and Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Robyn Labrum
- grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK ,Neurogenetics Unit, Rare and Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | | | - Rahul Phadke
- grid.424537.30000 0004 5902 9895Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mary M. Reilly
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Catherine DeVile
- grid.424537.30000 0004 5902 9895Department of Neurosciences, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna Sarkozy
- grid.424537.30000 0004 5902 9895Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Footitt
- grid.424537.30000 0004 5902 9895Metabolic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - James Davison
- grid.424537.30000 0004 5902 9895Metabolic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.420468.cNational Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Shamima Rahman
- grid.424537.30000 0004 5902 9895Metabolic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Henry Houlden
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Enrico Bugiardini
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Rosaline Quinlivan
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK ,grid.424537.30000 0004 5902 9895Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael G. Hanna
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Jana Vandrovcova
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Robert D. S. Pitceathly
- grid.83440.3b0000000121901201Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK ,grid.436283.80000 0004 0612 2631NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
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12
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Shoemark A, Griffin H, Wheway G, Hogg C, Lucas JS, Camps C, Taylor J, Carroll M, Loebinger MR, Chalmers JD, Morris-Rosendahl D, Mitchison HM, De Soyza A, Brown D, Ambrose JC, Arumugam P, Bevers R, Bleda M, Boardman-Pretty F, Boustred CR, Brittain H, Caulfield MJ, Chan GC, Fowler T, Giess A, Hamblin A, Henderson S, Hubbard TJP, Jackson R, Jones LJ, Kasperaviciute D, Kayikci M, Kousathanas A, Lahnstein L, Leigh SEA, Leong IUS, Lopez FJ, Maleady-Crowe F, McEntagart M, Minneci F, Moutsianas L, Mueller M, Murugaesu N, Need AC, O'Donovan P, Odhams CA, Patch C, Perez-Gil D, Pereira MB, Pullinger J, Rahim T, Rendon A, Rogers T, Savage K, Sawant K, Scott RH, Siddiq A, Sieghart A, Smith SC, Sosinsky A, Stuckey A, Tanguy M, Taylor Tavares AL, Thomas ERA, Thompson SR, Tucci A, Welland MJ, Williams E, Witkowska K, Wood SM. Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis. Eur Respir J 2022; 60:13993003.00176-2022. [PMID: 35728977 DOI: 10.1183/13993003.00176-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.
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Affiliation(s)
- Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Griffin
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gabrielle Wheway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Hogg
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Carme Camps
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Jenny Taylor
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and NHLI, Imperial College London, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- These authors contributed equally to this manuscript
| | - Anthony De Soyza
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
- These authors contributed equally to this manuscript
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13
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Williams E, Thoene M, Jackson M, Ponce J, Timmerman M, Hanson C. The Associations Between Maternal Dietary Choline Intake and Infant Growth Outcomes. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.099] [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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14
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Yakushev A, Lens L, Düllmann CE, Khuyagbaatar J, Jäger E, Krier J, Runke J, Albers HM, Asai M, Block M, Despotopulos J, Di Nitto A, Eberhardt K, Forsberg U, Golubev P, Götz M, Götz S, Haba H, Harkness-Brennan L, Herzberg RD, Heßberger FP, Hinde D, Hübner A, Judson D, Kindler B, Komori Y, Konki J, Kratz J, Kurz N, Laatiaoui M, Lahiri S, Lommel B, Maiti M, Mistry AK, Mokry C, Moody KJ, Nagame Y, Omtvedt JP, Papadakis P, Pershina V, Rudolph D, Samiento L, Sato T, Schädel M, Scharrer P, Schausten B, Shaughnessy DA, Steiner J, Thörle-Pospiech P, Toyoshima A, Trautmann N, Tsukada K, Uusitalo J, Voss KO, Ward A, Wegrzecki M, Wiehl N, Williams E, Yakusheva V. On the adsorption and reactivity of element 114, flerovium. Front Chem 2022; 10:976635. [PMID: 36092655 PMCID: PMC9453156 DOI: 10.3389/fchem.2022.976635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Flerovium (Fl, element 114) is the heaviest element chemically studied so far. To date, its interaction with gold was investigated in two gas-solid chromatography experiments, which reported two different types of interaction, however, each based on the level of a few registered atoms only. Whereas noble-gas-like properties were suggested from the first experiment, the second one pointed at a volatile-metal-like character. Here, we present further experimental data on adsorption studies of Fl on silicon oxide and gold surfaces, accounting for the inhomogeneous nature of the surface, as it was used in the experiment and analyzed as part of the reported studies. We confirm that Fl is highly volatile and the least reactive member of group 14. Our experimental observations suggest that Fl exhibits lower reactivity towards Au than the volatile metal Hg, but higher reactivity than the noble gas Rn.
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Affiliation(s)
- A. Yakushev
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- *Correspondence: A. Yakushev,
| | - L. Lens
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Ch. E. Düllmann
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Khuyagbaatar
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - E. Jäger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - J. Krier
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - J. Runke
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - H. M. Albers
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Asai
- Japan Atomic Energy Agency, Tokai, Japan
| | - M. Block
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Despotopulos
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - A. Di Nitto
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. Eberhardt
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | | | - M. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - S. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | | | | | - F. P. Heßberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - D. Hinde
- Australian National University, Canberra, ACT, Australia
| | - A. Hübner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D. Judson
- University of Liverpool, Liverpool, United Kingdom
| | - B. Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - J. Konki
- University of Jyväskylä, Jyväskylä, Finland
| | - J.V. Kratz
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - N. Kurz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Laatiaoui
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - S. Lahiri
- Saha Institute of Nuclear Physics, Kolkata, India
| | - B. Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Maiti
- Indian Institute of Technology Roorkee, Roorkee, India
| | - A. K. Mistry
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - Ch. Mokry
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. J. Moody
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - Y. Nagame
- Japan Atomic Energy Agency, Tokai, Japan
| | | | - P. Papadakis
- University of Liverpool, Liverpool, United Kingdom
| | - V. Pershina
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - T.K. Sato
- Japan Atomic Energy Agency, Tokai, Japan
| | - M. Schädel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Scharrer
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - B. Schausten
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D. A. Shaughnessy
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - J. Steiner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Thörle-Pospiech
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - N. Trautmann
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. Tsukada
- Japan Atomic Energy Agency, Tokai, Japan
| | | | - K.-O. Voss
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - A. Ward
- University of Liverpool, Liverpool, United Kingdom
| | - M. Wegrzecki
- Łukasiewicz Research Network—Institute of Electron Technology, Warsaw, Poland
| | - N. Wiehl
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - E. Williams
- Australian National University, Canberra, ACT, Australia
| | - V. Yakusheva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
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15
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Tsilifis C, Schim van der Loeff I, Williams E, Owens S, Powell S, Gennery A, Slatter M. BCG lymphadenitis: a potential complication of immune reconstitution following haematopoietic stem cell transplant. Arch Dis Child Educ Pract Ed 2022; 107:274-275. [PMID: 33355234 DOI: 10.1136/archdischild-2020-320883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/22/2020] [Indexed: 11/04/2022]
Abstract
An MHC class II deficient 2-year-old boy presented with fever and an enlarging left neck mass 100 days post allogeneic haematopoietic stem cell transplant (HSCT). Fever persisted despite treatment with broad-spectrum β-lactam antibiotics. His BCG vaccination site at presentation was quiescent. Ultrasound showed enlarged cervical lymph nodes. An incisional biopsy of the large nodal mass yielded acid-fast bacilli, identified as Mycobacterium bovis by genome sequencing. Treatment with rifampicin, isoniazid and pyridoxine was started. The mass suppurated (figure 1), before healing concurrently with T-lymphocyte reconstitution at approximately day 130 post-HSCT.
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Affiliation(s)
- Christo Tsilifis
- Paediatric Immunology and Infectious Diseases, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Ina Schim van der Loeff
- Paediatric Immunology and Infectious Diseases, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Eleri Williams
- Paediatric Immunology and Infectious Diseases, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Paediatric Otolaryngology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Paediatric Haematopoietic Stem Cell Transplant Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Slatter
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Paediatric Haematopoietic Stem Cell Transplant Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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16
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Soni A, Wright N, Agwu JC, Drew J, Kershaw M, Moudiotis C, Regan F, Williams E, Timmis A, Ng SM. Fifteen-minute consultation: Practical use of continuous glucose monitoring. Arch Dis Child Educ Pract Ed 2022; 107:188-193. [PMID: 33963071 PMCID: PMC9125373 DOI: 10.1136/archdischild-2020-321190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022]
Abstract
Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently, rapid advancements in the development of continuous glucose monitoring devices have led to increased use of technology to help children and young people with diabetes manage their condition. These devices have the potential to improve diabetes control and reduce hypoglycaemia especially if used in conjunction with a pump to automate insulin delivery. This paper aims to provide an update on main CGM devices available and practical considerations for doctors if they come across a child with diabetes who is using one of these devices.
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Affiliation(s)
- Astha Soni
- Paediatrics, Sheffield Children's Hospital, Sheffield, UK
| | - Neil Wright
- Paediatric Endocrinology & Diabetes, Sheffield Children's Hospital, Sheffield, UK
| | - Juliana Chizo Agwu
- Paediatrics, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.,Institute of Clinical Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Josephine Drew
- Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Melanie Kershaw
- Endocrinology and diabetes, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | | | - Fiona Regan
- Paediatrics, Wexham Park Hospital, Slough, UK
| | - Eleri Williams
- Paediatrics, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
| | - Alison Timmis
- Paediatrics, Countess of Chester Hospital, NHS Foundation Trust, Chester, Cheshire West and Chester, UK
| | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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17
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Tsilifis C, Hartley K, Vasey N, Flood T, Battersby A, McErlane F, Williams E. Prolonged IgG recovery following rituximab administration. Arch Dis Child 2022; 107:archdischild-2022-324026. [PMID: 35534119 DOI: 10.1136/archdischild-2022-324026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Christo Tsilifis
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Hartley
- Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Vasey
- Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Terry Flood
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
| | | | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Eleri Williams
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
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18
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Lum SH, Greener S, Perez-Heras I, Drozdov D, Payne RP, Watson H, Carruthers K, January R, Nademi Z, Owens S, Williams E, Waugh S, Burton-Fanning S, Leahy TR, Cant A, Abinun M, Flood T, Hambleton S, Gennery AR, Slatter M. T-replete HLA-matched grafts vs T-depleted HLA-mismatched grafts in inborn errors of immunity. Blood Adv 2022; 6:1319-1328. [PMID: 34972212 PMCID: PMC8864655 DOI: 10.1182/bloodadvances.2020004072] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/07/2021] [Indexed: 11/28/2022] Open
Abstract
Hematopoietic cell transplantation (HCT) has become standard-of-care for an increasing number of inborn errors of immunity (IEI). This report is the first to compare transplant outcomes according to T-cell-replete (ie, T-replete) HLA-matched grafts using alemtuzumab (n = 117) and T-cell-depleted (ie, T-depleted) HLA-mismatched grafts using T-cell receptor-αβ (TCRαβ)/CD19 depletion (n = 47) in children with IEI who underwent first HCT between 2014 and 2019. All patients received treosulfan-based conditioning except patients with DNA repair disorders. For T-replete grafts, the stem cell source was marrow in 25 (21%) patients, peripheral blood stem cell (PBSC) in 85 (73%), and cord blood in 7 (6%). TCRαβ/CD19 depletion was performed on PBSCs from 45 haploidentical parental donors and 2 mismatched unrelated donors. The 3-year overall survival (OS) and event-free survival for the entire cohort were 85% (77%-90%) and 79% (69%-86%), respectively. Analysis according to age at transplant revealed a comparable 3-year OS between T-replete grafts (88%; 76%-94%) and T-depleted grafts (87%; 64%-96%) in younger patients (aged <5 years at HCT). For older patients (aged >5 years), the OS was significantly lower in T-depleted grafts (55%; 23%-78%) compared with T-replete grafts (87%; 68%-95%) (P = .03). Grade III to IV acute graft-versus-host disease was observed in 8% of T-replete marrow, 7% of T-replete PBSC, 14% of T-replete cord blood, and 2% of T-depleted PBSC (P = .73). Higher incidence of viremia (P < .001) and delayed CD3 reconstitution (P = .003) were observed after T-depleted graft HCT. These data indicate that mismatched donor transplant after TCRαβ/CD19 depletion represents an excellent alternative for younger children with IEI in need of an allograft.
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Affiliation(s)
- Su Han Lum
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sinéad Greener
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Inigo Perez-Heras
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Daniel Drozdov
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Rebecca P. Payne
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - Robert January
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Zohreh Nademi
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Eleri Williams
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sheila Waugh
- Microbiology and Virology Department, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; and
| | - Shirelle Burton-Fanning
- Microbiology and Virology Department, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; and
| | | | - Andrew Cant
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mario Abinun
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Terry Flood
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew R. Gennery
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mary Slatter
- Children’s Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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19
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Tanaka T, Hinde DJ, Dasgupta M, Williams E, Vo-Phuoc K, Simenel C, Simpson EC, Jeung DY, Carter IP, Cook KJ, Lobanov NR, Luong DH, Palshetkar C, Rafferty DC, Ramachandran K. Mass Equilibration and Fluctuations in the Angular Momentum Dependent Dynamics of Heavy Element Synthesis Reactions. Phys Rev Lett 2021; 127:222501. [PMID: 34889627 DOI: 10.1103/physrevlett.127.222501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/12/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
Mass and angle distributions for the ^{52}Cr+^{198}Pt and ^{54}Cr+^{196}Pt reactions (both forming ^{250}No) were measured and subtracted, giving new information on fast quasifission mass evolution, and the first direct determination of the dependence of sticking times on angular momentum. TDHF calculations showed good agreement with average experimental values, but experimental mass distributions unexpectedly extended to symmetric splits while the peak yield remained close to the initial masses. This implies a strong role of fluctuations in mass division early in the collision, giving insights into the transition from fast energy dissipative deep-inelastic collisions to quasifission.
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Affiliation(s)
- T Tanaka
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - D J Hinde
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - M Dasgupta
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - E Williams
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - K Vo-Phuoc
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - C Simenel
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
- Department of Fundamental and Theoretical Physics, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - E C Simpson
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - D Y Jeung
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - I P Carter
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - K J Cook
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - N R Lobanov
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - D H Luong
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - C Palshetkar
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - D C Rafferty
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
| | - K Ramachandran
- Department of Nuclear Physics and Accelerator Applications, Research School of Physics, The Australian National University, Canberra, Australian Capital Territory 2601, Australia
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20
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Williams E, Brastianos P, Santagata S, Cahill D, Ramkissoon S, Juratli T. P04.09 Frequent inactivating mutations of PBRM1 in meningioma with papillary features. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Papillary meningiomas (PM) are rare WHO grade III tumors that are associated with frequent recurrences and metastatic disease in spite of surgery and radiation. Due to their low incidence and scarcity of tumor tissues available for genomic analyses, the genetic alterations associated with PM remain unclear.
MATERIAL AND METHODS
We mined data collected as part of our clinical comprehensive genomic profiling (CGP) initiative which has to date analyzed 8 PM (>50% papillary morphology) and 22 meningiomas with focal papillary features (10–50%) amongst over 500 additional meningiomas of other subtypes. The samples were analyzed in a CAP/CLIA-accredited laboratory (Foundation Medicine, Cambridge, MA). GCP was performed on hybridization-captured, adaptor ligation-based libraries to a mean coverage depth of >650x for 236 or 315 genes plus the introns from 19 or 28 genes frequently involved in cancer.
RESULTS
In our cohort of 8 PMs, we identified three cases with inactivation of PBRM1; two cases with a truncating mutation in PBRM1 and one with homozygous deletion of PBRM1. Of the 22 meningiomas with only focal papillary features, 8 cases were PBRM1-mutant. Thus, 11 of 30 cases (36.7%) with at least focal (>10%) papillary morphology had inactivation of PBRM1.In the entire cohort of 562 meningiomas, we identified five additional cases with inactivating alterations in PBRM1 that did not display overt papillary morphology in the H&E sections available for analysis. Thus, 11 of 16 PBRM1-mutant cases (69%) occurred in meningioma with papillary histologic features as opposed to 19 of 546 wild-type cases (3.5%), supporting a significant association between papillary features and PBRM1 mutation (p<0.0001). The majority of PBRM1-mutant meningiomas occurred in female patients (n=10/16, 62.5%), and median age was 51 years. Most cases were located supratentorially (n=10).
CONCLUSION
We identified the tumor suppressor gene PBRM1 as a recurrently altered gene in meningiomas with papillary histomorphology. Further investigational studies are needed to assess outcomes of PBRM1-mutant meningioma and to determine whether mutation is an independent negative prognostic biomarker.
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Affiliation(s)
- E Williams
- Foundation Medicine Inc, Boston, MA, United States
| | - P Brastianos
- Massachusetts General Hospital, Boston, MA, United States
| | - S Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
| | - D Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - S Ramkissoon
- Foundation Medicine Inc, Boston, MA, United States
| | - T Juratli
- Department of Neurosurgery, University Hospital Dresden, Dresden, Germany
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21
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Shiraki M, Williams E, Yokoyama N, Shinoda K, Nademi Z, Matsumoto K, Nihira H, Honda Y, Izawa K, Nishikomori R, Slatter MA, Cant AJ, Gennery AR, Ohnishi H, Kanegane H. Hematopoietic Cell Transplantation Ameliorates Autoinflammation in A20 Haploinsufficiency. J Clin Immunol 2021; 41:1954-1956. [PMID: 34427832 DOI: 10.1007/s10875-021-01124-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Mayuka Shiraki
- Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, , 501-1194, Japan
| | - Eleri Williams
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | | | | | - Zohreh Nademi
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Hiroshi Nihira
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Honda
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan.,Department of Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazushi Izawa
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuta Nishikomori
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Mary A Slatter
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Andrew J Cant
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Andrew R Gennery
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Hidenori Ohnishi
- Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, , 501-1194, Japan. .,Clinical Genetics Center, Gifu University Hospital, Gifu, Japan.
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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22
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Bond KA, Williams E, Nicholson S, Lim S, Johnson D, Cox B, Putland M, Gardiner E, Tippett E, Graham M, Mordant F, Catton M, Lewin SR, Subbarao K, Howden BP, Williamson DA. Longitudinal evaluation of laboratory-based serological assays for SARS-CoV-2 antibody detection. Pathology 2021; 53:773-779. [PMID: 34412859 PMCID: PMC8289701 DOI: 10.1016/j.pathol.2021.05.093] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
Abstract
Serological assays for SARS-CoV-2 infection are now widely available for use in diagnostic laboratories. Limited data are available on the performance characteristics in different settings, and at time periods remote from the initial infection. Validation of the Abbott (Architect SARS-CoV-2 IgG), DiaSorin (Liaison SARS-CoV-2 S1/S2 IgG) and Roche (Cobas Elecsys Anti-SARS-CoV-2) assays was undertaken utilising 217 serum samples from 131 participants up to 7 months following COVID-19 infection. The Abbott and DiaSorin assays were implemented into routine laboratory workflow, with outcomes reported for 2764 clinical specimens. Sensitivity and specificity were concordant with the range reported by the manufacturers for all assays. Sensitivity across the convalescent period was highest for the Roche at 95.2-100% (95% CI 81.0-100%), then the DiaSorin at 88.1-100% (95% CI 76.0-100%), followed by the Abbott 68.2-100% (95% CI 53.4-100%). Sensitivity of the Abbott assay fell from approximately 5 months; on this assay paired serum samples for 45 participants showed a significant drop in the signal-to-cut-off ratio and 10 sero-reversion events. When used in clinical practice, all samples testing positive by both DiaSorin and Abbott assays were confirmed as true positive results. In this low prevalence setting, despite high laboratory specificity, the positive predictive value of a single positive assay was low. Comprehensive validation of serological assays is necessary to determine the optimal assay for each diagnostic setting. In this low prevalence setting we found implementation of two assays with different antibody targets maximised sensitivity and specificity, with confirmatory testing necessary for any sample which was positive in only one assay.
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Affiliation(s)
- K A Bond
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.
| | - E Williams
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S Nicholson
- Victorian Infectious Diseases Reference Laboratory at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S Lim
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of General Medicine, The University of Melbourne, Vic, Australia
| | - D Johnson
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of General Medicine, The University of Melbourne, Vic, Australia
| | - B Cox
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - M Putland
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - E Gardiner
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - E Tippett
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - M Graham
- Department of Microbiology and Infectious Diseases, Monash Health, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia
| | - F Mordant
- WHO Collaborating Centre for Reference and Research on Influenza at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - M Catton
- Victorian Infectious Diseases Reference Laboratory at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S R Lewin
- The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic, Australia
| | - K Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; WHO Collaborating Centre for Reference and Research on Influenza at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - B P Howden
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - D A Williamson
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
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23
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Radwan N, Nademi Z, Lum SH, Flood T, Abinun M, Owens S, Williams E, Gennery AR, Hambleton S, Slatter MA. Outcome of Hematopoietic Stem Cell Transplantation in patients with Mendelian Susceptibility to Mycobacterial Diseases. J Clin Immunol 2021; 41:1774-1780. [PMID: 34387798 PMCID: PMC8604818 DOI: 10.1007/s10875-021-01116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
Predisposition to mycobacterial infection is a key presenting feature of several rare inborn errors of intrinsic and innate immunity. Hematopoietic stem cell transplantation (HSCT) can be curative for such conditions, but published reports are few. We present a retrospective survey of the outcome of 11 affected patients (7 males, 4 females) who underwent HSCT between 2007 and 2019. Eight patients had disseminated mycobacterial infection prior to transplant. Median age at first transplant was 48 months (9 -192); three patients were successfully re-transplanted due to secondary graft failure. Donors were matched family (1), matched unrelated (3), and mismatched unrelated and haploidentical family (5 each). Stem cell source was peripheral blood (9), bone marrow (4), and cord blood (1). TCRαβ/CD19 + depletion was performed in 6. Conditioning regimens were treosulfan, fludarabine (4), with additional thiotepa (in 8), and fludarabine, melphalan (2); all had serotherapy with alemtuzumab (8) or anti T-lymphocyte globulin (6). Median hospital stay was 113 days (36–330). Three patients developed acute grade I-II skin and one grade IV skin graft versus host disease. Four patients had immune-reconstitution syndrome. Two reactivated cytomegalovirus (CMV), 1 Epstein-Barr virus, and 3 adenovirus post HSCT. Nine are alive, 1 died early post-transplant from CMV, and the other was a late death from pneumococcal sepsis. Patients with active mycobacterial infection at HSCT continued anti-mycobacterial therapy for almost 12 months. In conclusion, HSCT is a successful treatment for patients with mycobacterial susceptibility even with disseminated mycobacterial infection and in the absence of an HLA matched donor.
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Affiliation(s)
- Nesrine Radwan
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.,Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Zohreh Nademi
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Su Han Lum
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Terry Flood
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Mario Abinun
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.,Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Stephen Owens
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Eleri Williams
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Andrew R Gennery
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sophie Hambleton
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mary A Slatter
- Children's Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. .,Paediatric Immunology, CRB level 4, Block 2, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, UK.
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Bennett JL, Tsilifis C, Flinn A, Altmann T, Jansen N, Tumelty H, Aitken K, Bhopal S, Harrison E, Ravenscroft S, Sen E, Williams E, Flood T, Sampath S, Battersby A, McErlane F. P011 Sharing is caring: a regional service development project exploring secondary immunosuppression in children. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.010] [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/Aims
The range of approved immunosuppressive and immunomodulatory (IM) agents has grown considerably with an increasing list of indications across paediatric specialties. At present, there is limited evidence supporting best practice for prescribing and monitoring of IM agents in children and young people (CYP). We present a staged service development project exploring cross-specialty prescribing and monitoring of IM agents at a tertiary children’s hospital (Great North Children’s Hospital, GNCH) and data sharing with local hospitals across northeast England.
Methods
In Phase 1, we searched pharmacy databases and surveyed specialty teams in GNCH to identify clinicians regularly prescribing IM agents to CYP over a twelve-month period. Phase 2 was a cross-specialty retrospective case-notes review of prescribing, monitoring and infection surveillance in a representative sample of CYP on IM agents. Phase 3 explored information sharing with six other hospitals in the region and acute presentations to these sites involving CYP on IM agents.
Results
Phase 1 identified 9 paediatric and 2 adult specialties prescribing IM agents to 416 CYP. 32 discrete IM therapies were prescribed with significant between-specialty overlap in drugs prescribed but a wide range of prescribing and monitoring practices. Phase 2 assessed 77 CYP on IM agents in detail - 57% were prescribed >1 IM agent, 100% had FBC measured at least once (range once only to weekly), 18% developed lymphopenia at least once and 40% were prescribed prophylactic antibiotics. Previous varicella exposure had been assessed in 70%. Phase 3 data are summarised in Table 1. P011 Table 1:Information sharing and acute presentations to regional hospitals local to immunosuppressed patientsTotal number of patients141Mean age in years (range)11 (2 - 17)NDiagnosisJIA without uveitis108JIA with uveitis9Uveitis alone8Systemic JIA4Period fever4Behçet’s disease2Juvenile dermatomyositis2Scleroderma1Juvenile systemic lupus erythematosus1Mixed connective tissue disease1Granulomatosis with polyangiitis1Immunosuppressive or immunomodulatory agent usedAdalimumab65Methotrexate42Tocilizumab22Mycophenolate mofetil10Etanercept10Infliximab5Sulfasalazine5Prednisolone4Abatacept4Leflunomide4Canakinumab2Colchicine2Anakinra2Rituximab2Cyclophosphamide1Number of immunosuppressive or immunomodulatory agents per patient3 agents52 agents441 agent92Number of acute presentations by diagnosis or presenting complaint (n = 19)Fever4Chickenpox4Viral upper respiratory tract infection2Joint pain2Abdominal pain2Rash2Eye infection1Tonsilitis1Wheeze1Yes (%)No (%)Named local consultant (n = 129)3763Correct diagnosis recorded locally (n = 130)8020Correct immunosuppressive or immunomodulatory agent recorded locally (n = 130)5050Open access for febrile illness (n = 116)4159Reviewed in past 2 years for acute illness (n = 109)1783Note: presented numbers for immunosuppressive or immunomodulatory agents are not mutually exclusive. JIA, juvenile idiopathic arthritis
Conclusion
IM agents are central to modern paediatric clinical care across a wide range of diseases. This staged project identified significant variation in IM prescribing and monitoring practice between specialties at GNCH. Communication between specialty and local teams is inadequate. Particular areas of concern include limited diagnostic, blood monitoring and medication information sharing and limited local information governing management of intercurrent illness and vaccination. Although different disease processes can necessitate different advice and prescribing practices, sharing examples of good practice will minimise unnecessary variation. We propose the development of a regional immunosuppression working group to improve quality and safety across our region.
Disclosure
J.L. Bennett: None. C. Tsilifis: None. A. Flinn: None. T. Altmann: None. N. Jansen: None. H. Tumelty: None. K. Aitken: None. S. Bhopal: None. E. Harrison: None. S. Ravenscroft: None. E. Sen: None. E. Williams: None. T. Flood: None. S. Sampath: None. A. Battersby: None. F. McErlane: None.
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Affiliation(s)
- Joshua L Bennett
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Christo Tsilifis
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UNITED KINGDOM
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Aisling Flinn
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Thomas Altmann
- Paediatrics, Cumberland Infirmary, Carlisle, UNITED KINGDOM
| | - Nathaniel Jansen
- Paediatrics, Darlington Memorial Hospital, Darlington, UNITED KINGDOM
| | - Hannah Tumelty
- Paediatrics, University Hospital of North Durham, Durham, UNITED KINGDOM
| | - Katherine Aitken
- Paediatrics, Queen Elizabeth Hospital, Gateshead, UNITED KINGDOM
| | - Sunil Bhopal
- Paediatrics, Northumbria Healthcare NHS Foundation Trust, Cramlington, UNITED KINGDOM
| | - Eleanor Harrison
- Paediatrics, Northumbria Healthcare NHS Foundation Trust, Cramlington, UNITED KINGDOM
| | - Sarah Ravenscroft
- Paediatrics, James Cook University Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Eleri Williams
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Terry Flood
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Sunil Sampath
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Alexandra Battersby
- General Paediatrics, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
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Cooper R, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. Pharmacological approaches of ADHD. Eur Psychiatry 2021. [PMCID: PMC9471268 DOI: 10.1192/j.eurpsy.2021.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract Body Adults with ADHD describe self-medicating with cannabis. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from trials. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14-18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the intent-to-treat analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17,95%CI-0.40-0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD. Disclosure During this work-RC was a Ph.D. student funded by a grant to PA from Vifor Pharma. PA received funds (consultancy/sponsored talks/research/education) from Shire, Lilly, Novartis, Janssen, PCMScientific, Vifor Pharma, QBTech. Sativex was free from GW Pharm
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Walia G, Lu M, Bourla A, Santos E, Schulze K, Cabili M, Williams E, Mirkovic N, Dicecca R, Lee S, Fang B, Schwartzberg L, Herbst R, Chiang A. P09.55 A Platform to Prospectively Link Real-World Clinico-Genomic, Imaging, and Outcomes Data for Patients With Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.483] [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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27
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Pinilla RE, Aramendiz MC, Williams E, Caycedo-Marulanda A. Correction to: Endo‑VAC ® customization for sinus/anastomotic‑leaks/dehiscence after colorectal anastomosis. Tech Coloproctol 2021; 25:355. [PMID: 33512638 DOI: 10.1007/s10151-020-02407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R E Pinilla
- Department of Gastrointestinal Surgery, Instituto Nacional de Cancerologia, Bogota, Colombia.,Department of Surgery, National University of Colombia, Bogota, Colombia
| | - M C Aramendiz
- Department of Gastrointestinal Surgery, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - E Williams
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - A Caycedo-Marulanda
- Department of Surgery, Queen's University, Kingston, ON, Canada. .,Department of Surgery, Kingston Health Sciences Centre Kingston, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
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Haigh L, Chadwick H, Gillgrass L, Pollard K, Shaw N, Watson R, Williams E, Wood A, Wright S, Etherington C, Spoletini G, Clifton I, Peckham D. P206 Patient feedback following the introduction of a dedicated ‘Symkevi® Initiation Clinic’ prior to starting modulator therapy. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Rehman J, Rempel G, Williams E, Meakins L, Bauman M, Massicotte P, Davis R, Dahl J, Mackie A. DEVELOPMENT AND EVALUATION OF A PREOPERATIVE PREPARATION PROGRAM FOR PARENTS OF CHILDREN UNDERGOING FONTAN SURGERY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.066] [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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30
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Lucas L, Cullum R, Dwivedi V, Waits D, Ghosh T, Kaufmann D, Knerr E, Markham J, Williams E, Woods J, Halanych K, David A, Riese D. Targeting BRAF WT metastatic melanomas: Identifying ERBB4 mutant alleles as biomarkers for novel combinatorial treatment strategies. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31154-0] [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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31
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Scott K, Gupta S, Williams E, Arthur M, Somayajulu UV, Noguchi L. "I can guess the month … but beyond that, I can't tell" an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India. BMC Pregnancy Childbirth 2020; 20:529. [PMID: 32917163 PMCID: PMC7488485 DOI: 10.1186/s12884-020-03201-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/21/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accurately estimating gestational age is essential to the provision of time-sensitive maternal and neonatal interventions, including lifesaving measures for imminent preterm birth and trimester-specific health messaging. METHODS We explored healthcare provider perspectives on gestational age estimation in the state of Rajasthan, India, including the methods they use (last menstrual period [LMP] dating, ultrasound, or fundal height measurement); barriers to making accurate estimates; how gestational age estimates are documented and used for clinical decision-making; and what could help improve the accuracy and use of these estimates. We interviewed 20 frontline healthcare providers and 10 key informants. Thematic network analysis guided our coding and synthesis of findings. RESULTS Health care providers reported that they determined gestational age using some combination of LMP, fundal height, and ultrasound. Their description of their practices showed a lack of standard protocol, varying levels of confidence in their capacity to make accurate estimates, and differing strategies for managing inconsistencies between estimates derived from different methods. Many frontline healthcare providers valued gestational age estimation more to help women prepare for childbirth than as a tool for clinical decision making. Feedback on accuracy was rare. The providers sampled could not offer ultrasound directly, and instead could only refer women to ultrasound at higher level facilities, and usually only in the second or third trimesters because of late antenatal care-seeking. Low recall among pregnant women limited the accuracy of LMP. Fundal height was heavily relied upon, despite its lack of precision. CONCLUSION The accuracy of gestational age estimates is influenced by factors at four levels: 1. health system (protocols to guide frontline workers, interventions that make use of gestational age, work environment, and equipment); 2. healthcare provider (technical understanding of and capacity to apply the gestational age estimation methods, communication and rapport with clients, and value assessment of gestational age); 3. client (time of first antenatal care, migration status, language, education, cognitive approach to recalling dates, and experience with biomedical services); and, 4. the inherent limitations and ease of application of the methods themselves.
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Affiliation(s)
- K Scott
- USAID's Maternal and Child Survival Program/Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - S Gupta
- USAID's Maternal and Child Survival Program/Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - E Williams
- USAID's Maternal and Child Survival Program/Jhpiego, Baltimore, USA
| | - M Arthur
- USAID's Maternal and Child Survival Program/USAID, Washington, D.C., USA
| | | | - L Noguchi
- USAID's Maternal and Child Survival Program/Jhpiego, Baltimore, USA
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32
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Elvin J, Danziger N, Corines J, Vergilio JA, Killian J, Lin D, Williams E, Tse J, Ramkissoon S, Severson E, Hemmerich A, Edgerly C, Duncan D, Huang R, Schrock A, Alexander B, Venstrom J, Reddy P, McGregor K, Ross J. 2001P Adenoid cystic carcinomas (ACC) of the trachea, salivary gland, breast: A comparative comprehensive genomic profiling (CGP) study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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33
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Alexander B, Sokol E, Danziger N, Pavlick D, Elvin J, Killian J, Lin D, Williams E, Ramkissoon S, Severson E, Hemmerich A, Duncan D, Edgerly C, Huang R, Hiemenz M, Reddy P, McGregor K, Venstrom J, Schrock A, Ross J. 107P Immune Checkpoint Inhibitor (ICPI) resistance genes STK11 and KEAP1: A comparative Comprehensive Genomic Profiling (CGP) study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.228] [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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34
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Reddy P, Danziger N, Elvin J, Vergilio JA, Killian J, Lin D, Williams E, Ramkissoon S, Severson E, Hemmerich A, Duncan D, Edgerly C, Huang R, Hiemenz M, Chung J, McGregor K, Venstrom J, Schrock A, Alexander B, Ross J. 957P Ameloblastoma of the head and neck (HNAMB): A comprehensive profiling (CGP) study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1072] [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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35
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Ng SM, Lay JT, Regan F, Soni A, Wright N, Agwu JC, Williams E, Timmis A, Kershaw M, Moudiotis C, Drew J. Variations in diabetes transition care for children and young people: a national survey. Diabet Med 2020; 37:1407-1409. [PMID: 32511813 DOI: 10.1111/dme.14336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 03/16/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- S M Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - J T Lay
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK
| | - F Regan
- Wexham Park Hospital, Slough, UK
| | - A Soni
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - N Wright
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - J C Agwu
- Department of Paediatrics, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Institute of Clinical Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - E Williams
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - A Timmis
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - M Kershaw
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - C Moudiotis
- Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Drew
- Department of Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
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36
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Alinezhad S, Thomas P, Williams E, Vela I. A multifaceted precision approach to high risk localized prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33837-4] [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: 11/28/2022] Open
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37
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Joshi A, Roberts MJ, Perera M, Williams E, Rhee H, Pryor D, Lehman M, Heathcote P, Wood S, Coucher J, Gustafson S, Miles K, Vela I. The clinical efficacy of PSMA PET/MRI in biochemically recurrent prostate cancer compared with standard of care imaging modalities and confirmatory histopathology: results of a single-centre, prospective clinical trial. Clin Exp Metastasis 2020; 37:551-560. [PMID: 32519046 DOI: 10.1007/s10585-020-10043-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
Prospective evidence for the clinical role and efficacy of prostate specific membrane antigen (PSMA) positron emission tomography (PET)/magnetic resonance imaging (MRI) combining MRI characterization and localization of lesions with PET avidity in comparison to conventional imaging is limited. In a prospective clinical trial, we aimed to evaluate the diagnostic yield and therapeutic impact of PSMA PET/MRI in men with biochemical recurrence (BCR) following curative therapy. A single-centre, prospective clinical trial at the Princess Alexandra Hospital recruited 30 patients with BCR. Patients underwent PSMA PET/MRI and concurrent conventional CT chest, abdomen, pelvis and whole-body bone scan. Biopsy was performed when safety possible for histological correlation of identified lesions. Clinical efficacy and impact of PSMA PET findings were evaluated. 30 patients with BCR were recruited (median PSA 0.69 ng/ml). PSMA avid lesions were present in 21 patients (70%). 23 patients were previously treated with definitive surgery, 6 patients received external beam radiotherapy and 1 patient had low dose rate brachytherapy. A total of 8 of 9 lesions biopsied were positive (88.9% histological correlation). PSMA PET/MRI detected local recurrence (p = 0.005) and pelvic lesions (p = 0.06) more accurately than conventional imaging. PSMA PET/MRI may be useful in staging men with biochemical recurrence, especially when PSA is low. Our data demonstrates a high detection rate, especially for locally recurrent disease, and highlights the role of this modality when PSA is low. This modality has the potential to significantly improve prostate cancer detection and may have implications for earlier salvage treatment, avoidance of futile local therapy and change patient management to lead to improved outcomes.
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Affiliation(s)
- A Joshi
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Australian Prostate Cancer Research Centre - Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - M J Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - M Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - E Williams
- Australian Prostate Cancer Research Centre - Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Brisbane, QLD, Australia
| | - H Rhee
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Australian Prostate Cancer Research Centre - Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Brisbane, QLD, Australia
| | - D Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - M Lehman
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - P Heathcote
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - S Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Australian Prostate Cancer Research Centre - Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Brisbane, QLD, Australia
| | - J Coucher
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - S Gustafson
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - K Miles
- Department of Nuclear Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - I Vela
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia. .,Australian Prostate Cancer Research Centre - Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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Tolchin D, Yeager JP, Prasad P, Dorrani N, Russi AS, Martinez-Agosto JA, Haseeb A, Angelozzi M, Santen G, Ruivenkamp C, Mercimek-Andrews S, Depienne C, Kuechler A, Mikat B, Ludecke HJ, Bilan F, Le Guyader G, Gilbert-Dussardier B, Keren B, Heide S, Haye D, Van Esch H, Keldermans L, Ortiz D, Lancaster E, Krantz ID, Krock BL, Pechter KB, Arkader A, Medne L, DeChene ET, Calpena E, Melistaccio G, Wilkie AO, Suri M, Foulds N, Begtrup A, Henderson LB, Forster C, Reed P, McDonald MT, McConkie-Rosell A, Thevenon J, Le Tanno P, Coutton C, Tsai AC, Stewart S, Maver A, Gorazd R, Pichon O, Nizon M, Cogné B, Isidor B, Martin-Coignard D, Stoeva R, Lefebvre V, Le Caignec C, Ambrose J, Bleda M, Boardman-Pretty F, Boissiere J, Boustred C, Caulfield M, Chan G, Craig C, Daugherty L, de Burca A, Devereau A, Elgar G, Foulger R, Fowler T, Furió-Tarí P, Hackett J, Halai D, Holman J, Hubbard T, Kasperaviciute D, Kayikci M, Lahnstein L, Lawson K, Leigh S, Leong I, Lopez F, Maleady-Crowe F, Mason J, McDonagh E, Moutsianas L, Mueller M, Need A, Odhams C, Patch C, Perez-Gil D, Polychronopoulos D, Pullinger J, Rahim T, Rendon A, Rogers T, Ryten M, Savage K, Scott R, Siddiq A, Sieghart A, Smedley D, Smith K, Sosinsky A, Spooner W, Stevens H, Stuckey A, Thomas E, Thompson S, Tregidgo C, Tucci A, Walsh E, Watters S, Welland M, Williams E, Witkowska K, Wood S, Zarowiecki M. De Novo SOX6 Variants Cause a Neurodevelopmental Syndrome Associated with ADHD, Craniosynostosis, and Osteochondromas. Am J Hum Genet 2020; 106:830-845. [PMID: 32442410 DOI: 10.1016/j.ajhg.2020.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
SOX6 belongs to a family of 20 SRY-related HMG-box-containing (SOX) genes that encode transcription factors controlling cell fate and differentiation in many developmental and adult processes. For SOX6, these processes include, but are not limited to, neurogenesis and skeletogenesis. Variants in half of the SOX genes have been shown to cause severe developmental and adult syndromes, referred to as SOXopathies. We here provide evidence that SOX6 variants also cause a SOXopathy. Using clinical and genetic data, we identify 19 individuals harboring various types of SOX6 alterations and exhibiting developmental delay and/or intellectual disability; the individuals are from 17 unrelated families. Additional, inconstant features include attention-deficit/hyperactivity disorder (ADHD), autism, mild facial dysmorphism, craniosynostosis, and multiple osteochondromas. All variants are heterozygous. Fourteen are de novo, one is inherited from a mosaic father, and four offspring from two families have a paternally inherited variant. Intragenic microdeletions, balanced structural rearrangements, frameshifts, and nonsense variants are predicted to inactivate the SOX6 variant allele. Four missense variants occur in residues and protein regions highly conserved evolutionarily. These variants are not detected in the gnomAD control cohort, and the amino acid substitutions are predicted to be damaging. Two of these variants are located in the HMG domain and abolish SOX6 transcriptional activity in vitro. No clear genotype-phenotype correlations are found. Taken together, these findings concur that SOX6 haploinsufficiency leads to a neurodevelopmental SOXopathy that often includes ADHD and abnormal skeletal and other features.
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Ferguson EC, Wright N, Regan F, Agwu JC, Williams E, Soni A, Timmis A, Kershaw M, Drew J, Moudiotis C, Ng SM. Variations in access to continuous glucose monitoring and flash glucose sensors for children and young people in England and Wales: a national survey. Arch Dis Child 2020; 105:609-610. [PMID: 31527045 DOI: 10.1136/archdischild-2019-317800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 11/03/2022]
Affiliation(s)
| | - Neil Wright
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Juliana Chizo Agwu
- Department of Paediatrics, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.,Institute of Clinical Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleri Williams
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Astha Soni
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Alison Timmis
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Melanie Kershaw
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Josephine Drew
- Department of Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK .,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Lum SH, Selvarajah S, Deya-Martinez A, McNaughton P, Sobh A, Waugh S, Burton-Fanning S, Newton L, Gandy J, Nademi Z, Owens S, Williams E, Emonts M, Flood T, Cant A, Abinun M, Hambleton S, Gennery AR, Slatter M. Outcome of autoimmune cytopenia after hematopoietic cell transplantation in primary immunodeficiency. J Allergy Clin Immunol 2020; 146:406-416. [PMID: 32442647 DOI: 10.1016/j.jaci.2020.04.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post hematopoietic cell transplantation (HCT) autoimmune cytopenia (AIC) is a potentially life-threatening complication, but studies focusing on large cohorts of patients transplanted for primary immunodeficiency are lacking. OBJECTIVES This study sought to determine the incidence, risk factors, and outcomes of post-HCT AIC and B-lymphocyte function following rituximab. METHODS We retrospectively studied 502 children with primary immunodeficiency who were transplanted at our center between 1987 and 2018. RESULTS Thirty-six patients (9%) developed post-HCT AIC, with a median onset of 6.5 months post-HCT. On univariate analysis, pre-HCT AIC, mismatched donor, alemtuzumab, anti-thymocyte antiglobulin, and acute and chronic graft versus host disease were significantly associated with post-HCT AIC. After multivariate analysis, alemtuzumab (subdistribution hazard ratio, 9.0; 95% CI, 1.50-54.0; P = .02) was independently associated with post-HCT AIC. Corticosteroid and high-dose intravenous immunoglobulin achieved remission in 50% (n = 18), additional rituximab led to remission in 25% (n = 9), and the remaining 25% were treated with a combination of various modalities including sirolimus (n = 5), bortezomib (n = 3), mycophenolate mofetil (n = 2), splenectomy (n = 2), and second HCT (n = 3). The mortality of post-HCT AIC reduced from 25% (4 of 16) prior to 2011 to 5% (1 of 20) after 2011. The median follow-up of 5.8 years (range, 0.4 to 29.1 years) showed that 26 of 30 survivors (87%) were in complete remission, and 4 were in remission with ongoing sirolimus and low-dose steroids. Of the 17 who received rituximab, 7 had B-lymphocyte recovery, 5 had persistent low B-lymphocyte count and remained on intravenous immunoglobulin replacement, 2 had second HCT, and 3 died. CONCLUSIONS The frequency of post HCT AIC in our cohort was 9%, and the most significant risk factors for its occurrence were the presence of graft versus host disease and the use of alemtuzumab.
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Affiliation(s)
- Su Han Lum
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Sabeena Selvarajah
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Angela Deya-Martinez
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter McNaughton
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ali Sobh
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sheila Waugh
- Microbiology and Virology, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Lisa Newton
- Microbiology and Virology, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Julie Gandy
- Microbiology and Virology, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Zohreh Nademi
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Eleri Williams
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Terry Flood
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew Cant
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mario Abinun
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Microbiology and Virology, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mary Slatter
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle upon Tyne Hospital National Health System Foundation Trust, Newcastle upon Tyne, United Kingdom
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Lum SH, Selvarajah S, Deya-Martinez A, McNaughton P, Sobh A, Waugh S, Burton-Fanning S, Newton L, Gandy J, Owens S, Williams E, Emonts M, Flood T, Cant A, Abinun M, Hambleton S, Gennery A, Slatter M. Outcome and Risk Factors of Autoimmune Cytopenia after Hematopoietic Cell Transplantation for Children with Primary Immunodeficiency. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.519] [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: 10/25/2022]
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Swinton-Bland BMA, Hinde DJ, Dasgupta M, Jeung DY, Williams E, Cook KJ, Prasad E, Rafferty DC, Sengupta C, Simenel C, Simpson EC, Smith JF, Vo-Phuoc K, Walshe J. Systematic Study of Quasifission in 48Ca-induced reactions. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023203007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The production of superheavy elements through the fusion of two heavy nuclei is severely hindered by the quasifission process, which results in the fission of heavy systems before an equilibrated compound nucleus (CN) can be formed. The heaviest elements have been synthesised using 48Ca as the projectile nucleus. However, the use of 48Ca in the formation of new superheavy elements has been exhausted, thus a detailed understanding of the properties that made 48Ca so successful is required. Measurements of mass-angle distributions allow fission fragment mass distribution widths to be determined. The effect of the orientation of prolate deformed target nuclei is presented. Closed shells in the entrance channel are also shown to be more important than the stability of the formed CN in reducing the quasifission component, with reduced mass widths for reactions with the closed shell target nuclei 144Sm and 208Pb. Comparison to mass widths for 48Ti-induced reactions show a significant increase in the mass width compared to 48Ca-induced reactions, highlighting the difficulty faced in forming new superheavy elements using projectiles with higher atomic number than 48Ca.
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Ng SM, Woodger K, Regan F, Soni A, Wright N, Agwu JC, Williams E, Timmis A, Kershaw M, Moudiotis C, Drew J. Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey. BMJ Paediatr Open 2020; 4:e000884. [PMID: 34192183 PMCID: PMC7607512 DOI: 10.1136/bmjpo-2020-000884] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/22/2020] [Indexed: 12/04/2022] Open
Abstract
In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children's Diabetes Clinicians found that the proportion of new-onset type 1 diabetes (T1D) presenting with diabetes ketoacidosis (DKA) during this COVID-19 pandemic was higher than previously reported, and there has been an increase in presentation of severe DKA at diagnosis in children and young people under the age of 18 years. Delayed presentations of T1D have been documented in up 20% of units with reasons for delayed presentation ranging from fear of contracting COVID-19 to an inability to contact or access a medical provider for timely evaluation. Public health awareness and diabetes education should be disseminated to healthcare providers on the timeliness of referrals of children with T1D.
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Affiliation(s)
- Sze May Ng
- Department of Paediatrics, Southport and Ormskirk Hospital NHS Trust, Ormskirk, UK.,Department of Women's and Children's Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Katherine Woodger
- Department of Paediatrics, Southport and Ormskirk Hospital NHS Trust, Ormskirk, UK
| | - Fiona Regan
- Department of Paediatrics, Wexham Park Hospital, Slough, UK
| | - Astha Soni
- Department of General Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Neil Wright
- Department of Paediatric Endocrinology & Diabetes, Sheffield Children's Hospital, Sheffield, UK
| | - Juliana Chizo Agwu
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Eleri Williams
- Department of Paediatrics, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
| | - Alison Timmis
- Department of Paediatrics, Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire West and Chester, UK
| | - Melanie Kershaw
- Department of Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Christopher Moudiotis
- Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Josephine Drew
- Department of Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Eschenbacher W, Phillips E, Williams E, Lawrence M. M261 ICF1 SYNDROME PRESENTING WITH BACTEREMIA, MENINGITIS AND RESPIRATORY FAILURE. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.366] [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: 11/24/2022]
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Berry L, Palmer T, Wells F, Williams E, Sibal B, Timms J. Nosocomial outbreak of measles amongst a highly vaccinated population in an English hospital setting. Infect Prev Pract 2019; 1:100018. [PMID: 34368679 PMCID: PMC8336304 DOI: 10.1016/j.infpip.2019.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/04/2022] Open
Abstract
In May 2017 a patient attended the emergency department at a hospital in England, with a presumed allergic reaction. He was subsequently diagnosed with measles. There were seven further confirmed cases, five of whom had received two doses of MMR vaccine. This outbreak highlights the importance of not relying on vaccination status to rule out the diagnosis of measles. Epidemiological investigations of this outbreak were particularly challenging due to the highly infectious nature of the measles virus, and prevented full elucidation of either the source of this outbreak or the transmission pathways.
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Affiliation(s)
- L Berry
- University Hospital Coventry and Warwickshire NHS Trust Coventry, United Kingdom
| | - T Palmer
- Communicable Disease Control, West Midlands Health Protection Team, Public Health England, Birmingham, United Kingdom
| | - F Wells
- Infection prevention and control, University Hospital Coventry and Warwickshire NHS Trust, United Kingdom
| | - E Williams
- Coventry & Warwickshire Occupational Health Shared Service, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | - B Sibal
- Communicable Disease Control, West Midlands Health Protection Team, Public Health England, Birmingham, United Kingdom
| | - J Timms
- Department of Virology and Molecular Pathology, Coventry and Warwickshire Pathology Services, University Hospital Coventry and Warwickshire NHS Trust, United Kingdom
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Banerjee K, Hinde DJ, Dasgupta M, Simpson EC, Jeung DY, Simenel C, Swinton-Bland BMA, Williams E, Carter IP, Cook KJ, David HM, Düllmann CE, Khuyagbaatar J, Kindler B, Lommel B, Prasad E, Sengupta C, Smith JF, Vo-Phuoc K, Walshe J, Yakushev A. Mechanisms Suppressing Superheavy Element Yields in Cold Fusion Reactions. Phys Rev Lett 2019; 122:232503. [PMID: 31298876 DOI: 10.1103/physrevlett.122.232503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/17/2018] [Indexed: 06/10/2023]
Abstract
Superheavy elements are formed in fusion reactions which are hindered by fast nonequilibrium processes. To quantify these, mass-angle distributions and cross sections have been measured, at beam energies from below-barrier to 25% above, for the reactions of ^{48}Ca, ^{50}Ti, and ^{54}Cr with ^{208}Pb. Moving from ^{48}Ca to ^{54}Cr leads to a drastic fall in the symmetric fission yield, which is reflected in the measured mass-angle distribution by the presence of competing fast nonequilibrium deep inelastic and quasifission processes. These are responsible for reduction of the compound nucleus formation probablity P_{CN} (as measured by the symmetric-peaked fission cross section), by a factor of 2.5 for ^{50}Ti and 15 for ^{54}Cr in comparison to ^{48}Ca. The energy dependence of P_{CN} indicates that cold fusion reactions (involving ^{208}Pb) are not driven by a diffusion process.
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Affiliation(s)
- K Banerjee
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - D J Hinde
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - M Dasgupta
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - E C Simpson
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - D Y Jeung
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - C Simenel
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - B M A Swinton-Bland
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - E Williams
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - I P Carter
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - K J Cook
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - H M David
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
| | - Ch E Düllmann
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
- Helmholtz Institute Mainz, 55099 Mainz, Germany
- Institut für Kernchemie, Johannes Gutenberg-Universität Mainz, 55099 Mainz, Germany
| | - J Khuyagbaatar
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
- Helmholtz Institute Mainz, 55099 Mainz, Germany
| | - B Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
| | - B Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
| | - E Prasad
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - C Sengupta
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - J F Smith
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - K Vo-Phuoc
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - J Walshe
- Department of Nuclear Physics, Research School of Physics and Engineering, The Australian National University, Canberra ACT 2601, Australia
| | - A Yakushev
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
- Helmholtz Institute Mainz, 55099 Mainz, Germany
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Keating D, Wilson L, Williams E, Kotsimbos T, Wilson J. P259 Ivacaftor withdrawal syndrome during a randomised placebo-controlled cross-over study. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Williams E, John NA, Blackstone J, Brownlee W, Frost C, Greenwood J, Chataway J. TP1-11 MS-STAT2: a phase 3 trial of high dose simvastatin in secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesDisease modifying treatment for secondary progressive multiple sclerosis (SPMS) represents a major unmet need. We outline here the rationale for the MS-STAT2 trial – a phase 3 study of simvastatin in decreasing clinical progression in SPMS. MS-STAT2 will be a landmark study not only for patients with SPMS, but also for the area of drug repurposing and academically led clinical trials as a whole.DesignMulticentre, double blind, parallel group randomised placebo-controlled trial. It follows the positive outcome from the phase 2 MS-STAT1 trial, which demonstrated a 43% reduction in the annualised rate of brain atrophy compared to placebo.1Subjects1180 patients with SPMS with an expanded disability status scale (EDSS) score of 4.0–6.5. Patients need to show evidence of disease progression over the preceding 2 years.MethodsSubject will be recruited at 28 sites across the UK, and randomised to simvastatin 80 mg or matched placebo and assessed every 6 months over the 3 year trial.ResultsThe primary outcome measure is time to 6 month confirmed disability progression, based on change in Expanded Disability Status Scale (EDSS) scores compared to baseline. Secondary outcomes include assessments of cognition, walking, upper limb function and vision. Sub-studies will include advanced imaging outcomes, ocular coherence tomography and fluid biomarkers.ConclusionsMS-STAT2 is set to be a pivotal trial for SPMS. Recruitment has now commenced and further sites are welcome.ReferenceChataway J, et al. MS-STAT. Lancet2014;383:2213–21.
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Stefanou M, Chandler HJ, Mignolet B, Williams E, Nanoh SA, Thompson JOF, Remacle F, Schaub R, Campbell EEB. Angle-resolved photoelectron spectroscopy and scanning tunnelling spectroscopy studies of the endohedral fullerene Li@C 60. Nanoscale 2019; 11:2668-2678. [PMID: 30357213 DOI: 10.1039/c8nr07088a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gas phase photoelectron spectroscopy (Rydberg Fingerprint Spectroscopy), TDDFT calculations and low temperature STM studies are combined to provide detailed information on the properties of the diffuse, low-lying Rydberg-like SAMO states of isolated Li@C60 endohedral fullerenes. The presence of the encapsulated Li is shown by the calculations to produce a significant distortion of the lowest-lying S- and P-SAMOs that is dependent on the position of the Li inside the fullerene cage. Under the high temperature conditions of the gas phase experiments, the Li is mobile and able to access different positions within the cage. This is accounted for in the comparison with theory that shows a very good agreement of the photoelectron angular distributions, allowing the symmetry of the observed SAMO states to be identified. When adsorbed on a metal substrate at low temperature, a strong interaction between the low-lying SAMOs and the metal substrate moves these states to energies much closer to the Fermi energy compared to the situation for empty C60 while the Li remains frozen in an off-centre position.
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Affiliation(s)
- M Stefanou
- EaStCHEM and School of Chemistry, University of Edinburgh, David Brewster Road, Edinburgh, EH9 3FJ, UK.
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