1
|
McLeod C, Ramsay J, Flanagan KL, Plebanski M, Marshall H, Dymock M, Marsh J, Estcourt MJ, Wadia U, Williams PCM, Tjiam MC, Blyth C, Subbarao K, Nicholson S, Faust S, Thornton RB, Mckenzie A, Snelling TL, Richmond P. Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO). Trials 2023; 24:202. [PMID: 36934272 PMCID: PMC10024280 DOI: 10.1186/s13063-023-07225-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.
Collapse
Affiliation(s)
- C McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia.
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.
| | - J Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - H Marshall
- Women's and Children's Health Network, North Adelaide, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - M Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - J Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - M J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - U Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - P C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Westmead, Australia
- School of Women and Children's Health, UNSW, Kensington, Australia
| | - M C Tjiam
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - K Subbarao
- WHO Collaborating Centre for Reference and Research On Influenza, University of Melbourne, Parkville, VIC, Australia
| | - S Nicholson
- Serology Laboratory, Victorian Infectious Diseases Research Laboratory, Melbourne, Australia
| | - S Faust
- Southampton Clinical Research Facility and Biomedical Research Centre, National Institute of Health Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - A Mckenzie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - T L Snelling
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - P Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
- General Paediatrics and Immunology Departments, Perth Children's Hospital, Nedlands, Australia
| |
Collapse
|
2
|
Dodd R, Sharman A, McGregor D, Stone E, Kielly-Carroll C, De Abreu Lourenco R, Marshall H, Rankin N. EP01.02-004 Education Messages and Strategies About Lung Cancer Screening: A Systematic Review. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
3
|
Lau J, Fischer B, Marshall H. EP15.01-001 Ask, Advise, Help (AAH) Smoking Cessation Brief Advice Delivery in Patients with Diagnosed Lung Cancer: A Retrospective Audit. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.999] [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]
|
4
|
Behar Harpaz S, Weber M, Wade S, Ngo P, Vaneckova P, Sarich P, Cressman S, Tammemagi M, Fong K, Marshall H, McWilliams A, Zalcberg J, Caruana M, Canfell K. MA11.03 Updated Cost-Effectiveness Analysis of Lung Cancer Screening for Australia, Capturing Differences in the Impact of NELSON and NLST Outcomes. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
5
|
Stirling R, Smith S, Brand M, Harden S, Briggs L, Leigh L, Brims F, Brooke M, Brunelli V, Chia C, Dawkins P, Lawrenson R, Duffy M, Evans S, Leong T, Marshall H, Patel D, Pavlakis N, Philip J, Rankin N, Singhal N, Stone E, Tay R, Vinod S, Windsor M, Wright G, Leong D, Zalcberg J. EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
6
|
Poveda Velasco A, Lheureux S, Colombo N, Cibula D, Elstrand M, Weberpals J, Bjurberg M, Oaknin A, Sikorska M, Gonzalez Martin A, Madry R, Rubio Perez M, Ledermann J, Ozgoren O, Barnicle A, Marshall H, Bashir Z, Skof E. 531P Maintenance olaparib monotherapy in patients (pts) with platinum-sensitive relapsed ovarian cancer (PSR OC) without a germline BRCA1/BRCA2 mutation (non-gBRCAm): Final overall survival (OS) results from the OPINION trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.659] [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: 11/01/2022] Open
|
7
|
Dodd R, Sharman A, Rhee J, Marshall H, Stone E, Yap M, McCullough S, McWilliams A, Rankin N. EP01.03-012 Acceptability and Feasibility of Lung Cancer Screening in Australia: The View of Key Stakeholders. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
8
|
Zegard A, Okafor O, Foley P, Umar F, Taylor R, Marshall H, Stegemann B, Moody W, Steeds R, Halliday B, Hammersley D, Jones R, Prasad S, Qiu T, Leyva F. Myocardial fibrosis predicts ventricular arrhythmias and sudden death after cardiac electronic device implantation. Europace 2022. [DOI: 10.1093/europace/euac053.384] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted educational grants
Background
Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. We sought to determine whether presence of MF on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts SCD and ventricular fibrillation / sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation.
Methods
In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of sudden cardiac death (SCD) and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation.
Results
Among 700 patients (age 68.0 ± 12.0yrs [mean ± SD]), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over 6.93 yrs (median; interquartile range 5.82-9.32). MFVA predicted SCD (hazard ratio [HR]: HR:26.3 [95% confidence interval [CI] 3.70-3337]; negative predictive value: 100%). In competing risks analyses, MFVA also predicted the arrhythmic endpoint (subdistribution [sHR]: 19.9 [95% CI 6.40-61.9]; negative predictive value:98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) > 17 g was associated with highest risk of SCD (HR: 44.6;95% CI 6.12-5685) and the arrhythmic endpoint (sHR: 30.3 [95% CI 9.60-95.8]). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint.
Conclusions
In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
Collapse
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - P Foley
- The Great Western Hospital, Swindon, United Kingdom of Great Britain & Northern Ireland
| | - F Umar
- Ottawa Cardiovascular Centre, The Ottawa Hospital, Ottawa, Canada
| | - R Taylor
- Worcestershire Acute Hospitals NHS trust, Alexandra Hospital, Worcestershire, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - W Moody
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - R Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - S Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
9
|
Kahn B, Marshall H. Treatment of pelvic nerve dysfunction with a short course of pudendal nerve blocks and nsaids: a 4-year quality assurance review. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.049] [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]
|
10
|
Tammemagi M, Myers R, Ruparel M, Tremblay A, Atkar-Khattra S, Marshall H, Brims F, Mcwilliams A, Fogarty P, Stone E, Manser R, Canfell K, Lim K, Rosell A, Weber M, Yee J, Mayo J, Berg C, Lam D, Janes S, Fong K, Lam S. OA19.01 Prospective Study of Lung Cancer Screening Criteria: USPSTF2013 vs PLCOm2012 – International Lung Screening Trial (ILST) Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.097] [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: 10/20/2022]
|
11
|
Okafor O, Zegard A, Stegemann B, Arif S, De Bono J, Marshall H, Leyva F. Endocardial pacing is not haemodynamically superior to trans-coronary sinus epicardial pacing in cardiac resynchronization therapy: the Endo-Epi CRT study. Europace 2021. [DOI: 10.1093/europace/euab116.444] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
Cardiac resynchronization therapy (CRT) conventionally involves trans-coronary sinus, epicardial left ventricular (LV) pacing. Some studies have suggested that endocardial LV pacing may be superior to epicardial LV pacing.
Objectives
To compare the acute haemodynamic effects of CRT when delivered from endocardial (Endo-CRT) and epicardial LV stimulation sites (Epi-CRT).
Methods and results
Sixteen CRT recipients (aged 70.4 ± 10.1 years [mean ± SD], 62.5% male, QRS: 156.5 ± 16.1 ms, LBBB in 13 [81.3%]) in sinus rhythm underwent intra-procedural measurements of the rate of rise of LV pressure (dP/dtmax) during Endo- and Epi-CRT (RADI pressure wire). Epi-CRT was delivered in basal, mid and apical positions. The Endo-CRT pacing site was chosen using iterative, biplane fluoroscopic views, to target the same position as the Epi-CRT site on the endocardium (see Figure A). Compared to AAI pacing (10 beats per minute above intrinsic rate), both Endo-CRT and Epi-CRT led to an increase in LV dP/dtmax (6.52 ± 8.90% and 6.15 ± 7.97% respectively, both p < 0.001). There were no significant differences in the change in LV dP/dtmax (ΔLV dP/dtmax) between Endo-CRT and Epi-CRT at basal (p = 0.54), mid (p = 0.78) or apical LV stimulation sites (p = 0.12) [Figure B].
Conclusions
Endo-CRT is not haemodynamically superior to Epi-CRT. Abstract Figure.
Collapse
Affiliation(s)
- O Okafor
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Zegard
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Arif
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J De Bono
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
12
|
Zegard A, Okafor O, Debono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Grayzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction greater than 35%. Europace 2021. [DOI: 10.1093/europace/euab116.363] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND Clinical guidelines adopt LVEF cut-offs <30 or <35% as an indication for implantable cardioverter defibrillator (ICD) therapy. Most patients succumbing to sudden cardiac death (SCD), however, have a LVEF≥35%.
OBJECTIVES To determine whether myocardial fibrosis (MF) and grayzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a LVEF≥35%.
METHODS In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of SCD, ventricular tachycardia, ventricular fibrillation or resuscitated cardiac arrest.
RESULTS Among 701 patients (age: 65.8 ± 12.3 yrs [mean ± SD]), 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥ 5.0 g was strongly associated with the primary endpoint (subdistribution hazard ratio [sHR]: 17.4 [95% CI 6.64-45.5]); area under receiver operator characteristic curve [AUC]: 0.85, p < 0.001). A weaker association was observed for TF2SD mass ≥ 23 g (HR: 10.4 [95% CI 4.22-25.8]; AUC: 0.80, p < 0.001). The range of sHRs for GZF3SD mass (1 to 526.6) was wider than for TF2SD mass (1 to 37.6).
CONCLUSIONS In CAD patients with a LVEF≥35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and a LVEF≥35% at risk of arrhythmic events. Abstract Figure.
Collapse
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Debono
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Lencioni
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
13
|
Zegard A, Okafor O, Debono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Myocardial fibrosis as a predictor of sudden death in patients with coronary artery disease. Europace 2021. [DOI: 10.1093/europace/euab116.339] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND The ‘grayzone’ of myocardial fibrosis (GZF) on cardiovascular magnetic resonance may be a substrate for ventricular arrhythmias (VAs).
OBJECTIVES To determine whether GZF predicts SCD and VAs (ventricular fibrillation or sustained ventricular tachycardia) in patients with coronary artery disease (CAD) and a wide range of LVEFs.
METHODS In this retrospective study of CAD patients, myocardial fibrosis presence on visual assessment (MFVA) and GZF mass in patients with MFVA was assessed in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs.
RESULTS Among 979 patients (age: 65.8 ± 12.3 yrs [mean ± SD]), 29(2.96%) suffered a SCD and 80(8.17%) met the arrhythmic endpoint over 5.82 years (median; interquartile range: 4.1-7.3). In the whole cohort, MFVA was strongly associated with SCD (hazard ratio [HR]:10.1, 95% CI 1.42-1278.9) and the arrhythmic endpoint (HR:28.0, 95% CI 4.07-3525.4). In competing risks analyses, associations between LVEF < 35% and SCD (subdistribution HR [sHR]:2.99, 95% CI 1.42-6.31) and the arrhythmic endpoint (sHR:4.71, 95% CI 2.97-7.47) were weaker. In competing risks analyses of the MFVA subcohort (n = 832), GZF using the 3SD method (GZF3SD) > 5.0 g was strongly associated with SCD (sHR:10.8, 95% CI 3.74-30.9) and the arrhythmic endpoint (sHR:7.40, 95% CI 4.29-12.8). Associations between LVEF < 35% and SCD (sHR:2.62, 95% CI 1.24-5.52) and the arrhythmic endpoint (sHR:4.14, 95% CI 2.61-6.57) were weaker.
CONCLUSIONS In CAD patients, MFVA plus quantified GZF3SD mass was more strongly associated with SCD and VAs than LVEF. In selecting patients for implantable cardioverter defibrillators, assessment of MFVA followed by quantification of GZF3SD mass may be preferable to LVEF. Abstract Figure.
Collapse
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Debono
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Lencioni
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
14
|
Blois SL, Marshall H, Abrams-Ogg ACG, Bersenas AM, Ruotsalo K, Monteith G. Accuracy of a point-of-care major crossmatch test and risk factors for major crossmatch incompatibility in cats. Vet J 2021; 272:105663. [PMID: 33941337 DOI: 10.1016/j.tvjl.2021.105663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Major crossmatch testing can help identify immunologic incompatibilities between blood donors and recipients; however, there are limited studies describing the accuracy of point-of-care crossmatch tests. The first aim of this study was to determine if a gel-based, point-of-care major crossmatch method (GEL-CM), without antiglobulin-enhancement, could accurately detect compatible and incompatible donor-recipient pairings, using an antiglobulin-enhanced laboratory-based major crossmatch method (LAB-CM) as the reference standard. The second aim was to describe the incidence of, and risk factors for, major crossmatch incompatibility in cats. Nineteen previously-transfused cats and 32 transfusion-naïve cats, representing 132 unique donor-recipient pairings, were included in this study. Both LAB-CM and GEL-CM tests were performed for most parings. There was poor agreement between the LAB-CM and GEL-CM results (kappa = 0.111; 95% confidence interval [CI], -0.093 to 0.314). Transfusion-naïve cats had incompatibility rates of 3% and 6% using LAB-CM and GEL-CM, respectively; previously-transfused cats had incompatibility rates of 32% and 26% using LAB-CM and GEL-CM, respectively. History of previous transfusion was the only identified cat risk factor for an incompatible LAB-CM (odds ratio [OR], 31.0; 95% CI, 3.77-254.98; P = 0.0019) and GEL-CM (OR, 5.7; 95% CI, 1.72-19.20; P = 0.0054). Further studies are needed to determine if GEL-CM can detect clinically-relevant immunologic incompatibilities that would result in transfusion reactions. Major crossmatch testing is of greater importance in cats that have previously received a transfusion.
Collapse
Affiliation(s)
- S L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - H Marshall
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - A C G Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - A M Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - K Ruotsalo
- Animal Health Laboratory, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| |
Collapse
|
15
|
Patel N, Hopcraft K, O'Rourke R, Williamson A, Georgiou P, Yang I, Fong K, Marshall H. P44.05 Bone Density Measures Out-Perform Clinical Risk Scores in Detection of Vertebral Fractures in a Lung Cancer Screening Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.844] [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]
|
16
|
Roach KM, Castells E, Dixon K, Mason S, Elliott G, Marshall H, Poblocka MA, Macip S, Richardson M, Khalfaoui L, Bradding P. Evaluation of Pirfenidone and Nintedanib in a Human Lung Model of Fibrogenesis. Front Pharmacol 2021; 12:679388. [PMID: 34712131 PMCID: PMC8546112 DOI: 10.3389/fphar.2021.679388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease with a poor prognosis and increasing incidence. Pirfenidone and nintedanib are the only approved treatments for IPF but have limited efficacy and their mechanisms of action are poorly understood. Here we have examined the effects of pirfenidone and nintedanib in a human model of lung fibrogenesis, and compared these with the putative anti-fibrotic compounds Lipoxin A4 (LXA4), and senicapoc, a KCa3.1 ion channel blocker. Methods: Early fibrosis was induced in cultured human lung parenchyma using TGFβ1 for 7 days, ± pirfenidone, nintedanib, or LXA4. Pro-fibrotic responses were examined by RT-PCR, immunohistochemistry and soluble collagen secretion. Results: Thirty six out of eighty four IPF and fibrosis-associated genes tested were significantly upregulated by TGFβ1 in human lung parenchyma with a ≥0.5 log2FC (n = 32). Nintedanib (n = 13) reduced the mRNA expression of 14 fibrosis-associated genes including MMPs (MMP1,-4,-13,-14), integrin α2, CXCR4 and PDGFB, but upregulated α-smooth muscle actin (αSMA). Pirfenidone only reduced mRNA expression for MMP3 and -13. Senicapoc (n = 11) previously attenuated the expression of 28 fibrosis-associated genes, including αSMA, several growth factors, collagen type III, and αV/β6 integrins. Pirfenidone and nintedanib significantly inhibited TGFβ1-induced fibroblast proliferation within the tissue, but unlike senicapoc, neither pirfenidone nor nintedanib prevented increases in tissue αSMA expression. LXA4 was ineffective. Conclusions: Pirfenidone and nintedanib demonstrate modest anti-fibrotic effects and provide a benchmark for anti-fibrotic activity of new drugs in human lung tissue. Based on these data, we predict that the KCa3.1 blocker senicapoc will show greater benefit than either of these licensed drugs in IPF.
Collapse
Affiliation(s)
- K M Roach
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - E Castells
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - K Dixon
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - S Mason
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - G Elliott
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - H Marshall
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - M A Poblocka
- Mechanisms of Cancer and Ageing Lab, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom
| | - S Macip
- Mechanisms of Cancer and Ageing Lab, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom.,FoodLab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - M Richardson
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - L Khalfaoui
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - P Bradding
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
17
|
Seligmann JF, Wright-Hughes A, Pottinger A, Velikova G, Oughton JB, Murden G, Rizwanullah M, Price C, Passant H, Heudtlass P, Marshall H, Johnston S, Dodwell D. Lapatinib plus Capecitabine versus Trastuzumab plus Capecitabine in the Treatment of Human Epidermal Growth Factor Receptor 2-positive Metastatic Breast Cancer with Central Nervous System Metastases for Patients Currently or Previously Treated with Trastuzumab (LANTERN): a Phase II Randomised Trial. Clin Oncol (R Coll Radiol) 2020; 32:656-664. [PMID: 32600919 DOI: 10.1016/j.clon.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/14/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Brain (central nervous system; CNS) metastases occur in 30-50% of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). A substantive evidence base for treatment is lacking, but activity with lapatinib plus capecitabine (lap-cap) has been reported. We compared lap-cap with trastuzumab plus capecitabine (tras-cap) in patients with HER2-positive MBC with CNS metastases previously treated with trastuzumab. MATERIALS AND METHODS This open-label randomised phase II screening trial aimed to randomise 130 participants over 2 years to receive lap-cap or tras-cap. Eligible patients had HER2-positive MBC with newly diagnosed or recently progressed CNS metastases; previous, or current, treatment included: trastuzumab, a taxane or anthracycline and recent completion of local cranial therapy. The primary end point was time to progression of CNS metastases within the 24-week trial period. Secondary objectives included CNS response rate, progression-free survival, steroid use for CNS symptoms and feasibility of recruitment to a large phase III trial. RESULTS Between September 2011 and October 2013, 30 participants were randomised, 16 to lap-cap and 14 to tras-cap. Recruitment to a large phase III trial was determined not to be feasible. At 24 weeks, CNS disease progression was 41.8% (95% confidence interval 16.1-67.5%) in lap-cap and 41.2% (95% confidence interval 12.8-69.6%) in tras-cap arms; progression-free survival was 44.4% (95% confidence interval 18.1-70.8%) in lap-cap and 50.0% (95% confidence interval 20.9-79.1%) in tras-cap arms. CONCLUSION Poor recruitment confirmed that a larger phase III trial would not be feasible and prohibited a preliminary evaluation of the superiority of lap-cap over tras-cap. Descriptive statistics are presented to inform the limited evidence base and future study design.
Collapse
Affiliation(s)
- J F Seligmann
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Wright-Hughes
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Pottinger
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Velikova
- St James's Institute of Oncology, St James University Hospital, Leeds, UK
| | - J B Oughton
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Murden
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - M Rizwanullah
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Price
- Department of Medical Oncology, University Hospitals, Bristol, UK
| | - H Passant
- Department of Medical Oncology, Velindre Hospital, Cardiff, UK
| | - P Heudtlass
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - S Johnston
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Dodwell
- St James's Institute of Oncology, St James University Hospital, Leeds, UK; Nuffield Department of Population Health, Oxford University, Oxford, UK.
| |
Collapse
|
18
|
Harji DP, Marshall H, Gordon K, Twiddy M, Pullan A, Meads D, Croft J, Burke D, Griffiths B, Verjee A, Sagar P, Stocken D, Brown J. Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial. Br J Surg 2020; 107:1595-1604. [PMID: 32573782 DOI: 10.1002/bjs.11703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 30 000 people undergo major emergency abdominal gastrointestinal surgery annually, and 36 per cent of these procedures (around 10 800) are carried out for emergency colorectal pathology. Some 14 per cent of all patients requiring emergency surgery have a laparoscopic procedure. The aims of the LaCeS (laparoscopic versus open colorectal surgery in the acute setting) feasibility trial were to assess the feasibility, safety and acceptability of performing a large-scale definitive phase III RCT, with a comparison of emergency laparoscopic versus open surgery for acute colorectal pathology. METHODS LaCeS was designed as a prospective, multicentre, single-blind, parallel-group, pragmatic feasibility RCT with an integrated qualitative study. Randomization was undertaken centrally, with patients randomized on a 1 : 1 basis between laparoscopic or open surgery. RESULTS A total of 64 patients were recruited across five centres. The overall mean steady-state recruitment rate was 1·2 patients per month per site. Baseline compliance for clinical and health-related quality-of-life data was 99·8 and 93·8 per cent respectively. The conversion rate from laparoscopic to open surgery was 39 (95 per cent c.i. 23 to 58) per cent. The 30-day postoperative complication rate was 27 (13 to 46) per cent in the laparoscopic arm and 42 (25 to 61) per cent in the open arm. CONCLUSION Laparoscopic emergency colorectal surgery may have an acceptable safety profile. Registration number: ISRCTN15681041 ( http://www.controlled-trials.com).
Collapse
Affiliation(s)
- D P Harji
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - K Gordon
- Clinical Trials Research Unit, Leeds, UK
| | - M Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - A Pullan
- Clinical Trials Research Unit, Leeds, UK
| | - D Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Croft
- Clinical Trials Research Unit, Leeds, UK
| | - D Burke
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - B Griffiths
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Verjee
- Patient and Public Involvement Representative for LaCeS Trial, UK
| | - P Sagar
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - D Stocken
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Clinical Trials Research Unit, Leeds, UK
| | | |
Collapse
|
19
|
Zegard A, Qiu T, Mcnulty D, Evison F, Okafor O, Marshall H, Gasparini M, Leyva F. 305Pacemaker therapy after cardiac valve replacement surgery: impact on heart failure hospitalizations. Europace 2020. [DOI: 10.1093/europace/euaa162.366] [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
Left ventricular (LV) function is a major determinant of long-term outcomes after valve replacement surgery. Although conventional (right ventricular) pacemaker therapy is life-saving, it may cause heart failure (HF).
Aims
To determine whether permanent pacemaker implantation (PPI) confers a risk of HF in surgical valve recipients.
Methods
The primary endpoint of HF hospitalization and the secondary endpoints of total mortality and total mortality / HF hospitalizations were compared in valve recipients with and without PPI. Traditional as well as multi-state, multivariable modelling was used to assess the influence of PPI on clinical outcomes.
Results
Amongst patients (n = 135,242) undergoing a first aortic (AVR; n = 111,674), mitral (MVR; n = 18,402) valve replacement, or AVR + MVR (n = 5,166) over 14 years in 176 centre, 12,952 (10.6%) had a PPI at any time during follow-up and 5,805 (4.3%) underwent PPI postoperatively. After 3.9 yrs (median, interquartile range: 6.1), heart failure (HF) hospitalizations (HR: 1.47, 95% C.I. 1.36-1.59), total mortality (HR: 1.10, 95% C.I. 1.05-1.16) and total mortality or HF hospitalizations (HR: 1.17, 95% C.I. 1.12-1.22; see figure) were higher in patients with post-operative PPI than in patients without. Multi-state modelling revealed that the transition hazard from PPI at any time to HF hospitalizations was markedly higher (transition hazard rate: 0.29, 95% C.I. 0.24-0.36) than from valve replacement surgery to HF hospitalization.
Conclusions
After valve replacement surgery, PPI is associated with increased HF hospitalization and total mortality, particularly after dual valve replacements.
Abstract Figure.
Collapse
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - D Mcnulty
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Evison
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Gasparini
- Humanitas Research Hospital, IRCCS, Electrophysiology and Pacing Unit, Rozzano, Italy
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
20
|
Rattanakosit T, Franke K, Marshall H, Agbaedeng T, Sanders P, Lau D, Mahajan R. P1428The outcome of atrial fibrillation ablation in patients undergoing radiofrequency ablation, guided by novel indices incorporating force, time and power. Europace 2020. [DOI: 10.1093/europace/euaa162.353] [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
Ablation index (AI) and Lesion Size Index (LSI) are novel parameters that incorporates contact force, time, and power in a weighted formula. Recent studies have shown that such indices predict lesion size and durability of pulmonary vein isolation (PVI). However, the outcomes of ablation guided by indices of force-time-power, such as PV reconnections and atrial fibrillation recurrence, have not been well characterised.
Objectives
To determine the association between indices of force-time-power and acute PV reconnections, procedure and fluoroscopy time and AF recurrence in patients undergoing radiofrequency PVI.
Methods
PUBMED and EMBASE were searched using the terms "catheter ablation" AND "Ablation index" OR "Contact force" OR "Force time integral" OR "lesion size" from inception through 22 May 2019. Studies reporting the procedure time, ablation time, fluoroscopy time, and incidence of AI acute and late reconnection and AF recurrence were included.
Result
Six studies were included in this study with 530 patients, which n = 416 were paroxysmal AF and 114 non-paroxysmal AF. All procedural characteristics (procedure, radiofrequency, and fluoroscopy times) were similar between AI guided and non-AI guided ablation (p > 0.05). Two studies comparing mean PV reconnections in AI guided vs. AI Blinded. Two studies compared minimum AI in reconnected vs. non-reconnected PV segments. Acute PV segment reconnection was associated with a lower minimum AI vs. non-reconnection. In 3 studies reporting AI guided vs. AI blinded ablations, AI was associated with an increased freedom from AF after average follow-up of 12 months.
Conclusions
Radiofrequency ablation guided by AI/LSI was associated with lower acute PV reconnection rates and improved AF freedom after PVI. There was no difference in fluoroscopy, ablation or procedure time with the use of these novel parameters.
Abstract Figure.
Collapse
Affiliation(s)
- T Rattanakosit
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - K Franke
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - H Marshall
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - T Agbaedeng
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - D Lau
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - R Mahajan
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| |
Collapse
|
21
|
Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
Collapse
Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
22
|
Swinson D, Hall P, Lord S, Marshall H, Ruddock S, Allmark C, Cairns D, Waters J, Wadsley J, Falk S, Roy R, Joseph M, Nicoll J, Kamposioras K, Tillett T, Cummins S, Grumett S, Stokes Z, Waddell T, Chatterjee A, Garcia A, Khan M, Petty R, Seymour M. OPTIMIZING CHEMOTHERAPY FOR FRAIL AND/OR ELDERLY PATIENTS WITH ADVANCED GASTROESOPHAGEAL CANCER (AGOAC): THE GO2 PHASE III TRIAL. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Franke K, Marshall H, Worthley M, Psaltis PJ. P3646A systematic review and meta-analysis on spontaneous coronary artery dissection: epidemiology, risk factors and outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Spontaneous Coronary Artery Dissection (SCAD) is an elusive but increasingly recognised cause of Acute Coronary Syndrome (ACS). Most knowledge about SCAD has arisen from small to medium sized cohort studies that have been published since 2012.
Purpose
This systematic review and meta-analysis aimed to provide an update on SCAD's association with cardiovascular risk factors, angiographic variants and outcomes.
Methods
The term “Spontaneous Coronary Artery Dissection” was searched in PubMed, EMBASE and SCOPUS on the 2nd of February 2019, yielding a total of 1517 articles. Following exclusion (e.g. of isolated case reports and duplicate cohorts), 31 original studies that reported at least one desired parameter in patients with SCAD were included. Statistical analysis was performed independently for each parameter using random effects models.
Results
Of the k=31 studies (n=77,025 patients), only 3 were published before 2012 (n=68). Mean age was 62.4 years and 85.1% [78.9%-89.8%, I2=91.7, k=28] were female. Prevalence of associated conditions and traditional cardiovascular risk factors are outlined in the table. Importantly, only 37.4% [30.0%-45.4%, I2=77.0, k=10] were associated with a traditional Type 1 angiographic appearance. Yearly incidence was 3.4% [2.4%-4.4%, I2=73.4, k=16] for SCAD recurrence and 5.8% [4.1%-7.5%, I2=85.7, k=16] for MACE. Incidence of MACE at follow-up was 4.1% [1.7%-9.9%, I2=74.0, k=3] for conservative treatment and 7.2% [5.1%-10.3%, I2=43.7, k=4] for PCI (p=0.14).
Estimated prevalence of traditional cardiovascular risk factors, associated conditions and angiographic variants in cohorts of patients with SCAD Associated Patient Factor Number of Studies Prevalence (%, [95% CI]) Heterogeneity (I2) Hypertension 29 36.0 [29.9–42.6] 97.9% Dyslipidemia 27 28.7 [17.4–43.5] 99.7% Smoking 29 23.3 [14.5–35.3] 99.6% Depression/Anxiety 6 28.1 [19.3–38.9] 94.3% Fibromuscular Dysplasia 9 50.7 [40.0–61.3] 91.9% Type 1 Angiographic Appearance 11 37.4 [30.0–45.4] 77.0% Type 2 Angiographic Appearance 11 62.4 [50.0–73.3] 93.3% Type 3 Angiographic Appearance 6 10.2 [6.2–16.4] 78.3%
Incidence of Recurrence in SCAD Cohorts
Conclusions
This meta-analysis confirms associations of SCAD with fibromuscular dysplasia, anxiety and depression, and reveals a small but important risk of recurrence and MACE. Furthermore, a majority of SCAD cases present with non-traditional angiographic appearances highlighting the need for increased familiarity with this condition among treating physicians.
Collapse
Affiliation(s)
- K Franke
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - H Marshall
- University of Adelaide, Adelaide, Australia
| | - M Worthley
- University of Adelaide, Adelaide, Australia
| | - P J Psaltis
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
24
|
Franke K, Marshall H, Kennewell P, Pham HD, Rattanakosit T, Aboustate N, Tully P, Mahajan R. P989Incidence of appropriate implantable cardioverter defibrillator therapy and sudden cardiac death in cardiac sarcoidosis - a systematic review and meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy.
Purpose
This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of sudden cardiac death (SCD) in patients with CS.
Methods
The terms “Cardiac Sarcoidosis*” AND “Implantable Cardioverter Defibrillator” AND “Sudden Cardiac Death” were searched on PubMed, EMBASE, and Scopus on 21st of September 2018 yielding 759 articles. After exclusions, 12 studies met inclusion criteria.
Results
The 12 studies consisted of 612 patients with CS of which 534 had ICD implanted for primary or secondary prevention. Assuming appropriate device therapy as a surrogate for SCD, the annual incidence of appropriate ICD therapies and SCD combined was 6.3% (95% CI; 3.5%-9.1%) in primary prevention cohorts, 11.6% (95% CI; 7.8%-15.3%) in secondary prevention cohorts, and 8.7% (95% CI; 6.0%-11.5%) in both cohorts. The mean left ventricular ejection fraction (LVEF) was pooled as 59±7 (n=155) in primary prevention cohorts and 48±15 (n=48) in secondary prevention cohorts. However, the LVEF was 35±13 (n=28) in those with appropriate ICD therapy, and 49±16 (n=47) in those with ICDs without therapy.
Incidence of SCD in Combined Cohorts
Conclusion
The incidence of ventricular arrhythmias and SCD is high not only secondary but also in primary prevention cohorts of CS. This data supports the role of implanting ICDs for primary prevention in patients with CS with mild to moderate reduction in LVEF.
Acknowledgement/Funding
None
Collapse
Affiliation(s)
- K Franke
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - H Marshall
- University of Adelaide, Adelaide, Australia
| | | | - H D Pham
- University of Adelaide, Adelaide, Australia
| | - T Rattanakosit
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - N Aboustate
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - P Tully
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, South Australian Health and Medical Research Institute, and Lyell McEwin Hospital, Adelaide, Australia
| |
Collapse
|
25
|
Hall P, Swinson D, Lord S, Handforth C, Cairns D, Marshall H, Petty R, Bennett M, Velikova G, Seymour M. Chemotherapy for frail and elderly patients (pts) with advanced gastroesophageal cancer (aGOAC): Quality of Life (QoL) results from the GO2 phase III trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
Bebane PSA, Hunt BJ, Pegoraro M, Jones ARC, Marshall H, Rosato E, Mallon EB. The effects of the neonicotinoid imidacloprid on gene expression and DNA methylation in the buff-tailed bumblebee Bombus terrestris. Proc Biol Sci 2019; 286:20190718. [PMID: 31213186 PMCID: PMC6599982 DOI: 10.1098/rspb.2019.0718] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
Neonicotinoids are effective insecticides used on many important arable and horticultural crops. They are nicotinic acetylcholine receptor agonists which disrupt the function of insect neurons and cause paralysis and death. In addition to direct mortality, there are numerous sublethal effects of low doses of neonicotinoids on bees. We hypothesize that some of these large array of effects could be a consequence of epigenetic changes in bees induced by neonicotinoids. We compared whole methylome (BS-seq) and RNA-seq libraries of the brains of buff-tailed bumblebee Bombus terrestris workers exposed to field-realistic doses of the neonicotinoid imidacloprid to libraries from control workers. We found numerous genes which show differential expression between neonicotinoid-treated bees and control bees, but no differentially methylated cytosines in any context. We found CpG methylation to be focused mainly in exons and associated with highly expressed genes. We discuss the implications of our results for future legislation.
Collapse
Affiliation(s)
- P S A Bebane
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - B J Hunt
- 2 School of Natural Sciences and Psychology, John Moores University Liverpool , Liverpool L3 3AF , UK
| | - M Pegoraro
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - A R C Jones
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - H Marshall
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - E Rosato
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - E B Mallon
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| |
Collapse
|
27
|
Smith L, Hughes D, Chan HF, Johnson K, Bray J, Rodgers O, Collier G, Norquay G, Biancardi A, Hughes P, Kotecha S, Wildman M, West N, Horsley A, Marshall H, Wild J. WS17-2 The sensitivity of MRI to detect both functional and structural lung abnormalities in sub-clinical cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
28
|
Smith L, Marshall H, Norquay G, Collier G, Rodgers O, Hughes P, Biancardi A, West N, Wildman M, Horsley A, Wild J. P211 129Xe ventilation MRI and LCI to assess acute maximal exercise as a method of airway clearance. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Smith L, Collier G, Marshall H, Hughes P, Biancardi A, Norquay G, Bray J, Rodgers O, Wildman M, West N, Horsley A, Wild J. P212 Ventilation MRI tracks longitudinal lung function changes in patients with cystic fibrosis and clinically stable FEV1 and Lung Clearance Index. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30505-3] [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: 10/26/2022]
|
30
|
Hart K, Marshall H, Swinscoe J, Robinson S, Matthew T, Tozer-Loft S, Hatton M, Wild J, Ireland R, Tahir B. OC-0523 3He MRI for functional lung avoidance VMAT treatment planning in lung cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30943-0] [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: 10/26/2022]
|
31
|
Franke K, Marshall H, Kennewell P, Pham H, Rattanakosit T, Aboustate N, Tully P, Mahajan R. A Systematic Review and Meta-Analysis on the Incidence of Appropriate Implantable Cardioverter Defibrillator Therapy and Sudden Cardiac Death in Cardiac Sarcoidosis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.153] [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]
|
32
|
Franke K, Marshall H, Worthley M, Psaltis P. A Systematic Review and Meta-analysis on Epidemiology, Angiographic Variants and Outcomes in Spontaneous Coronary Artery Dissection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.571] [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: 10/26/2022]
|
33
|
Burgess T, Braunack-Mayer A, Tooher R, Collins J, O'Keefe M, Skinner R, Watson M, Ashmeade H, Proeve C, Marshall H. Optimizing intersectoral collaboration between health and education: the Health Bridges study. J Public Health (Oxf) 2018; 38:e430-e437. [PMID: 28158696 DOI: 10.1093/pubmed/fdv190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Burgess
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | | | - R Tooher
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - J Collins
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - M O'Keefe
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | | | - M Watson
- Immunisation Section, Department for Health and Ageing, Adelaide, SA 5000, Australia
| | - H Ashmeade
- Department for Education and Child Development, South Australia, Australia
| | - C Proeve
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | | |
Collapse
|
34
|
Lam S, Myers R, Atkar-Khattra S, Yuan R, Yee J, English J, Grant K, Lee A, Mcguire A, McWilliams A, Brims F, Stone E, Chin V, Chantrill L, Connellan M, Plitt M, Marshall H, Yang I, Bowman R, Fong K, Mayo J. MA03.02 Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Coleman RE, Collinson M, Gregory W, Marshall H, Bell R, Dodwell D, Keane M, Gil M, Barrett-Lee P, Ritchie D, Bowman A, Liversedge V, De Boer RH, Passos-Coelho JL, O'Reilly S, Bertelli G, Joffe J, Brown JE, Wilson C, Tercero JC, Jean-Mairet J, Gomis R, Cameron D. Benefits and risks of adjuvant treatment with zoledronic acid in stage II/III breast cancer. 10 years follow-up of the AZURE randomized clinical trial (BIG 01/04). J Bone Oncol 2018; 13:123-135. [PMID: 30591866 PMCID: PMC6303395 DOI: 10.1016/j.jbo.2018.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022] Open
Abstract
Adjuvant bisphosphonates improve disease outcomes in postmenopausal early breast cancer (EBC) but the long-term effects are poorly described. The AZURE trial (ISRCTN79831382) was designed to determine whether adjuvant zoledronic acid (ZOL) improves disease outcomes in EBC. Previous analyses showed no effect on overall outcomes but identified benefits in postmenopausal women. Here we present the long-term risks and benefits of adjuvant ZOL with 10-years follow-up. Patients and methods 3360 patients with stage II/III breast cancer were included in an academic, international, phase III, randomized, open label trial. Patients were followed up on a regular schedule until 10 years. Patients were randomized on a 1:1 basis to standard adjuvant systemic therapy +/− intravenous ZOL 4 mg every 3–4 weeks x6, and then at reduced frequency to complete 5 years treatment. The primary outcome was disease free survival (DFS). Secondary outcomes included invasive DFS (IDFS), overall survival (OS), sites of recurrence, skeletal morbidity and treatment outcomes according to primary tumor amplification of the transcription factor, MAF. Pre-planned subgroup analyses focused on interactions between menopausal status and treatment effects. Results With a median follow up of 117 months [IQR 70.4–120.4), DFS and IDFS were similar in both arms (HRDFS = 0.94, 95%CI = 0.84–1.06, p = 0.340; HRIDFS = 0.91, 95%CI = 0.82–1.02, p = 0.116). However, outcomes remain improved with ZOL in postmenopausal women (HRDFS = 0.82, 95%CI = 0.67–1.00; HRIDFS = 0.78, 95%CI = 0.64–0.94). In the 79% of tested women with a MAF FISH negative tumor, ZOL improved IDFS (HRIDFS = 0.75, 95%CI = 0.58–0.97) and OS HROS = 0.69, 95%CI = 0.50–0.94), irrespective of menopause. ZOL did not improve disease outcomes in MAF FISH + tumors. Bone metastases as a first DFS recurrence (BDFS) were reduced with ZOL (HRB-DFS = 0.76, 95%CI = 0.63–0.92, p = 0.005). ZOL reduced skeletal morbidity with fewer fractures and skeletal events after disease recurrence. 30 cases of osteonecrosis of the jaw in the ZOL arm (1.8%) have occurred. Conclusions Disease benefits with adjuvant ZOL in postmenopausal early breast cancer persist at 10 years of follow-up. The biomarker MAF identified a patient subgroup that derived benefit from ZOL irrespective of menopausal status.
Collapse
Affiliation(s)
- R E Coleman
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - M Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - W Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R Bell
- Andrew Love Cancer Centre, Geelong, Australia
| | - D Dodwell
- St James Institute of Oncology, University of Leeds, UK
| | - M Keane
- University Hospital Galway, Ireland
| | - M Gil
- Institut Català d´Oncologia - IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - D Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Bowman
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
| | - V Liversedge
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R H De Boer
- Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | - J Joffe
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - J E Brown
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - C Wilson
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | | | | | - R Gomis
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Science and Technology Institute, CIBERONC and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - D Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
| |
Collapse
|
36
|
Pickup LC, Aziz A, Gaffey T, Fyaaz S, Babu A, Marshall H, Hudsmith L, De Bono J. P710Catheter ablation of atrial tachyarrhythmia in the fontan circulation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L C Pickup
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - A Aziz
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - T Gaffey
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - S Fyaaz
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - A Babu
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Department of Electrophysiology, Birmingham, United Kingdom
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Department of Adult Congential Heart Disease, Birmingham, United Kingdom
| | - J De Bono
- Queen Elizabeth Hospital Birmingham, Department of Electrophysiology, Birmingham, United Kingdom
| |
Collapse
|
37
|
Wilson C, Bell R, Hinsley S, Marshall H, Brown J, Cameron D, Dodwell D, Coleman R. Adjuvant zoledronic acid reduces fractures in breast cancer patients; an AZURE (BIG 01/04) study. Eur J Cancer 2018; 94:70-78. [PMID: 29544162 DOI: 10.1016/j.ejca.2018.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
Abstract
The fracture impact of adjuvant bisphosphonates in breast cancer is not defined with most trials reporting changes in bone mineral density as a surrogate. The AZURE trial (ISRCTN79831382) evaluated the impact of adjuvant zoledronic acid (ZOL) on fractures. The AZURE trial is an academic, multi-centre, randomised phase III study evaluating the addition of ZOL 4 mg to standard therapy (neo/adjuvant chemotherapy and/or endocrine therapy) for 5 years (administered by intravenous (iv) infusion every 3-4 weeks for 6 doses, then 3 monthly × 8 and 6 monthly × 5) in patients with stage II/III early breast cancer. Fracture data collected as part of skeletal-related adverse event reporting were analysed after a median of 84.2 months of follow-up and 966 disease-free survival (DFS) events. We assessed number of fractures, time-to-first fracture and the incidence of fractures before and after disease recurrence. Two hundred forty-four patients reported ≥1 fracture, 140 (8.3%) in the control arm (171 fractures) and 104 (6.2%) in the ZOL arm (120 fractures). Of the 291 fractures reported, 207 fractures occurred in the absence of recurrence (control 111, ZOL 96), 80 after recurrence (control 59, ZOL 21). The 5-year fracture rate was reduced from 5.9% (95%CI 4.8, 7.1%; control) to 3.8% (95%CI 2.9, 4.7%) with ZOL. ZOL significantly increased time-to-first fracture (HR 0.69, 95%CI 0.53-0.90; P = 0.0053) but the majority of fracture prevention benefit occurred after a DFS event (HR 0.3; 95%CI 0.17, 0.53; P < 0.001). Fracture benefits from ZOL were similar across menopausal sub-groups. In conclusion, adjuvant ZOL reduced the risk of clinical fractures, the majority of this protection occurred after disease recurrence.
Collapse
Affiliation(s)
- C Wilson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK.
| | - R Bell
- Deakin University, Geelong, Australia
| | - S Hinsley
- Clinical Trials Research Unit, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - D Cameron
- Cancer Research UK Edinburgh Centre, Western General Hospital, University of Edinburgh, UK
| | - D Dodwell
- Institute of Oncology, Bexley Wing, St James Hospital, Leeds, UK
| | - R Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| |
Collapse
|
38
|
Tahir B, Hughes P, Robinson S, Marshall H, Stewart N, Biancardi A, Chan H, Collier G, Hart K, Swinscoe J, Hatton M, Wild J, Ireland R. OC-0182: A comparison of CT ventilation with 3He and 129Xe MRI for functional avoidance treatment planning. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30492-4] [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: 10/14/2022]
|
39
|
Zegard A, Umar F, Taylor RJ, Acquaye E, Gubran C, Chalil S, Patel K, Panting J, Marshall H, Qiu T, Leyva F. 667Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - F Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - R J Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - E Acquaye
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - C Gubran
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S Chalil
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
| |
Collapse
|
40
|
Zegard A, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Ferro CJ, Marshall H, Qiu T, Leyva F. 273Renal function and the long term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - R Taylor
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - PWX Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom, Swindon, United Kingdom
| | - F Umar
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - K Patel
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom, Birmingham, United Kingdom
| | - J Panting
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom, Birmingham, United Kingdom
| | - C J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
| |
Collapse
|
41
|
Zegard A, Patel K, Panting J, Marshall H, Qiu T, Leyva F. P818Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. Europace 2018. [DOI: 10.1093/europace/euy015.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
| |
Collapse
|
42
|
Zegard A, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Van Dam P, Prinzen FW, Marshall H, Qiu T, Leyva F. P1136Long-term outcomes of cardiac resynchronization therapy using apical versus non-apical left ventricular pacing. Europace 2018. [DOI: 10.1093/europace/euy015.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - R Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - PWX Foley
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - F Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - P Van Dam
- PEACS, Arnhem, The Netherlands, Arnhem, Netherlands
| | - F W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
| |
Collapse
|
43
|
Demetriades P, Bell A, Gubran C, Marshall H, de Bono J, Hudsmith L. Suitability of cardiac resynchronisation therapy in patients with Fontan circulation and congenitally corrected transposition of the great arteries. Int J Cardiol 2017; 249:166-168. [DOI: 10.1016/j.ijcard.2017.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/30/2022]
|
44
|
Abstract
Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.
Collapse
Affiliation(s)
- H Marshall
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - M McMillan
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - R M Andrews
- b Menzies School of Health Research , Brisbane , Queensland , Australia
| | - K Macartney
- c Sydney Medical School, Sydney, New South Wales, Australia; Department of Infectious Diseases and Microbiology , The Children's Hospital at Westmead, Sydney, New South Wales, Australia; National Centre for Immunization Research and Surveillance , Sydney , New South Wales , Australia
| | - K Edwards
- d Vanderbilt University , Nashville , TN , USA
| |
Collapse
|
45
|
Zegard A, Acquaye E, Gubran C, Taylor R, Foley P, Umar F, Patel K, Panting J, Marshall H, Qiu T, Leyva F. 19Clinical outcomes of cardiac resynchronization therapy with or without defibrillation in non-ischemic cardiomyopathy: impact of left ventricular midwall fibrosis. Europace 2017. [DOI: 10.1093/europace/eux283.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
Zegard A, Umar F, Taylor R, Acquaye E, Gubran C, Chalil S, Patel K, Panting J, Marshall H, Qiu T, Leyva F. 43Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the etiology of cardiomyopathy. Europace 2017. [DOI: 10.1093/europace/eux283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
47
|
Bond R, Marshall H, Hudsmith L, De Bono J. 70Incidence of arrhythmias in Ebstein’s anomaly in a single centre. Europace 2017. [DOI: 10.1093/europace/eux283.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Danchin MH, Costa-Pinto J, Attwell K, Willaby H, Wiley K, Hoq M, Leask J, Perrett KP, O'Keefe J, Giles ML, Marshall H. Vaccine decision-making begins in pregnancy: Correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine 2017; 36:6473-6479. [PMID: 28811050 DOI: 10.1016/j.vaccine.2017.08.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/09/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maternal and childhood vaccine decision-making begins prenatally. Amongst pregnant Australian women we aimed to ascertain vaccine information received, maternal immunisation uptake and attitudes and concerns regarding childhood vaccination. We also aimed to determine any correlation between a) intentions and concerns regarding childhood vaccination, (b) concerns about pregnancy vaccination, (c) socioeconomic status (SES) and (d) uptake of influenza and pertussis vaccines during pregnancy and routine vaccines during childhood. METHODS Women attending public antenatal clinics were recruited in three Australian states. Surveys were completed on iPads. Follow-up phone surveys were done three to six months post delivery, and infant vaccination status obtained via the Australian Childhood Immunisation Register (ACIR). RESULTS Between October 2015 and March 2016, 975 (82%) of 1184 mothers consented and 406 (42%) agreed to a follow up survey, post delivery. First-time mothers (445; 49%) had significantly more vaccine concerns in pregnancy and only 73% had made a decision about childhood vaccination compared to 89% of mothers with existing children (p-value<0.001). 66% of mothers reported receiving enough information during pregnancy on childhood vaccination. In the post delivery survey, 46% and 82% of mothers reported receiving pregnancy influenza and pertussis vaccines respectively. The mother's degree of vaccine hesitancy and two attitudinal factors were correlated with vaccine uptake post delivery. There was no association between reported maternal vaccine uptake or SES and childhood vaccine uptake. CONCLUSION First time mothers are more vaccine hesitant and undecided about childhood vaccination, and only two thirds of all mothers believed they received enough information during pregnancy. New interventions to improve both education and communication on childhood and maternal vaccines, delivered by midwives and obstetricians in the Australian public hospital system, may reduce vaccine hesitancy for all mothers in pregnancy and post delivery, particularly first-time mothers.
Collapse
Affiliation(s)
- M H Danchin
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia; Department of General Medicine, The Royal Children's Hospital, Australia; School of Population and Global Health, The University of Melbourne, Australia.
| | - J Costa-Pinto
- Department of General Medicine, The Royal Children's Hospital, Australia
| | - K Attwell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University, Australia
| | - H Willaby
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Australia
| | - K Wiley
- National Centre for Immunisation Research and Surveillance, Australia
| | - M Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Australia
| | - J Leask
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Australia; National Centre for Immunisation Research and Surveillance, Australia
| | - K P Perrett
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia; Department of General Medicine, The Royal Children's Hospital, Australia; School of Population and Global Health, The University of Melbourne, Australia
| | - Jacinta O'Keefe
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia
| | - M L Giles
- The Alfred Hospital, Royal Women's Hospital and Monash Health and Monash University, Australia
| | - H Marshall
- Women's and Children's Hospital and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| |
Collapse
|
49
|
Sousa AR, Marshall RP, Warnock LC, Bolton S, Hastie A, Symon F, Hargadon B, Marshall H, Richardson M, Brightling CE, Haldar P, Milone R, Chalk P, Williamson R, Panettieri R, Knowles R, Bleecker ER, Wardlaw AJ. Responsiveness to oral prednisolone in severe asthma is related to the degree of eosinophilic airway inflammation. Clin Exp Allergy 2017; 47:890-899. [PMID: 28493293 DOI: 10.1111/cea.12954] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/31/2017] [Accepted: 04/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with severe asthma appear relatively corticosteroid resistant. Corticosteroid responsiveness is closely related to the degree of eosinophilic airway inflammation. The extent to which eosinophilic airway inflammation in severe asthma responds to treatment with systemic corticosteroids is not clear. OBJECTIVE To relate the physiological and inflammatory response to systemic corticosteroids in asthma to disease severity and the baseline extent of eosinophilic inflammation. METHODS Patients with mild/moderate and severe asthma were investigated before and after 2 weeks of oral prednisolone (Clintrials.gov NCT00331058 and NCT00327197). We pooled the results from two studies with common protocols. The US study contained two independent centres and the UK one independent centre. The effect of oral corticosteroids on FEV1 , Pc20, airway inflammation and serum cytokines was investigated. Baseline measurements were compared with healthy subjects. RESULTS Thirty-two mild/moderate asthmatics, 50 severe asthmatics and 35 healthy subjects took part. At baseline, both groups of asthmatics had a lower FEV1 and Pc20 and increased eosinophilic inflammation compared to healthy subjects. The severe group had a lower FEV1 and more eosinophilic inflammation compared to mild/moderate asthmatics. Oral prednisolone caused a similar degree of suppression of eosinophilic inflammation in all compartments in both groups of asthmatics. There were small improvements in FEV1 and Pc20 for both mild/ moderate and severe asthmatics with a correlation between the baseline eosinophilic inflammation and the change in FEV1 . There was a ~50% reduction in the serum concentration of CXCL10 (IP-10), CCL22 (MDC), CCL17 (TARC), CCL-2 (MCP-1) and CCL-13 (MCP-4) in both asthma groups after oral corticosteroids. CONCLUSIONS AND CLINICAL RELEVANCE Disease severity does not influence the response to systemic corticosteroids. The study does not therefore support the concept that severe asthma is associated with corticosteroid resistance. Only baseline eosinophilic inflammation was associated with the physiological response to corticosteroids, confirming the importance of measuring eosinophilic inflammation to guide corticosteroid use.
Collapse
Affiliation(s)
- A R Sousa
- GlaxoSmithKline Stevenage, Stevenage, UK
| | | | | | - S Bolton
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Hastie
- Center for Genomics & Personalized Medicine, Section of Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - F Symon
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - B Hargadon
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - H Marshall
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Richardson
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C E Brightling
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - P Haldar
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R Milone
- GlaxoSmithKline Stevenage, Stevenage, UK
| | - P Chalk
- Knowles Consulting, Stevenage, UK
| | | | - R Panettieri
- Rutgers, the State University of New Jersey, New Jersey, USA
| | | | - E R Bleecker
- Center for Genomics & Personalized Medicine, Section of Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - A J Wardlaw
- Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Respiratory Biomedical Research Unit University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
50
|
Zegard A, Qiu T, Mcnulty D, Evison F, Marshall H, Doshi SN, Ludman P, Gasparini M, Prinzen F, Leyva F. P463The long-term risk of heart failure hospitalization after surgical and transcatheter valve replacement. Europace 2017. [DOI: 10.1093/ehjci/eux141.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|