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Aevermann BD, Di Domizio J, Olah P, Saidoune F, Armstrong JM, Bachelez H, Barker J, Haniffa M, Julia V, Juul K, Krishnaswamy JK, Litman T, Parsons I, Sarin KY, Schmuth M, Sierra M, Simpson M, Homey B, Griffiths CEM, Scheuermann RH, Gilliet M. Cross-Comparison of Inflammatory Skin Disease Transcriptomics Identifies PTEN as a Pathogenic Disease Classifier in Cutaneous Lupus Erythematosus. J Invest Dermatol 2024; 144:252-262.e4. [PMID: 37598867 DOI: 10.1016/j.jid.2023.06.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 08/22/2023]
Abstract
Tissue transcriptomics is used to uncover molecular dysregulations underlying diseases. However, the majority of transcriptomics studies focus on single diseases with limited relevance for understanding the molecular relationship between diseases or for identifying disease-specific markers. In this study, we used a normalization approach to compare gene expression across nine inflammatory skin diseases. The normalized datasets were found to retain differential expression signals that allowed unsupervised disease clustering and identification of disease-specific gene signatures. Using the NS-Forest algorithm, we identified a minimal set of biomarkers and validated their use as diagnostic disease classifier. Among them, PTEN was identified as being a specific marker for cutaneous lupus erythematosus and found to be strongly expressed by lesional keratinocytes in association with pathogenic type I IFNs. In fact, PTEN facilitated the expression of IFN-β and IFN-κ in keratinocytes by promoting activation and nuclear translocation of IRF3. Thus, cross-comparison of tissue transcriptomics is a valid strategy to establish a molecular disease classification and to identify pathogenic disease biomarkers.
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Affiliation(s)
- Brian D Aevermann
- J. Craig Venter Institute, La Jolla, California, USA; Chan Zuckerberg Initiative, Redwood City, California, USA
| | - Jeremy Di Domizio
- Department of Dermatology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Olah
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Fanny Saidoune
- Department of Dermatology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Hervé Bachelez
- Department of Dermatology, Paris Diderot University, Paris, France
| | - Jonathan Barker
- St John's Institute of Dermatology, Faculty of Life Sciences & Medicine, Kings College London, London, United Kingdom
| | - Muzlifah Haniffa
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, United Kingdom
| | | | | | | | | | - Ian Parsons
- Celgene International Sarl, Boudry, Switzerland
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Michael Simpson
- Department of Genomic Medicine, King's College London, London, United Kingdom
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christopher E M Griffiths
- Section of Dermatology, Department of Medicine, University of Manchester, Manchester, United Kingdom
| | - Richard H Scheuermann
- J. Craig Venter Institute, La Jolla, California, USA; Department of Pathology, University of California San Diego School of Medicine, La Jolla, California, USA; La Jolla Institute for Immunology, La Jolla, California, USA
| | - Michel Gilliet
- Department of Dermatology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
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Barker J. Pioneers in Dermatology and Venereology: An interview with Professor Jonathan Barker. J Eur Acad Dermatol Venereol 2024; 38:17-19. [PMID: 38126692 DOI: 10.1111/jdv.19629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Jonathan Barker
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas's Hospitals, London, UK
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3
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Choon SE, Barker J, Bachelez H. Understanding generalized pustular psoriasis for improved patient care. Exp Dermatol 2023; 32:1186-1187. [PMID: 37545118 DOI: 10.1111/exd.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Siew Eng Choon
- Hospital Sultanah Aminah Johor Bahru and Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
| | - Jonathan Barker
- St John's Institute of Dermatology, Guys and St Thomas's Hospitals and Kings College London, London, UK
| | - Herve Bachelez
- AP-HP Hôpital Saint-Louis, Laboratory of Genetic Diseases, INSERM U1163, Imagine Institute, Université de Paris, Paris, France
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Elewski BE, Lebwohl MG, Anadkat MJ, Barker J, Ghoreschi K, Imafuku S, Mrowietz U, Li L, Quaresma M, Thoma C, Bachelez H. Rapid and sustained improvements in Generalized Pustular Psoriasis Physician Global Assessment scores with spesolimab for treatment of generalized pustular psoriasis flares in the randomized, placebo-controlled Effisayil 1 study. J Am Acad Dermatol 2023; 89:36-44. [PMID: 36870370 DOI: 10.1016/j.jaad.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Effisayil 1 was a randomized, placebo-controlled study of spesolimab, which is an anti-IL-36 receptor antibody, in patients presenting with a generalized pustular psoriasis flare. OBJECTIVE To assess the effects of spesolimab over the 12-week study. METHODS The primary endpoint of the study was Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 at week 1. Patients (N = 53) were randomized (2:1) to receive a single intravenous dose of 900 mg spesolimab or placebo on day 1. Patients could receive open-label spesolimab for persistent flare symptoms on day 8. RESULTS Most patients receiving spesolimab achieved a GPPGA pustulation subscore of 0 (60.0%) and GPPGA total score of 0 or 1 (60.0%) by week 12. In patients randomized to placebo who received open-label spesolimab on day 8, the proportion with GPPGA pustulation subscore of 0 increased from 5.6% at day 8 to 83.3% at week 2. No factors predictive of spesolimab response were identified in patient demographics or clinical characteristics. LIMITATIONS The effect of initial randomization was not determined conventionally beyond week 1 due to patients receiving open-label spesolimab. CONCLUSION Rapid control of generalized pustular psoriasis flare symptoms with spesolimab was sustained over 12 weeks, further supporting its potential use as a therapeutic option for patients.
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Affiliation(s)
- Boni E Elewski
- University of Alabama School of Medicine, Birmingham, Alabama.
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Milan J Anadkat
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ling Li
- Boehringer Ingelheim Investment Co, Ltd, Shanghai, China
| | | | | | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France; INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
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Tsakok T, Saklatvala J, Rispens T, Loeff FC, de Vries A, Allen MH, Barbosa IA, Baudry D, Dasandi T, Duckworth M, Meynell F, Russell A, Chapman A, McBride S, McKenna K, Perera G, Ramsay H, Ramesh R, Sands K, Shipman A, Burden AD, Griffiths CE, Reynolds NJ, Warren RB, Mahil S, Barker J, Dand N, Smith C, Simpson MA. Development of antidrug antibodies against adalimumab maps to variation within the HLA-DR peptide-binding groove. JCI Insight 2023; 8:e156643. [PMID: 36810251 PMCID: PMC9977494 DOI: 10.1172/jci.insight.156643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
Targeted biologic therapies can elicit an undesirable host immune response characterized by the development of antidrug antibodies (ADA), an important cause of treatment failure. The most widely used biologic across immune-mediated diseases is adalimumab, a tumor necrosis factor inhibitor. This study aimed to identify genetic variants that contribute to the development of ADA against adalimumab, thereby influencing treatment failure. In patients with psoriasis on their first course of adalimumab, in whom serum ADA had been evaluated 6-36 months after starting treatment, we observed a genome-wide association with ADA against adalimumab within the major histocompatibility complex (MHC). The association signal mapped to the presence of tryptophan at position 9 and lysine at position 71 of the HLA-DR peptide-binding groove, with both residues conferring protection against ADA. Underscoring their clinical relevance, these residues were also protective against treatment failure. Our findings highlight antigenic peptide presentation via MHC class II as a critical mechanism in the development of ADA against biologic therapies and downstream treatment response.
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Affiliation(s)
- Teresa Tsakok
- Department of Medical and Molecular Genetics and
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Floris C. Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Michael H. Allen
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Ines A. Barbosa
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - David Baudry
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Tejus Dasandi
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Michael Duckworth
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Freya Meynell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Alice Russell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Anna Chapman
- Department of Dermatology, Queen Elizabeth Hospital, London, United Kingdom
| | - Sandy McBride
- Department of Dermatology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Kevin McKenna
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Gayathri Perera
- Department of Dermatology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Helen Ramsay
- Department of Dermatology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Raakhee Ramesh
- Department of Dermatology, Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom
| | - Kathleen Sands
- Department of Dermatology, East Kent Hospitals University National Health Service Foundation Trust, Kent, United Kingdom
| | - Alexa Shipman
- Department of Dermatology, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | | | - A. David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Christopher E.M. Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nick J. Reynolds
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Translational and Clinical Medicine, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard B. Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Satveer Mahil
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Jonathan Barker
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics and
- Health Data Research UK, London, United Kingdom
| | - Catherine Smith
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
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6
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Mrowietz U, Barker J, Conrad C, Jullien D, Gisondi P, Flower A, Reddy J, Paris M, Picard H, Jardon S, Augustin M. Efficacy and safety of apremilast in patients with limited skin involvement, plaque psoriasis in special areas and impaired quality of life: Results from the EMBRACE randomized trial. J Eur Acad Dermatol Venereol 2023; 37:348-355. [PMID: 36300769 DOI: 10.1111/jdv.18689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/14/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION/BACKGROUND Manifestations of psoriasis in special areas are difficult to treat and are associated with a high disease burden and significant quality of life (QoL) impairment. Topical therapies may be inadequate for these patients, necessitating systemic treatment. OBJECTIVE The objective of EMBRACE was to evaluate the impact on QoL, efficacy and safety of apremilast 30 mg BID in patients with limited skin involvement with plaque psoriasis manifestations in special areas and impaired QoL. METHODS EMBRACE (NCT03774875) was a phase 4, randomized, placebo-controlled, multinational study. Patients had plaque psoriasis not controlled by topical therapy; lack of response, contraindication or intolerance to conventional first-line systemic therapy; psoriasis in ≥1 special area (including visible locations, scalp, nails, genital areas or palmoplantar areas); Psoriasis Area and Severity Index (PASI) ≥3 to ≤10; and Dermatology Life Quality Index (DLQI) >10. The primary endpoint was DLQI response (≥4-point reduction) at Week 16. RESULTS Of 277 randomized patients (apremilast: n = 185; placebo: n = 92), 221 completed Week 16 (apremilast: n = 152; placebo: n = 69). The primary endpoint (≥4-point reduction in DLQI at Week 16) was met by significantly more patients receiving apremilast (73.3%) versus placebo (41.3%; p < 0.0001). Significantly greater improvement in affected body surface area (BSA) and PASI was observed with apremilast versus placebo at Week 16. There were also significantly greater improvements with apremilast versus placebo in itch numeric rating scale (-2.5 vs. -0.9, p < 0.0001) and skin discomfort/pain visual analog scale (-21.5 vs. -5.4, p = 0.0003) and greater achievement of Patient Benefit Index ≥1 (77% vs. 40%, p < 0.0001) at Week 16. No new safety signals were observed. CONCLUSIONS Apremilast significantly improved skin-related QoL in patients with limited skin involvement with plaque psoriasis in special areas and highly impaired QoL. The safety profile was consistent with prior apremilast studies.
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Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jonathan Barker
- St John's Institute of Dermatology of King's College, London, UK
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Denis Jullien
- Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | | | | | | | | | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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8
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Choy S, Paolino A, Kim B, Lim S, Seo J, Tan S, Tan W, Corbett M, Barker J, Lynch M, Smith C, Mahil S. 100 Deep learning image analyses in dermatology, beyond skin lesions: a systematic review. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.110] [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: 11/19/2022]
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9
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Mitchell B, Saklatvala J, Martin N, Smith C, Barker J, Renteria M, Simpson M. 306 Exploring the relationship between acne and mental health. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.318] [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: 11/19/2022]
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10
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Solanky S, Khan S, Ejarque RA, Tosi I, Dawe H, Barker J, Di Meglio P, Consortium P. 096 IL23-induced STAT3 nuclear translocation in MAIT cells at baseline is a candidate biomarker of response to biologics targeting the IL23/IL17 axis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.106] [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: 11/19/2022]
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11
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Francis L, McCluskey D, Baudry D, Dhami P, Barker J, Smith C, Capon F, Mahil S. 022 Using single-cell transcriptomics to characterise early mechanisms of disease remission in psoriasis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.031] [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: 11/19/2022]
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12
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Hardman-Smart J, Ejarque RA, Solanky S, Tosi I, Grys K, Barker J, Griffiths C, Reynolds N, Smith C, Warren R, Di Meglio P, Consortium P. 115 The frequency of intermediate monocytes before treatment is a candidate biomarker of clinical response to secukinumab in of psoriasis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.125] [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: 11/19/2022]
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13
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Ashoori M, Hardman-Smart J, Dawe H, Tosi I, E vincent, Barker J, Smith C, Di Meglio P. 337 Multi-level dysregulation of the AHR/CYP1A1 axis in psoriasis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.350] [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: 11/19/2022]
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14
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Hernandez A, Thomas L, Baum P, Visvanathan S, Barker J, Løset M, Smith C, Capon F. 272 An exome wide association study identifies new genetic determinants for palmar plantar pustulosis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.284] [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: 11/19/2022]
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15
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Mavilakandy A, Antoun I, Kotb A, Koev IM, Barker J, Vali Z, Sidhu B, Pooranachandran V, Li X, Ng GA. Outcomes of very high-power short-duration ablation using 90w for pulmonary vein isolation in patients with atrial fibrillation: a real world observation study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.470] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Pulmonary vein isolation (PVI) ablation is the established gold standard therapy for patients with symptomatic drug refractory atrial fibrillation (AF). Advancements in radiofrequency (RF) ablation, have led to the development of the novel contact force-sensing temperature-controlled very high-power short-duration (vHPSD) RF ablation. This setting delivers 90W for up to 4 seconds with a constant irrigation flow rate of 8ml/min. The aim of this study was to compare procedural outcomes and safety with conventional radiofrequency ablation.
Methods
An observational study was conducted with patients who underwent first time PVI ablation from 2019 to 2021. The cohort was divided in to: 1) vHPSD ablation – QMODE+ via QDOT MICRO catheter, 2) QMODE via QDOT MICRO catheter and 3) Conventional power-controlled RF (PCRF) ablation via THERMOCOOOL SMARRTOUCH SF (STSF) catheter. The QMODE+ vHPSD ablation group was prospectively recruited while the QMODE and PCRF group were retrospectively collected. Primary outcomes were procedural success, PVI duration, ablation duration and incidence of perioperative adverse events. Secondary outcomes were intraprocedural morphine and midazolam requirement.
Results
A total of 155 patients were included in the study with 80, 30 and 45 patients in the QMODE+ (vHPSD), QMODE and PCRF, respectively. PVI was successfully attained in all patients. QMODE+ (vHPSD) demonstrated significantly reduced time required for PVI and total energy application in comparison to the QMODE and PCRF groups (68.3±3.30 vs. 92.9±4.86 vs. 93.6±4.34 min, P<0.0001; 9.7±0.452 vs. 33.9±0.452 vs. 36.0±1.56 min, P<0.0001, respectively) (Figure 1). Intravenous morphine and midazolam requirement was lower in the QMODE+ (vHPSD) group compared to the QMODE and PCRF groups (10.3±0.45 vs. 16.1±0.935 vs. 15.3±0.686 mg, P<0.0001; 4.05±0.402 vs. 8.63±1.07 vs. 8.58±0.821 mg, P<0.0001) (Figure 2). QMODE+ (vHPSD) observed a non-significant reduction in fluoroscopy time compared to QMODE and PCRF. One cardiac tamponade were observed in both the QMODE+ (vHPSD) and QMODE group while the PCRF group exhibited an embolic stoke and two pericardial effusions that did not require drainage.
Conclusion
In this study, QMODE+ (vHPSD) demonstrated a comparable safety profile to the other treatment arms. Procedural duration and energy application time was substantially reduced while a non-significant reduction was observed for fluoroscopy time for QMODE+. Furthermore, sedation requirement was reduced and thus potentially conveyed greater patient tolerability of the procedure when conducted with QMODE+.
Notwithstanding the limitations of observational study design, these preliminary findings are promising with respect to periprocedural outcomes and safety of QMODE+. Longer term outcomes with respect to maintenance of sinus rhythm and symptomatic burden will be essential to assessing the overall efficacy of this novel technology.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mavilakandy
- University of Leicester , Leicester , United Kingdom
| | - I Antoun
- University of Leicester , Leicester , United Kingdom
| | - A Kotb
- University of Leicester , Leicester , United Kingdom
| | - I M Koev
- University of Leicester , Leicester , United Kingdom
| | - J Barker
- University of Leicester , Leicester , United Kingdom
| | - Z Vali
- University of Leicester , Leicester , United Kingdom
| | - B Sidhu
- University of Leicester , Leicester , United Kingdom
| | | | - X Li
- University of Leicester , Leicester , United Kingdom
| | - G A Ng
- University of Leicester , Leicester , United Kingdom
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Kotb A, Armstrong S, Antoun I, Koev I, Mavilakandy A, Barker J, Vali Z, Panchal G, Li X, Lazdam M, Ibrahim M, Sandilands A, Chin S, Somani R, Andre Ng G. Atrial fibrillation virtual ward: reshaping the future of AF care. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2804] [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
Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management.
Methods
An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR <140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT).
Results
Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients.
Conclusion
This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kotb
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - S Armstrong
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - I Antoun
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - I Koev
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - A Mavilakandy
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - J Barker
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - Z Vali
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - G Panchal
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - X Li
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - M Lazdam
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - M Ibrahim
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - A Sandilands
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - S Chin
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - R Somani
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - G Andre Ng
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
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Bachelez H, Barker J, Burden AD, Navarini AA, Krueger JG. Generalized pustular psoriasis is a disease distinct from psoriasis vulgaris: evidence and expert opinion. Expert Rev Clin Immunol 2022; 18:1033-1047. [PMID: 36062811 DOI: 10.1080/1744666x.2022.2116003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, severe, clinically heterogeneous disease characterized by flares of widespread, non-infectious, macroscopically visible pustules that occur with or without systemic inflammation, and are associated with significant morbidity and mortality. Historically, GPP has been classified as a variant of psoriasis vulgaris (PV, or plaque psoriasis); however, accumulating evidence indicates that these are distinct conditions, requiring different treatment approaches. AREAS COVERED In this perspectives article we review evidence that supports the classification of GPP as distinct from PV. EXPERT OPINION The histopathologic and clinical appearance of GPP is distinct from that of PV and fundamental differences exist between the two conditions in terms of genetic causes and expression-related mechanisms of disease development. GPP results from dysregulation of the innate immune system, with disruption of the interleukin (IL)-36 inflammatory pathway, induction of inflammatory keratinocyte responses, and recruitment of neutrophils. PV is driven by the adaptive immune system, with a key role played by IL-17. Considering GPP as a separate disease will enable greater focus on its specific pathogenesis and the needs of patients. Many treatments for PV have insufficient efficacy in GPP and a therapeutic approach developed specifically for GPP might lead to better patient outcomes.
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Affiliation(s)
- Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France.,INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
| | - Jonathan Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A David Burden
- Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | | | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Elewski B, Barker J, Mrowietz U, Imafuku S, Hu N, Quaresma M, Thoma C. 32924 Sustained treatment effect of spesolimab over 12 weeks for generalized pustular psoriasis flares; results from the Effisayil 1 study. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dand N, Tsoi L, Barker J, Simpson M, Elder J, Psoriasis GWAS Consortium I. 505 Expanded GWAS meta-analysis offers novel insights into psoriasis biology. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.514] [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: 12/01/2022]
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20
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Tsoi L, Zhang Z, Stuart P, Dand N, Patrick M, Simpson M, Voorhees J, Barker J, Nair R, Elder J. 471 Integrated psoriasis GWAS and eQTL analysis reveals risk-associated genetic control of TRAF3IP2-AS1 expression in activated CD8 T-cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin A, Brown S, Maloy M, Ruiz JD, Devlin S, DeRespiris L, Proli A, Jakubowski AA, Papadopoulos EB, Sauter CS, Tamari R, Castro-Malaspina H, Shaffer B, Barker J, Perales MA, Giralt SA, Gyurkocza B. Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2022; 63:1686-1693. [PMID: 35142567 PMCID: PMC9983694 DOI: 10.1080/10428194.2022.2032036] [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] [Indexed: 10/19/2022]
Abstract
Given prophylactic methotrexate (MTX) is often held in the setting of toxicity we investigated the impact of omitting minidose-MTX dose(s). Outcomes were compared between patients who had 1-3 doses omitted and those who received all four planned doses of minidose-MTX. Of 370 consecutive patients, 50 had MTX dose(s) omitted. When MTX was omitted, initial management was mycophenolate mofetil (MMF; 36/50 patients) with or without corticosteroids (14/50 patients). Rates of grade 3-4 acute GVHD were similar between groups. Omission of minidose-MTX resulted in an increased risk of chronic GVHD (cGVHD; HR 2.27; p = .024) and decreased overall survival (HR 1.61; p = .024). However, other transplant-related outcomes were comparable. In summary, omission of minidose-MTX doses was not associated with an increased risk of acute GVHD when an alternative was added (e.g. MMF ± corticosteroids). This did not abrogate the increased risk of cGVHD or decreased overall survival.
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Affiliation(s)
- A Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - JD Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - AA Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - EB Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - CS Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - R Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - H Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - J Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - MA Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - SA Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
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Machado PM, Schaefer M, Mahil S, Dand N, Gianfrancesco M, Lawson-Tovey S, Yiu Z, Yates M, Hyrich K, Gossec L, Carmona L, Mateus E, Wiek D, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sufka P, Sirotich E, Wallace Z, Olofsson T, Lomater C, Romeo N, Wendling D, Pham T, Miceli Richard C, Fautrel B, Silva L, Santos H, Martins FR, Hasseli R, Pfeil A, Regierer A, Isnardi C, Soriano E, Quintana R, Omura F, Machado Ribeiro F, Pinheiro M, Bautista-Molano W, Alpizar-Rodriguez D, Saad C, Dubreuil M, Haroon N, Gensler LS, Dau J, Jacobsohn L, Liew J, Strangfeld A, Barker J, Griffiths CEM, Robinson P, Yazdany J, Smith C. OP0249 CHARACTERISTICS ASSOCIATED WITH POOR COVID-19 OUTCOMES IN PEOPLE WITH PSORIASIS AND SPONDYLOARTHRITIS: DATA FROM THE COVID-19 PsoProtect AND GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSome factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.ObjectivesTo determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.MethodsThis study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.ResultsA total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).ConclusionMore severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.AcknowledgementsWe thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.Disclosure of InterestsNone declared
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Oláh P, Szlávicz E, Kuchner M, Nemmer J, Zeeuwen P, Lefèvre-Utile A, Fyhrquist N, Prast-Nielsen S, Skoog T, Serra A, Rodríguez E, Raap U, Meller S, Gyulai R, Hupé P, Kere J, Levi-Schaffer F, Tsoka S, Alexander H, Nestle FO, Schröder JM, Weidinger S, van den Bogaard E, Soumelis V, Greco D, Barker J, Lauerma A, Ranki A, Andersson B, Alenius H, Homey B. INFLUENCE OF FLG LOSS-OF-FUNCTION MUTATIONS IN HOST–MICROBE INTERACTIONS DURING ATOPIC SKIN INFLAMMATION. J Dermatol Sci 2022; 106:132-140. [DOI: 10.1016/j.jdermsci.2022.04.007] [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] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
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24
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Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saklatvala J, Mitchell B, Martin N, Barker J, Han J, Smith C, Renteria M, Simpson M. 160 Genome-wide association meta-analysis of acne reveals 29 novel risk loci and molecular overlap with Mendelian hair and skin disorders and other complex traits. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Solanky S, Ejarque RA, Tosi I, Dawe H, Mahil S, Smith C, Barker J, Consortium P, Di Meglio P. 051 STAT3 nuclear translocation in circulating MAIT cells is a potential biomarker of clinical outcome to ustekinumab in psoriasis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.053] [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]
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Hardman-Smart J, Solanky S, Munir O, Forughian R, Tosi I, Mahil S, Barker J, Smith C, Di Meglio P. 056 Dissecting the pathogenesis of anti-TNF-induced paradoxical psoriasis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ottman N, Barrientos‐Somarribas M, Fyhrquist N, Alexander H, Wisgrill L, Olah P, Tsoka S, Greco D, Levi‐Schaffer F, Soumelis V, Schröder JM, Kere J, Nestle FO, Barker J, Ranki A, Lauerma A, Homey B, Andersson B, Alenius H. Microbial and transcriptional differences elucidate atopic dermatitis heterogeneity across skin sites. Allergy 2021; 76:1173-1187. [PMID: 33001460 PMCID: PMC8246754 DOI: 10.1111/all.14606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/22/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/29/2022]
Abstract
It is well established that different sites in healthy human skin are colonized by distinct microbial communities due to different physiological conditions. However, few studies have explored microbial heterogeneity between skin sites in diseased skin, such as atopic dermatitis (AD) lesions. To address this issue, we carried out deep analysis of the microbiome and transcriptome in the skin of a large cohort of AD patients and healthy volunteers, comparing two physiologically different sites: upper back and posterior thigh. Microbiome samples and biopsies were obtained from both lesional and nonlesional skin to identify changes related to the disease process. Transcriptome analysis revealed distinct disease-related gene expression profiles depending on anatomical location, with keratinization dominating the transcriptomic signatures in posterior thigh, and lipid metabolism in the upper back. Moreover, we show that relative abundance of Staphylococcus aureus is associated with disease severity in the posterior thigh, but not in the upper back. Our results suggest that AD may select for similar microbes in different anatomical locations-an "AD-like microbiome," but distinct microbial dynamics can still be observed when comparing posterior thigh to upper back. This study highlights the importance of considering the variability across skin sites when studying the development of skin inflammation.
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Affiliation(s)
- Noora Ottman
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | | | - Nanna Fyhrquist
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Human Microbiome Research Program University of Helsinki Helsinki Finland
| | - Helen Alexander
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust and King's College London London UK
| | - Lukas Wisgrill
- Division of Neonatology Pediatric Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Peter Olah
- Department of Dermatology University Hospital Duesseldorf Duesseldorf Germany
- Department of Dermatology, Venereology and Oncodermatology University of Pécs Pécs Hungary
| | - Sophia Tsoka
- Department of Informatics Faculty of Natural and Mathematical Sciences King’s College London London UK
| | - Dario Greco
- Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Institute of Biomedical Technology University of Tampere Tampere Finland
- Institute of Biotechnology University of Helsinki Helsinki Finland
| | - Francesca Levi‐Schaffer
- Pharmacology Unit School of Pharmacy Faculty of Medicine The Institute for Drug Research The Hebrew University of Jerusalem Jerusalem Israel
| | | | - Jens M. Schröder
- Department of Dermatology University Hospital Schleswig‐Holstein Kiel Germany
| | - Juha Kere
- Department of Biosciences and Nutrition Karolinska Institutet Stockholm Sweden
- School of Basic and Medical Biosciences King’s College London London UK
| | - Frank O. Nestle
- Cutaneous Medicine Unit St. John’s Institute of Dermatology and Biomedical Research Centre Faculty of Life Sciences and Medicine King’s College London London UK
| | - Jonathan Barker
- St John’s Institute of Dermatology Division of Genetics and Molecular Medicine Faculty of Life Sciences and Medicine Kings College London London UK
| | - Annamari Ranki
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Bernhard Homey
- Department of Dermatology University Hospital Duesseldorf Duesseldorf Germany
| | - Björn Andersson
- Department of Cell and Molecular Biology Karolinska Institutet Stockholm Sweden
| | - Harri Alenius
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Human Microbiome Research Program University of Helsinki Helsinki Finland
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Ong ELH, Calonje E, Bakkour W, Muneer A, Barker J, Bunker CB. An intractable under-recognized anogenitogluteal rash. Clin Exp Dermatol 2021; 46:769-772. [PMID: 33650728 DOI: 10.1111/ced.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E L H Ong
- Dermatopathology Department, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - E Calonje
- Dermatopathology Department, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - W Bakkour
- Dermatology Department, University College London Hospitals, London, UK
| | - A Muneer
- Department of Urology, University College London Hospitals, London, UK
| | - J Barker
- Department of Dermatology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - C B Bunker
- Dermatology Department, University College London Hospitals, London, UK
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Cronin DS, Bustamante MC, Barker J, Singh D, Rafaels KA, Bir C. Assessment of Thorax Finite Element Model Response for Behind Armor Blunt Trauma Impact Loading Using an Epidemiological Database. J Biomech Eng 2021; 143:1087628. [PMID: 33009546 DOI: 10.1115/1.4048644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 11/08/2022]
Abstract
Nonperforating ballistic impacts on thoracic armor can cause blunt injuries, known as behind-armor blunt trauma (BABT). To evaluate the potential for this injury, the back face deformation (BFD) imprinted into a clay backing is measured; however, the link between BFD and potential for injury is uncertain. Computational human body models (HBMs) have the potential to provide an improved understanding of BABT injury risk to inform armor design but require assessment with relevant loading scenarios. In this study, a methodology was developed to apply BABT loading to a computational thorax model, enhanced with refined finite element mesh and high-deformation rate mechanical properties. The model was assessed using an epidemiological BABT survivor database. BABT impact boundary conditions for 10 cases from the database were recreated using experimentally measured deformation for specific armor/projectile combinations, and applied to the thorax model using a novel prescribed displacement methodology. The computational thorax model demonstrated numerical stability under BABT impact conditions. The predicted number of rib fractures, the magnitude of pulmonary contusion, and injury rank, increased with armor BFD, back face velocity, and input energy to the thorax. In three of the 10 cases, the model overpredicted the number of rib fractures, attributed to impact location positional sensitivity and limited details from the database. The integration of an HBM with the BABT loading method predicted rib fractures and injury ranks that were in good agreement with available medical records, providing a potential tool for future armor evaluation and injury assessment.
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Affiliation(s)
- D S Cronin
- Department of MME, University of Waterloo, 200 University Avenue West, Waterloo, ON N2 L 3G1, Canada
| | - M C Bustamante
- Department of MME, University of Waterloo, 200 University Avenue West, Waterloo, ON N2 L 3G1, Canada
| | - J Barker
- Department of MME, University of Waterloo, 200 University Avenue West, Waterloo, ON N2 L 3G1, Canada
| | - D Singh
- Department of MME, University of Waterloo, 200 University Avenue West, Waterloo, ON N2 L 3G1, Canada
| | - K A Rafaels
- Army Futures Command, CCDC Army Research Laboratory, Aberdeen Proving Ground, MD 21005
| | - C Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202
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Yogarajah S, Mahendran K, Barker J, Setterfield J, Carey B. WITHDRAWN: Going Through A Rough Patch. Advances in Oral and Maxillofacial Surgery 2021. [DOI: 10.1016/j.adoms.2020.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Loeff FC, Tsakok T, Dijk L, Hart MH, Duckworth M, Baudry D, Russell A, Dand N, van Leeuwen A, Griffiths CE, Reynolds NJ, Barker J, Burden AD, Warren RB, de Vries A, Bloem K, Wolbink GJ, Smith CH, Rispens T, Barker J, Benham M, Burden D, Evans I, Griffiths C, Hussain S, Kirby B, Lawson L, Mason K, McElhone K, Murphy R, Ormerod A, Owen C, Reynolds N, Smith C, Warren R, Barker JN, Barnes MR, Burden AD, DiMeglio P, Emsley R, Evans A, Griffiths CE, Payne K, Reynolds NJ, Smith CH, Stocken D, Warren RB. Clinical Impact of Antibodies against Ustekinumab in Psoriasis: An Observational, Cross-Sectional, Multicenter Study. J Invest Dermatol 2020; 140:2129-2137. [DOI: 10.1016/j.jid.2020.03.957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 01/07/2023]
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Schmuth M, Biedermann T, Picardo M, Florestan T, Barker J. ESDR 2010-2020: Journey toward Translational and Systems Dermatology. J Invest Dermatol 2020; 140:S167-S170. [PMID: 32800164 DOI: 10.1016/j.jid.2020.02.045] [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] [Received: 02/16/2020] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Matthias Schmuth
- Department of Dermatology, Venereology and Allergy, Medical University Innsbruck, Innsbruck, Austria.
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute (IRCCS), Rome, Italy
| | - Thomas Florestan
- European Society for Dermatological Research, Geneva, Switzerland
| | - Jonathan Barker
- School of Basic & Medical Biosciences, St John's Institute of Dermatology, King's College London, London, United Kingdom
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Nambu Y, Barker J, Okino Y, Kikkawa T, Shiomi Y, Enderle M, Weber T, Winn B, Graves-Brook M, Tranquada JM, Ziman T, Fujita M, Bauer GEW, Saitoh E, Kakurai K. Observation of Magnon Polarization. Phys Rev Lett 2020; 125:027201. [PMID: 32701305 DOI: 10.1103/physrevlett.125.027201] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
We measure the mode-resolved direction of the precessional motion of the magnetic order, i.e., magnon polarization, via the chiral term of inelastic polarized neutron scattering spectra. The magnon polarization is a unique and unambiguous signature of magnets and is important in spintronics, affecting thermodynamic properties such as the magnitude and sign of the spin Seebeck effect. However, it has never been directly measured in any material until this work. The observation of both signs of magnon polarization in Y_{3}Fe_{5}O_{12} also gives direct proof of its ferrimagnetic nature. The experiments agree very well with atomistic simulations of the scattering cross section.
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Affiliation(s)
- Y Nambu
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - J Barker
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Y Okino
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - T Kikkawa
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
- WPI-AIMR, Tohoku University, Sendai 980-8577, Japan
| | - Y Shiomi
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - M Enderle
- Institut Laue-Langevin (ILL), 38042 Grenoble, France
| | - T Weber
- Institut Laue-Langevin (ILL), 38042 Grenoble, France
| | - B Winn
- Oak Ridge National Lab (ORNL), Oak Ridge, Tennessee 37831, USA
| | - M Graves-Brook
- Oak Ridge National Lab (ORNL), Oak Ridge, Tennessee 37831, USA
| | - J M Tranquada
- Brookhaven National Lab (BNL), Upton, New York 11973-5000, USA
| | - T Ziman
- Institut Laue-Langevin (ILL), 38042 Grenoble, France
- Université Grenoble Alpes, CNRS, LPMMC, 38000 Grenoble, France
| | - M Fujita
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - G E W Bauer
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
- WPI-AIMR, Tohoku University, Sendai 980-8577, Japan
- Zernike Institute for Advanced Materials, University of Groningen, 9747 AG Groningen, Netherlands
| | - E Saitoh
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
- WPI-AIMR, Tohoku University, Sendai 980-8577, Japan
- Department of Applied Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Advanced Science Research Center, Japan Atomic Energy Agency, Tokai 319-1195, Japan
| | - K Kakurai
- Neutron Science and Technology Center, Comprehensive Research Organization for Science and Society (CROSS), Tokai, Ibaraki 319-1106, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Saitama 351-0198, Japan
- Materials Science Research Center, Japan Atomic Energy Agency, Tokai 319-1195, Japan
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Mahil SK, Yiu ZZN, Mason KJ, Dand N, Coker B, Wall D, Fletcher G, Bosma A, Capon F, Iversen L, Langan SM, Di Meglio P, Musters AH, Prieto-Merino D, Tsakok T, Warren RB, Flohr C, Spuls PI, Griffiths CEM, Barker J, Irvine AD, Smith CH. Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic. Br J Dermatol 2020; 183:404-406. [PMID: 32348554 PMCID: PMC7267275 DOI: 10.1111/bjd.19161] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - K J Mason
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - N Dand
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - B Coker
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Wall
- Hair Restoration Blackrock, Dublin, Ireland.,National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - G Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - A Bosma
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F Capon
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark
| | - S M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P Di Meglio
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - A H Musters
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D Prieto-Merino
- Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - C Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - A D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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36
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Pouget JG, Han B, Wu Y, Mignot E, Ollila HM, Barker J, Spain S, Dand N, Trembath R, Martin J, Mayes MD, Bossini-Castillo L, López-Isac E, Jin Y, Santorico SA, Spritz RA, Hakonarson H, Polychronakos C, Raychaudhuri S, Knight J. Cross-disorder analysis of schizophrenia and 19 immune-mediated diseases identifies shared genetic risk. Hum Mol Genet 2020; 28:3498-3513. [PMID: 31211845 PMCID: PMC6891073 DOI: 10.1093/hmg/ddz145] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 03/02/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 01/01/2023] Open
Abstract
Many immune diseases occur at different rates among people with schizophrenia compared to the general population. Here, we evaluated whether this phenomenon might be explained by shared genetic risk factors. We used data from large genome-wide association studies to compare the genetic architecture of schizophrenia to 19 immune diseases. First, we evaluated the association with schizophrenia of 581 variants previously reported to be associated with immune diseases at genome-wide significance. We identified five variants with potentially pleiotropic effects. While colocalization analyses were inconclusive, functional characterization of these variants provided the strongest evidence for a model in which genetic variation at rs1734907 modulates risk of schizophrenia and Crohn’s disease via altered methylation and expression of EPHB4—a gene whose protein product guides the migration of neuronal axons in the brain and the migration of lymphocytes towards infected cells in the immune system. Next, we investigated genome-wide sharing of common variants between schizophrenia and immune diseases using cross-trait LD score regression. Of the 11 immune diseases with available genome-wide summary statistics, we observed genetic correlation between six immune diseases and schizophrenia: inflammatory bowel disease (rg = 0.12 ± 0.03, P = 2.49 × 10−4), Crohn’s disease (rg = 0.097 ± 0.06, P = 3.27 × 10−3), ulcerative colitis (rg = 0.11 ± 0.04, P = 4.05 × 10–3), primary biliary cirrhosis (rg = 0.13 ± 0.05, P = 3.98 × 10−3), psoriasis (rg = 0.18 ± 0.07, P = 7.78 × 10–3) and systemic lupus erythematosus (rg = 0.13 ± 0.05, P = 3.76 × 10–3). With the exception of ulcerative colitis, the degree and direction of these genetic correlations were consistent with the expected phenotypic correlation based on epidemiological data. Our findings suggest shared genetic risk factors contribute to the epidemiological association of certain immune diseases and schizophrenia.
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Affiliation(s)
- Jennie G Pouget
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Buhm Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yang Wu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Hanna M Ollila
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA.,Finnish Institute for Molecular Medicine, Helsinki, Finland.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA and Broad Institute, Cambridge, MA, USA
| | - Jonathan Barker
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,St. John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sarah Spain
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Nick Dand
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard Trembath
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Javier Martin
- Institute of Parasitology and Biomedicine López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Granada, Spain
| | - Maureen D Mayes
- The University of Texas Health Science Center-Houston, Houston, USA
| | - Lara Bossini-Castillo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Granada, Spain
| | - Ying Jin
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora 80045, CO, USA
| | - Stephanie A Santorico
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Richard A Spritz
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora 80045, CO, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Constantin Polychronakos
- Endocrine Genetics Laboratory, Department of Pediatrics and the Child Health Program of the Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Soumya Raychaudhuri
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Partners HealthCare Center for Personalized Genetic Medicine, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Jo Knight
- Lancaster Medical School and Data Science Institute, Lancaster University, Lancaster, UK
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Blegvad C, Nybo Andersen AM, Groot J, Zachariae C, Barker J, Skov L. Clinical characteristics including cardiovascular and metabolic risk factors in adolescents with psoriasis. J Eur Acad Dermatol Venereol 2020; 34:1516-1523. [PMID: 31989688 DOI: 10.1111/jdv.16229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical studies on psoriasis in adolescents have mainly been performed in patients with severe psoriasis. Population-based studies of clinical characteristics and risk factors for later cardiovascular and metabolic disease in children and adolescents are lacking. OBJECTIVES To examine the clinical characteristics of adolescents with psoriasis nested in a general population cohort. Furthermore, to investigate cardiovascular and metabolic risk factors in the adolescents with psoriasis compared to parentally predisposed and non-predisposed adolescents without psoriasis from the same birth cohort. METHODS We identified adolescents with and without psoriasis using a nationwide general population birth cohort in Denmark. A clinical examination included skin inspection and scoring of psoriasis severity, completion of a questionnaire on psoriasis and comorbidities, physical measurements, and blood sampling. Participants also completed self-administered questionnaires on quality of life and mental health. RESULTS We included 81 adolescents with psoriasis and 234 controls (110 with genetic predisposition for psoriasis and 124 without predisposition). Median age was 15.6 (13.5-18.5) years, and in those with active psoriasis, median Psoriasis Area and Severity Index score was 1.2 (0.1-11.4). The scalp was the most common site of psoriasis, both at debut and at time of examination. Diaper rash in infancy was more frequent in the psoriasis group. No significant differences regarding quality of life, anxiety and depression were found. More adolescents with psoriasis were obese (8.6% vs. 1.7%, P = 0.008), and physical measures of abdominal obesity were also significantly higher. HbA1c was significantly higher (31.55 vs. 30.81 mmol/mol, P = 0.048), while no differences were found for blood pressure, lipids or high-sensitivity C-reactive protein. In a subgroup analysis, this was evident in the non-predisposed psoriasis-free controls only. CONCLUSIONS Overall, adolescents with psoriasis from this general population had mild disease. Still, early markers of cardiovascular and metabolic disease were elevated.
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Affiliation(s)
- C Blegvad
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A-M Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Groot
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Barker
- St John's Institute of Dermatology, King's College London, London, UK
| | - L Skov
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Cro S, Patel P, Barker J, Burden DA, Griffiths CEM, Lachmann HJ, Reynolds NJ, Warren RB, Capon F, Smith C, Cornelius V. A randomised placebo controlled trial of anakinra for treating pustular psoriasis: statistical analysis plan for stage two of the APRICOT trial. Trials 2020; 21:158. [PMID: 32041649 PMCID: PMC7011285 DOI: 10.1186/s13063-020-4103-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current treatment options for Palmoplantar Pustulosis (PPP), a debilitating chronic skin disease which affects the hands and feet, are limited. The Anakinra for Pustular psoriasis: Response in a Controlled Trial (APRICOT) aims to determine the efficacy of anakinra in the treatment of PPP. This article describes the statistical analysis plan for the final analysis of this two-staged trial, which was determined prior to unblinding and database lock. This is an update to the published protocol and stage one analysis plan. METHODS APRICOT is a randomised, double-blind, placebo-controlled trial of anakinra versus placebo, with two stages and an adaptive element. Stage one compared treatment arms to ensure proof-of-concept and determined the primary outcome for stage two of the trial. The primary outcome was selected to be the change in Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. Secondary outcomes include other investigator-assessed efficacy measures of disease severity, participant-reported measures of efficacy and safety measures. This manuscript describes in detail the outcomes, sample size, general analysis principles, the pre-specified statistical analysis plan for each of the outcomes, the handling of missing outcome data and the planned sensitivity and supplementary analyses for the second stage of the APRICOT trial. DISCUSSION This statistical analysis plan was developed in compliance with international trial guidelines and is published to increase transparency of the trial analysis. The results of the trial analysis will indicate whether anakinra has a role in the treatment of PPP. TRIAL REGISTRATION ISCRTN, ISCRTN13127147. Registered on 1 August 2016. EudraCT Number 2015-003600-23. Registered on 1 April 2016.
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Affiliation(s)
- Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, W12 7RH, London, UK.
| | - Prakash Patel
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan Barker
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - David A Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - Christopher E M Griffiths
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, NW3 2PF, London, UK
| | - Nick J Reynolds
- Translational and Clinical Research Institute, University of Newcastle, Newcastle upon Tyne, NE1 7RU, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Francesca Capon
- Department of Medical & Molecular Genetics, King's College London, London, SE1 9RT, UK
| | - Catherine Smith
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, Imperial College London, W12 7RH, London, UK
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Pan S, Tsakok T, Dand N, Lonsdale DO, Loeff FC, Bloem K, de Vries A, Baudry D, Duckworth M, Mahil S, Pushpa-Rajah A, Russell A, Alsharqi A, Becher G, Murphy R, Wahie S, Wright A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, David Burden A, Rispens T, Standing JF, Smith CH. Using Real-World Data to Guide Ustekinumab Dosing Strategies for Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study. Clin Transl Sci 2020; 13:400-409. [PMID: 31995663 PMCID: PMC7070790 DOI: 10.1111/cts.12725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/13/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022] Open
Abstract
Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real‐world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first‐line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored. Data were collected from a UK prospective multicenter observational cohort (491 patients on ustekinumab monotherapy, drug levels, and anti‐drug antibody measurements on 797 serum samples, 1,590 measurements of Psoriasis Area Severity Index (PASI)). Ustekinumab PKs were described with a linear one‐compartment model. A maximum effect (Emax) model inhibited progression of psoriatic skin lesions in the turnover PD mechanism describing PASI evolution while on treatment. A mixture model on half‐maximal effective concentration identified a potential nonresponder group, with simulations suggesting that, in future, the model could be incorporated into a Bayesian therapeutic drug monitoring “dashboard” to individualize dosing and improve treatment outcomes.
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Affiliation(s)
- Shan Pan
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Teresa Tsakok
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nick Dand
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Dagan O Lonsdale
- Institute of Infection and Immunity, St. George's, University of London, London, UK
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - David Baudry
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Michael Duckworth
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Satveer Mahil
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Angela Pushpa-Rajah
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Alice Russell
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ali Alsharqi
- Dermatology Department, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | | | - Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, UK
| | - Shyamal Wahie
- Dermatology Department, University Hospital of North Durham, Durham, UK
| | - Andrew Wright
- Centre for Skin Sciences, University of Bradford, Bradford, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, UK.,The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, UK
| | - Nick J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jonathan Barker
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Joseph F Standing
- Infection, Immunity, Inflammation Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine H Smith
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, Maitra I, Pearce L, Moug SJ, Ross B, Oleksiewicz J, Fearnhead N, Jump C, Boyle J, Shaw A, Barker J, Hughes J, Randall J, Tonga I, Kynaston J, Boal M, Eardley N, Kane E, Reader H, Mahapatra SR, Garner-Jones M, Tan JJ, Mohamed S, George R, Whiteman E, Malik K, Smart CJ, Bogdan M, Chaudhury MP, Sharma V, Subar D, Patel P, Chok SM, Lim E, Adhiyaman V, Davies G, Ross E, Maitra R, Steele CW, Roxburgh C, Griffiths S, Blencowe NS, Kirkham EN, Abraham JS, Griffiths K, Abdulaal Y, Iqbal MR, Tarazi M, Hill J, Khan A, Farrell I, Conn G, Patel J, Reddy H, Sarveswaran J, Arunachalam L, Malik A, Ponchietti L, Pawelec K, Goh YM, Vitish-Sharma P, Saad A, Smyth E, Crees A, Merker L, Bashir N, Williams G, Hayes J, Walters K, Harries R, Singh R, Henderson NA, Polignano FM, Knight B, Alder L, Kenchington A, Goh YL, Dicurzio I, Griffiths E, Alani A, Knight K, MacGoey P, Ng GS, Mackenzie N, Maitra I, Moug S, Ong K, McGrath D, Gammeri E, Lafaurie G, Faulkner G, Di Benedetto G, McGovern J, Subramanian B, Narang SK, Nowers J, Smart NJ, Daniels IR, Varcada M, Gala T, Cornish J, Barber Z, O'Neill S, McGregor R, Robertson AG, Paterson-Brown S, Raymond T, Thaha MA, English WJ, Forde CT, Paine H, Morawala A, Date R, Casey P, Bolton T, Gleaves X, Fasuyi J, Durakovic S, Dunstan M, Allen S, Riga A, Epstein J, Pearce L, Gaines E, Howe A, Choonara H, Dewi F, Bennett J, King E, McCarthy K, Taylor G, Harris D, Nageswaran H, Stimpson A, Siddiqui K, Lim LI, Ray C, Smith L, McColl G, Rahman M, Kler A, Sharma A, Parmar K, Patel N, Crofts P, Baldari C, Thomas R, Stechman M, Aldridge R, O'Kelly J, Wilson G, Gallegos N, Kalaiselvan R, Rajaganeshan R, Mackenzie A, Naik P, Singh K, Gandraspulli H, Wilson J, Hancorn K, Khawaja A, Nicholas F, Marks T, Abbott C, Chandler S. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg 2020; 107:218-226. [DOI: 10.1002/bjs.11392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/20/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
Methods
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
Results
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
Conclusion
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
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Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Law
- Department of Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - K L Parmar
- Manchester Cancer Research Centre, Manchester, NorthWest Deanery, UK
| | - J M Boyle
- Royal College of Surgeons of England, London, UK
| | - P Casey
- Health Education North West, Manchester, NorthWest Deanery, UK
| | - I Maitra
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Tsakok T, Wilson N, Dand N, Loeff FC, Bloem K, Baudry D, Duckworth M, Pan S, Pushpa-Rajah A, Standing JF, de Vries A, Alsharqi A, Becher G, Murphy R, Wahie S, Wright A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, Burden AD, Rispens T, Stocken D, Smith C. Association of Serum Ustekinumab Levels With Clinical Response in Psoriasis. JAMA Dermatol 2019; 155:1235-1243. [PMID: 31532460 PMCID: PMC6751771 DOI: 10.1001/jamadermatol.2019.1783] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Can therapeutic drug monitoring for the interleukin-12 and interleukin-23 inhibitor ustekinumab optimize treatment pathways and outcomes in patients with psoriasis? Findings This cohort study of 491 patients with psoriasis found that early serum ustekinumab levels were associated with a subsequent 75% reduction from baseline in Psoriasis Area and Severity Index score, although this association did not hold across other Psoriasis Area and Severity Index outcomes. Drug immunogenicity appeared to be low, with antidrug antibodies detected in only 17 of 490 patients (3.5%). Meaning This study provides evidence that measurement of early ustekinumab levels could be useful to direct treatment strategy in patients with psoriasis; adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome. Importance High-cost biologic therapies have transformed the management of immune-mediated inflammatory diseases. To optimize outcomes and reduce costs, dose adjustment informed by measurement of circulating drug levels has been shown to be effective in various settings. However, limited evidence exists for this approach with the interleukin 12 and interleukin 23 inhibitor ustekinumab. Objective To evaluate clinical utility of therapeutic drug monitoring for ustekinumab in patients with psoriasis. Design, Setting, and Participants A prospective observational cohort of 491 adults with psoriasis was recruited to the multicenter Biomarkers of Systemic Treatment Outcomes in Psoriasis study within the British Association of Dermatologists Biologic and Immunomodulators Register from June 2009 to December 2017; samples from some patients were taken between 2009 and 2011 as part of a pilot study with the same inclusion criteria. Exposure Serum ustekinumab level measured at any point during the dosing cycle using an enzyme-linked immunosorbent assay. Main Outcomes and Measures Disease activity measured using the Psoriasis Area and Severity Index (PASI) score. Treatment response outcomes were PASI75 (75% reduction in PASI score from baseline [primary outcome]), PASI90 (90% reduction of PASI score from baseline), and absolute PASI score of 1.5 or less. Results A total of 491 patients (171 women and 320 men; mean [SD] age, 45.7 [12.8] years) had 1 or more serum samples (total, 853 samples obtained 0-56 weeks from start of treatment) and 1 or more PASI scores within the first year of treatment. Antidrug antibodies were detected in only 17 of 490 patients (3.5%). Early measured drug levels (1-12 weeks after starting treatment) were associated with PASI75 response 6 months after starting treatment (odds ratio, 1.38; 95% CI, 1.11-1.71) when adjusted for baseline PASI score, age, and ustekinumab dose. However, this finding was not consistent across the other PASI outcomes (PASI90 and PASI score of ≤1.5). Conclusions and Relevance This real-world study provides evidence that measurement of early serum ustekinumab levels could be useful to direct the treatment strategy for psoriasis. Adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome.
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Affiliation(s)
- Teresa Tsakok
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Nina Wilson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - David Baudry
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Shan Pan
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Angela Pushpa-Rajah
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Joseph F Standing
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Ali Alsharqi
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
| | | | - Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, United Kingdom
| | - Shyamal Wahie
- Department of Dermatology, University Hospital of North Durham, Durham, United Kingdom
| | - Andrew Wright
- Centre for Skin Sciences, University of Bradford, Bradford, United Kingdom
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom.,The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nick J Reynolds
- Dermatology Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jonathan Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Catherine Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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Fyhrquist N, Muirhead G, Prast-Nielsen S, Jeanmougin M, Olah P, Skoog T, Jules-Clement G, Feld M, Barrientos-Somarribas M, Sinkko H, van den Bogaard EH, Zeeuwen PLJM, Rikken G, Schalkwijk J, Niehues H, Däubener W, Eller SK, Alexander H, Pennino D, Suomela S, Tessas I, Lybeck E, Baran AM, Darban H, Gangwar RS, Gerstel U, Jahn K, Karisola P, Yan L, Hansmann B, Katayama S, Meller S, Bylesjö M, Hupé P, Levi-Schaffer F, Greco D, Ranki A, Schröder JM, Barker J, Kere J, Tsoka S, Lauerma A, Soumelis V, Nestle FO, Homey B, Andersson B, Alenius H. Microbe-host interplay in atopic dermatitis and psoriasis. Nat Commun 2019; 10:4703. [PMID: 31619666 PMCID: PMC6795799 DOI: 10.1038/s41467-019-12253-y] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2019] [Indexed: 02/08/2023] Open
Abstract
Despite recent advances in understanding microbial diversity in skin homeostasis, the relevance of microbial dysbiosis in inflammatory disease is poorly understood. Here we perform a comparative analysis of skin microbial communities coupled to global patterns of cutaneous gene expression in patients with atopic dermatitis or psoriasis. The skin microbiota is analysed by 16S amplicon or whole genome sequencing and the skin transcriptome by microarrays, followed by integration of the data layers. We find that atopic dermatitis and psoriasis can be classified by distinct microbes, which differ from healthy volunteers microbiome composition. Atopic dermatitis is dominated by a single microbe (Staphylococcus aureus), and associated with a disease relevant host transcriptomic signature enriched for skin barrier function, tryptophan metabolism and immune activation. In contrast, psoriasis is characterized by co-occurring communities of microbes with weak associations with disease related gene expression. Our work provides a basis for biomarker discovery and targeted therapies in skin dysbiosis. Atopic dermatitis (AD) and psoriasis (PSO) are associated with dysbiosis. Here, by analyses of skin microbiome and host transcriptome of AD and PSO patients, the authors find distinct microbial and disease-related gene transcriptomic signatures that differentiate both diseases.
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Affiliation(s)
- Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 17177, Sweden.,Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, 00014, Finland
| | - Gareth Muirhead
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, WC2R 2LS, UK.,Cutaneous Medicine Unit, St. John's Institute of Dermatology and Biomedical Research Centre, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Stefanie Prast-Nielsen
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Marine Jeanmougin
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France.,INSERM, U900, 75248, Paris, France.,Mines ParisTech, 77300, Fontainebleau, France.,INSERM, U932, 75248, Paris, France
| | - Peter Olah
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany.,Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, 7632, Hungary
| | - Tiina Skoog
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Gerome Jules-Clement
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France.,INSERM, U900, 75248, Paris, France.,Mines ParisTech, 77300, Fontainebleau, France.,INSERM, U932, 75248, Paris, France
| | - Micha Feld
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany
| | | | - Hanna Sinkko
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 17177, Sweden.,Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, 00014, Finland
| | - Ellen H van den Bogaard
- Department of Dermatology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, 6525, The Netherlands
| | - Patrick L J M Zeeuwen
- Department of Dermatology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, 6525, The Netherlands
| | - Gijs Rikken
- Department of Dermatology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, 6525, The Netherlands
| | - Joost Schalkwijk
- Department of Dermatology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, 6525, The Netherlands
| | - Hanna Niehues
- Department of Dermatology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, 6525, The Netherlands
| | - Walter Däubener
- Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Duesseldorf, Duesseldorf, 40225, Germany
| | - Silvia Kathrin Eller
- Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Duesseldorf, Duesseldorf, 40225, Germany
| | - Helen Alexander
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, Kings College London, London, SE1 9RT, UK
| | - Davide Pennino
- Cutaneous Medicine Unit, St. John's Institute of Dermatology and Biomedical Research Centre, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Sari Suomela
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Centre, Helsinki, 00250, Finland
| | - Ioannis Tessas
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Centre, Helsinki, 00250, Finland
| | - Emilia Lybeck
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Centre, Helsinki, 00250, Finland
| | - Anna M Baran
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany
| | - Hamid Darban
- Department of Cell and Molecular Biology, Science for Life Laboratory, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Roopesh Singh Gangwar
- Pharmacology Unit, School of Pharmacy, The Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel
| | - Ulrich Gerstel
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, 24105, Germany
| | - Katharina Jahn
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany
| | - Piia Karisola
- Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, 00014, Finland
| | - Lee Yan
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, WC2R 2LS, UK
| | - Britta Hansmann
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, 24105, Germany
| | - Shintaro Katayama
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Stephan Meller
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany
| | | | - Philippe Hupé
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France.,INSERM, U900, 75248, Paris, France.,Mines ParisTech, 77300, Fontainebleau, France.,CNRS, UMR144, 75248, Paris, France
| | - Francesca Levi-Schaffer
- Pharmacology Unit, School of Pharmacy, The Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 91120, Israel
| | - Dario Greco
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, 33520, Finland.,Institute of Biomedical Technology, University of Tampere, Tampere, 33520, Finland.,Institute of Biotechnology, University of Helsinki, Helsinki, 00014, Finland
| | - Annamari Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Centre, Helsinki, 00250, Finland
| | - Jens M Schröder
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, 24105, Germany
| | - Jonathan Barker
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, Kings College London, London, SE1 9RT, UK
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, 17177, Sweden.,School of Basic and Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Sophia Tsoka
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, WC2R 2LS, UK
| | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Centre, Helsinki, 00250, Finland
| | - Vassili Soumelis
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France.,INSERM, U932, 75248, Paris, France
| | - Frank O Nestle
- Cutaneous Medicine Unit, St. John's Institute of Dermatology and Biomedical Research Centre, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Bernhard Homey
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, 40225, Germany
| | - Björn Andersson
- Department of Cell and Molecular Biology, Science for Life Laboratory, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Harri Alenius
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 17177, Sweden. .,Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, 00014, Finland.
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Niaouris A, Haddad S, PushpaRajah A, Benzian-Olsson N, Baum P, Visvanathan S, Barker J, Smith C, Capon F. 281 CARD14 variants are associated with palmar plantar pustulosis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.282] [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]
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Benzian-Olsson N, Dand N, Chaloner C, Meynell F, Warren R, Reynolds N, Barker J, Smith C, Capon F. 150 Sex and Smoke-Related Differences in the Severity of Palmoplantar Pustulosis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, Blauvelt A. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol 2019; 82:117-122. [PMID: 31425723 DOI: 10.1016/j.jaad.2019.08.026] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, owing to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be miscategorized, which can lead to undertreatment of psoriasis. OBJECTIVE To develop a consensus statement on the classification of psoriasis severity. METHODS A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity. RESULTS After completion of the exercise, 7 severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate, and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: (1) body surface area >10%, (2) disease involving special areas, and (3) failure of topical therapy. LIMITATIONS This effort might have suffered from a lack of representation by all relevant stakeholders, including patients. CONCLUSION The consensus statement describes 2 categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.
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Affiliation(s)
- Bruce Strober
- Yale University School of Medicine, New Haven, Connecticut; Central Connecticut Dermatology, Cromwell, Connecticut.
| | - Caitriona Ryan
- Blackrock Clinic Dublin and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | | | | | - Alexa B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan Barker
- St John's Institute of Dermatology, King's College London, London, United Kingdom
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Robb A, Perry A, Rizal I, Mattu S, Barker J, Brodlie M, Doe S, Echevarria C, Thomas M, Townshend J, Bourke S, O'Brien C. P167 Microbiological characteristics of cystic fibrosis patients colonised with Exophiala dermatitidis in a regional centre. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30461-8] [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: 11/29/2022]
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Barker J, Girolomoni G, Egeberg A, Goncalves J, Pieper B, Kang T. Anti-TNF biosimilars in psoriasis: from scientific evidence to real-world experience. J DERMATOL TREAT 2019; 31:794-800. [PMID: 31094242 DOI: 10.1080/09546634.2019.1610553] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tumor necrosis factor (TNF) inhibitors account for a large proportion of drugs used to treat psoriasis and are indicated first-line options in certain settings. Several biosimilar drugs based on the anti-TNF agents adalimumab, infliximab, and etanercept are now available for use in patients with psoriasis. The favorable cost differential of biosimilars is expected to improve access to biologic therapy for biologic-naive psoriasis patients, who are often undertreated. Also, substantial cost savings can be made if patients are switched to biosimilars. To date, most clinical testing of anti-TNF biosimilars approved for use in psoriasis has been performed in patients with rheumatoid arthritis, and the results extrapolated to psoriasis. Although this may initially raise concerns for clinicians looking to start their psoriasis patients on biologic treatment with a biosimilar or switch from an original biologic to a biosimilar, the process of extrapolation is tightly regulated and scientifically justified. Furthermore, available real-world evidence of the safety and efficacy of anti-TNF agents in patients with psoriasis complements clinical trial data in patients with rheumatoid arthritis. When equipped with the appropriate knowledge, clinicians should have confidence to use biosimilars for the treatment of psoriasis.
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Affiliation(s)
- Jonathan Barker
- St John's Institute of Dermatology King's College, London, UK
| | | | - Alexander Egeberg
- Department of Dermatology and Allergy, Gentofte Hospital, Copenhagen, Denmark
| | - Joao Goncalves
- Faculty of Pharmacy, iMed - Research Institute for Medicines, University of Lisbon, Lisbon, Portugal
| | | | - Taegyun Kang
- Samsung Bioepis Co., Ltd, Incheon, Republic of Korea
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Meadows C, Toolan M, Slack A, Newman S, Ostermann M, Camporota L, Gardiner D, Webb S, Barker J, Vuylsteke A, Harvey C, Ledot S, Scott I, Barrett NA. Diagnosis of death using neurological criteria in adult patients on extracorporeal membrane oxygenation: Development of UK guidance. J Intensive Care Soc 2019; 21:28-32. [PMID: 32284715 DOI: 10.1177/1751143719832170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The diagnosis of death using neurological criteria is an important legal method of establishing death in the UK. The safety of the diagnosis lies in the exclusion of conditions which may mask the diagnosis and the testing of the fundamental reflexes of the brainstem including the apnoea reflex. Extracorporeal membrane oxygenation for cardiac or respiratory support can impact upon these tests, both through drug sequestration in the circuit and also through the ability to undertake the apnoea test. Until recently, there has been no nationally accepted guidance regarding the conduct of the tests to undertake the diagnosis of death using neurological criteria for a patient on extracorporeal membrane oxygenation. This article considers both the background to and the process of guideline development.
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Affiliation(s)
- Cis Meadows
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Toolan
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Slack
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Newman
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Ostermann
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Gardiner
- NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Webb
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK.,Joint Standards Committee of the Intensive Care Society & Faculty of Intensive Care Medicine, London, UK
| | - J Barker
- Department of Critical Care Medicine, Manchester University Hospitals, Manchester, UK
| | - A Vuylsteke
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK
| | - C Harvey
- Department of Critical Care Medicine, University Hospital of Leicester, Leicester, UK
| | - S Ledot
- Department of Critical Care Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - I Scott
- Department of Critical Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - N A Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Barker J, Cooke L, Beyers J. Plugging the Gap – Implementing the use of Corstop A.C.E. Stopper© in simple displacement of Balloon Retained Enteral Tubes. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rush KL, Barker J, Ollivier R, Ferrier M, Singini D. Screening for Atrial Fibrillation in Zambia’s Western Province. Glob J Health Sci 2019. [DOI: 10.5539/gjhs.v11n2p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: The prevalence of atrial fibrillation (AF) is increasing in sub-Saharan Africa and contributes to significant morbidity and mortality from stroke and other cardiovascular diseases. Case finding in some areas of the country, such as in rural Zambia is especially challenging with limited availability of ambulatory electrocardiogram monitoring devices. Moreover, there is very little qualitative research exploring Zambian patients’ experiences living with AF.
AIMS: The two-fold purpose of this study was i) to explore the use of a screening tool for detecting AF in Western Province, Zambia and ii) to understand the patient experience of living with AF.
SETTING: Mongu and Limulunga Districts in the Western Province of Zambia.
METHODS: Mixed methods. Convenience sampling for both quantitative and qualitative arms of the study was used to recruit participants attending public ‘Health Checks.’ Quantitative data were collected by means of an interview-administered survey and qualitative data were obtained through individual interviews.
RESULTS: An irregular manual pulse was found in 12.6% (n=33) of Zambians who attended the Health Checks and two participants were confirmed to have AF. Zambians with an irregular pulse had a significantly higher prevalence of hypertension and were significantly less sedentary than those without pulse irregularities. Two themes emerged from the interview with two patients diagnosed with AF: symptoms and healthcare access.
CONCLUSION: Hypertension continues to be a problem in adult Zambians and is an independent risk factor for stroke and, when diagnosed in conjunction with AF, further compounds stroke risk. Access to screening and diagnostic care for AF is essential, especially in currently underserved rural areas. In addition, participants presented with unique risk factors, such as consolidated periods of exercise, that require further research to determine context and seasonal variation so as to improve education and prevention strategies.
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