1
|
Harrogate S, Barnes J, Thomas K, Isted A, Kunst G, Gupta S, Rudd S, Banerjee T, Hinchliffe R, Mouton R. Peri-operative tobacco cessation interventions: a systematic review and meta-analysis. Anaesthesia 2023; 78:1393-1408. [PMID: 37656151 PMCID: PMC10952322 DOI: 10.1111/anae.16120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/02/2023]
Abstract
Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.
Collapse
Affiliation(s)
- S. Harrogate
- Elizabeth Blackwell InstituteUniversity of BristolBristolUK
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| | - J. Barnes
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| | - K. Thomas
- Department of Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - A. Isted
- Department of Anaesthesia, King's College Hospital NHS Foundation TrustLondonUK
| | - G. Kunst
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College LondonLondonUK
- Department of Anaesthesia, King's College Hospital NHS Foundation TrustLondonUK
| | - S. Gupta
- Department of AnaesthesiaUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - S. Rudd
- North Bristol NHS TrustBristolUK
| | | | - R. Hinchliffe
- Department of Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Vascular Services, North Bristol NHS TrustBristolUK
| | - R. Mouton
- Department of Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Department of Anaesthesia, North Bristol NHS TrustBristolUK
| |
Collapse
|
2
|
Thomas K, Gichoya J, Ding J, Sakhi H, Zaiman Z, Li H, Trivedi H, Park P, Bercu Z, Resnick N, Newsome J. Abstract No. 184 Repeat Transradial Access in Interventional Radiology: Our Institutional Experience. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
|
3
|
Ikonomidis I, Kountouri A, Mitrakou A, Thymis J, Katogiannis K, Korakas E, Varlamos C, Bamias A, Thomas K, Andreadou I, Tsoumani M, Kavatha D, Antoniadou A, Dimopoulos MA, Lambadiari V. SARS-CoV-2 is associated withabnormal biomarkers of oxidative stress,and endothelial function linked with cardiovascular dysfunction four months after the infection. Eur Heart J 2022. [PMCID: PMC9619520 DOI: 10.1093/eurheartj/ehac544.153] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction COVID-19 infection has been associated with increase arterial stiffness, endothelialdysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have beensuggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation afterCOVID-19 infection. Purpose The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial,coronary, and myocardial function markers four months after SARS-CoV-2 infection. Methods In a case-control prospective study, we included 70 patients 4 months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) malondialdehyde (MDA), an oxidative stress marker, thrombomodulin and von Willebrand factor as endothelial biomarkers. Results COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively) but lower values than controls (3.42±0.65, p=0.0135, 9.06±2.11%, p=0.002 respectively). Compared to controls, both COVID-19 and hypertensives had greater PBR5–25 (2.07±0.15μm and 2.07±0.26μm p=0.8 vs 1.89±0.17μm, p=0.001), higher PWV, (12.09±2.50 vs 11.92±2.94, p=0.7 vs 10.04±1.80m/sec, p=0.036) increased cSBP (128.43±17.39 vs 135.17±16.83 vs 117.89±18.85) and impaired LV and RV GLS (−19.50±2.56% vs −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020 and −16.99±3.17% vs −18.63±3.20%, p=0.002 vs −20.51±2.28%, p<0.001). MDA and thrombomodulin were higher in COVID-19 patients than both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50nmole/L, p=0.001 and 3716.63±188.36 vs 3114.46±179.18, p=0.017 vs 2590.02±156.51pg/ml, p<0.001). COVID-19 patients displayed similar vWF values with hypertensives but higher compared with healthy controls (4018.03±474.31 vs 3756.65±293.28 vs 2079.33±855.10 ng/ml, p=0.718 and p=0.016 respectively). Conclusions SARS-CoV-2 infection is associated with oxidative stress, endothelial and vascular dysfunction, which are linked to impaired longitudinal myocardial deformation 4 months after COVID-19 infection. Funding Acknowledgement Type of funding sources: None.
Collapse
Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - D Kavatha
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - M A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| |
Collapse
|
4
|
Ikonomidis I, Kountouri A, Mitrakou A, Katogiannis K, Thymis J, Korakas E, Pavlidis G, Andreadou I, Chania C, Bamias A, Thomas K, Antoniadou A, Lambadiari V, Filippatos G. Impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation four months after COVID-19 infection are partially improved at twelve months. Eur Heart J 2022. [PMCID: PMC9619591 DOI: 10.1093/eurheartj/ehac544.2645] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk. Purpose We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection Methods We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker. Results At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p<0.001) which increased at twelve months (p<0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p>0.05 for all the comparisons) and higher than those in controls (p<0.001, p=0.057, p=0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p=0.002, p=0.069 respectively), though remained impaired compared to controls (p=0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p=0.001,) and showed no statistically significant difference compared to controls (p>0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p=0.01, p=0.006 respectively). There was a modest improvement in GWW and GWE at twelve months,(p=0.043, p=0.001, respectively); however, these markers remained impaired compared to controls (p>0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p<0.001); however, these values remain higher than in controls (p=0.002) (Table 1). Conclusions SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection. Funding Acknowledgement Type of funding sources: None.
Collapse
Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - C Chania
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| |
Collapse
|
5
|
Koutsianas C, Panagiotopoulos A, Thomas K, Chalkia A, Lazarini A, Kapsala N, Flouda S, Argyriou E, Boki K, Petras D, Boumpas D, Vassilopoulos D. POS0832 MORTALITY TRENDS IN ANCA-ASSOCIATED VASCULITIDES (AAVs): DATA FROM A CONTEMPORARY, MULTICENTER ANCA REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3481] [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: 11/03/2022]
Abstract
BackgroundAAVs are a group of rheumatic diseases with excess morbidity and mortality (~3-fold higher compared to the general population). Long-term studies looking at mortality trends in contemporary patient cohorts are limited.ObjectivesTo investigate the overall long-term survival and all-cause mortality in a contemporary AAV patient cohort.MethodsMulticenter cohort study of patients registered and prospectively followed in the Greek ANCA Registry.ResultsData for 165 patients (989.38 patient-years of follow up) with a diagnosis of AAV (GPA n=95, 58%, MPA n=54, 33%, EGPA n=16, 9%) were analyzed (January 1, 1998 - January 10, 2022). 53% of patients were female, with a mean age of 65 (±16.4) years; the majority (97%) had generalized disease and were ANCA positive (76%). The mean follow-up since diagnosis was 5.9 (±5.1) years. At the end of follow-up, the overall mortality rate was 20% (33/165), whereas the cumulative mortality rates at 5 and 10 years were 24% and 26% respectively. Overall cumulative survival at 5 years was worse in patients with MPA (57%) compared to GPA (81%) and EGPA (92%), (p<0.001). There was no difference in long-term survival among those treated with different induction regimens including cyclophosphamide (CYC, n of deaths=24/83, 28.9%), rituximab (RTX, n=4/40, 10%) or the CYC+RTX combination (n=3/16, 18.7%). Furthermore, there was no difference in survival between relapsing (≥1 relapses) and non-relapsing (n=76) patients (Figure 1). Cumulative survival was worse in patients who initially presented with lung (66% vs. 90% at 5 years, p=0.007), kidney (56% vs. 96% at 5 years, p<0.001) and simultaneous lung and kidney (39% vs. 93% at 5 years, p<0.001) involvement. Among the 33 registered deaths, the most frequent causes were infections (52%), followed by cardiovascular events (24%), disease flares (14%) and malignancies (10%).Figure 1.ConclusionIn a contemporary multi-center AAV cohort, the cumulative mortality rates at 5 and 10 years were 24% and 26% respectively. Overall survival was worse in patients with MPA as well as those with combined lung and kidney involvement at baseline while there were no survival differences according to the initial induction regimen. Infection was the most common cause of death. These findings emphasize the unmet needs for better, less toxic therapies.AcknowledgementsSupported in part by the Greek Rheumatology Society and Professional Association of Rheumatologists (ERE-EPERE) and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece (DV #12085, 12086).Disclosure of InterestsNone declared
Collapse
|
6
|
Lazaridis I, Kraljevic M, Thomas K, Gätzi D, Stöcklin P, Zingg U, Delko T. Endoscopic surveillance after bariatric surgery: Results from a large, single-institution cohort. Br J Surg 2022. [DOI: 10.1093/bjs/znac175.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Sleeve gastrectomy (SG) and Roux-en-Y-gastric bypass (RYGB) are associated with long- term abnormalities, including erosive esophagitis (EE), hiatal hernia (HH), gastritis, Barrett`s esophagus and ulcers. The aim of this study is to assess the prevalence of abnormal endoscopic and histologic findings after SG and RYGB in a large cohort.
Methods
This is a retrospective analysis of 720 consecutive patients who underwent esophagogastroduodenoscopy (EGD) after primary SG or RYGB. Patients were invited for a control EGD after two years of follow-up. EGD was also performed in order to evaluate postoperative symptoms, such as nausea, vomiting or reflux. If revisional surgery was planned, an EGD was included in the prerevisional work up.
Results
304 post-SG patients (64.1% female) and 416 post-RYGB patients (85% female) were included. The mean age at the time of operation was 43.9 years (95% confidence intervals (CI) 42.5–43.3 years) for the post-SG group and 40.5 years (95% CI 39.4–41.6 years) for the post-RYGB group (p<0.001). The mean preoperative body mass index (BMI) was 44.2 kg/m2 (95%CI 43.4–44.9) and 41.1 kg/m2 (95%CI 40.7–41.5) for the post-SG and the post-RYGB group respectively (p<0.001). EE, gastritis and HH were more prevalent after SG than RYGB (38.8% vs 8.9%, 62.5% vs 27.6% and 28% vs 2.6% respectively, p<0.001). RYGB was associated with more postoperative ulcers than SG (14.4% vs 0.7%, p<0.001). The incidence of anastomotic strictures requiring anastomotic dilatation after RYGB was 4.6%. No significant difference was found in the prevalence of Barrett`s esophagus (4.3% post SG vs. 4.1 post RYGB, p=1.000) and Helicobacter pylori (3.3% post SG vs. 1.2% post RYGB, p=0.065) between the two groups.
Conclusion
SG is associated with higher rates of EE, gastritis and HH, while the prevalence of ulcers is higher post RYGB. There is a low risk of anastomotic stricture post RYGB. The incidence of Barrett`s oesophagus is low after both procedures. Routine use of EGD after bariatric surgery should be evaluated.
Collapse
Affiliation(s)
- I Lazaridis
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - M Kraljevic
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - K Thomas
- Department of Surgery, Limmattal Hospital , Zurich, Schlieren, Switzerland
| | - D Gätzi
- Medical Faculty, University of Basel , Basel, Switzerland
| | - P Stöcklin
- Medical Faculty, University of Basel , Basel, Switzerland
| | - U Zingg
- Department of Surgery, Limmattal Hospital , Zurich, Schlieren, Switzerland
| | - T Delko
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| |
Collapse
|
7
|
Panagiotopoulos A, Thomas K, Argyriou E, Chalkia A, Kapsala N, Koutsianas C, Mavrea E, Petras D, Boumpas D, Vassilopoulos D. AB0633 Health-Related Quality of Life in ANCA Vasculitides and Rheumatoid Arthritis patients: a cross-sectional comparative study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3869] [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: 11/03/2022]
Abstract
BackgroundANCA associated vasculitides (AAVs) are rare, serious forms of vasculitides. There are limited data regarding the quality of life in patients with AAVs compared to other chronic inflammatory diseases.ObjectivesThe purpose of this study was to compare the quality of life between patients with AAV and those with a chronic inflammatory arthritis such as rheumatoid arthritis (RA).MethodsMulticenter, cross-sectional study of AAV and RA patients followed in three tertiary referral centers. Data from 1007 healthy controls served as historic controls.1 HRQoL was assessed with the Short Form 36 Health Survey (SF-36) which includes physical and mental component summary scores (PCS and MCS). Disease activity were assessed with the Birmingham Vasculitis Activity Score version 3 (BVAS 3, for AAVs) and the DAS28-ESR (for RA) respectively and organ damage/function with the Vasculitis Damage Index (VDI for AAVs) score and Health Assessment Questionnaire (HAQ for RA) scores, respectively.Results66 patients with AAVs (GPA 62%, MPA 29% and EGPA 9%, females 56%, mean age 63.4 years, generalized disease 74%, mean disease duration 6.2 years, remission 73%) and 71 with RA (females 56%, mean age 63.3 years, remission 72%) were included. Both AAV and RA patients had significantly lower PCS and MCS scores compared to healthy controls (p < 0.05) while RA patients had lower PCS and MCS scores compared to AAV patients (p < 0.05). According to disease activity status, there was no difference in the SF-36 scores between those with active (BVAS > 1) and inactive (BVAS < 1) AAV, except for the energy-fatigue component (55.0 ± 21.8 vs. 67.2 ± 20.7, p= 0.038) whereas patients with active RA (DAS28-ESR > 3.2) had lower scores for all SF36 components compared to those with low disease activity (DAS28-ESR < 3.2). Additionally, active RA patients had lower both PCS and MCS scores compared to active AAV patients (p < 0.05). AAV patients with increased damage scores (VDI > 3) had lower PCS score compared to those with less organ damage (VDI < 3), (33.9 ± 10.1 vs. 49.1 ± 10.2, p < 0.001) while RA patients with increased damage/poor functionality (HAQ ≥ 0.75) had lower both PCS and MCS scores compared to those with less damage (HAQ ≤ 0.63), (35.0 ± 7.2 vs. 48.4 ± 8.6, p < 0.001) and (40.5 ± 8.6 vs. 48.2 ± 7.6, p < 0.001 respectively). Compared to patients with AAV, RA patients with increased damage had lower score for the pain component compared to AAV patients (37.7 ± 28.6 vs. 61.2 ± 29.5, p= 0.024).ConclusionIn general, patients with AAV and RA, demonstrate impaired quality of life compared to healthy controls. In the AAV group, quality of life correlated more with organ damage and less with disease activity whereas in RA patients, quality of life correlated both with disease activity and damage. These data emphasize the need for more efficacious therapies for AAV patients that could prevent chronic organ damage and improve quality of life.References[1]Pappa, E., Kontodimopoulos, N. & Niakas, D. Validating and norming of the Greek SF-36 Health Survey. Qual Life Res 14, 1433–1438 (2005).AcknowledgementsSupported in part by the Greek Rheumatology Society and Professional Association of Rheumatologists (ERE-EPERE) and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece (DV #12085, 12086).Disclosure of InterestsNone declared
Collapse
|
8
|
Beazley S, Focken A, Fernandez-Parra R, Thomas K, Adler A, Duke-Novakovski T. Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum. Vet Anaesth Analg 2022; 49:382-389. [DOI: 10.1016/j.vaa.2022.04.004] [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: 07/15/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
|
9
|
Davis NF, Donaldson JF, Shepherd R, Neisius A, Petrik A, Seitz C, Thomas K, Lombardo R, Tzelves L, Somani B, Gambarro G, Ruhayel Y, Türk C, Skolarikos A. Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel. J Pediatr Urol 2022; 18:132-140. [PMID: 35148953 DOI: 10.1016/j.jpurol.2022.01.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.
Collapse
Affiliation(s)
- N F Davis
- Beaumont and Connolly Hospitals, Department of Urology, Dublin, Ireland.
| | - J F Donaldson
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Shepherd
- European Association of Urology Guidelines Office, Arnhem, the Netherlands
| | - A Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Academic Teaching Hospital of the Johannes Gutenberg University, Department of Urology, Mainz, Germany
| | - A Petrik
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - C Seitz
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - K Thomas
- Stone Unit, Guy's and St. Thomas' National Health Services Foundation Hospital, Department of Urology, London, UK
| | - R Lombardo
- Department of Urology, Ospedale Sant'Andrea 'Sapienza' University, Rome, Italy
| | - L Tzelves
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Medical School, Department of Urology, Athens, Greece
| | - B Somani
- Spire Southampton Hospital, Chalybeate Cl, Southampton, SO16 6UY, UK
| | - G Gambarro
- Head Division of Nephrology and Dialysis, University of Verona, Medicine, Verona, Italy
| | - Y Ruhayel
- Department of Urology, Skane University Hospital, Malmo, Sweden
| | - C Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Medical School, Department of Urology, Athens, Greece
| |
Collapse
|
10
|
Katogiannis K, Ikonomidis I, Thymis J, Mitrakou A, Kountouri A, Stamoulis K, Korakas E, Varlamos C, Andreadou I, Tsoumani M, Bamias A, Thomas K, Antoniadou A, Dimopoulos MA, Lambadiari V. Association of COVID-19 with impaired endothelial glycocalyx, vascular function and myocardial efficiency four months after infection. Eur Heart J Cardiovasc Imaging 2022. [PMCID: PMC9383395 DOI: 10.1093/ehjci/jeab289.065] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
SARS-CoV-2 infection may lead to endothelial and vascular dysfunction. We
investigated alterations of arterial stiffness, endothelial coronary and myocardial
function markers four months after COVID-19 infection.
Methods
In a case-control prospective study, we included 100 patients four months after COVID-19 infection, 50 age- and sex-matched healthy individuals. We measured a) pulse wave velocity (PWV), b) flow-mediated dilation (FMD) of brachial artery, c) coronary Flow Reserve (CFR) by Doppler echocardiography d) left ventricular (LV) global longitudinal strain (GLS), e) left ventricular myocardial work index, constructive work, wasted work and work efficiency and e) von-Willenbrand factor and thrombomodulin as endothelial biomarkers.
Results
COVID-19 patients had lower CFR and FMD values than controls (2.39 ± 0.39 vs 3.31 ± 0.59, p = 0.0122, 5.12 ± 2.95% vs 8.12 ± 2.23%, p = 0.006 respectively). Compared to controls, COVID-19 patients had higher PWV (PWVc-f 12.32 ± 2.44 vs 10.11 ± 1.85 m/sec, p = 0.033) and impaired LV GLS (-19.11 ± 2.14% vs -20.41 ± 1.61%, p = 0.001). Compared to controls, COVID-19 patients had higher myocardial work index, and wasted work (2067.7 ± 325.9 mmHg% vs 1929.4 ± 312.7 mmHg%, p = 0.026, 104.6 ± 58.9 mmHg% vs 75.1 ± 52.6 mmHg%, p = 0.008, respectively), while myocardial efficiency was lower (94.8 ± 2.5% vs 96.06 ± 2.3%, p = 0.008). and thrombomodulin were higher in COVID-19 patients than controls (3716.63 ± 188.36 vs 2590.02 ± 156.51pg/ml, p < 0.001). MDA was higher in COVID-19 patients than controls (10.55 ± 2.45 vs 1.01 ± 0.50 nmole/L, p = 0.001). Residual cardiovascular symptoms at 4 months were associated with oxidative stress markers. Myocardial work efficiency was related with PWV (F=-0.309, p = 0.016) and vWillenbrand (F=-0.541, p = 0.037). Myocardial wasted work was related with PWV (F = 0.255, p = 0.047) and vWillenbrand (F = 0.610, p = 0.016).
Conclusions
SARS-CoV-2 may cause vascular dysfunction, followed by a waste of cardiac work, in order to compensate for increased arterial stiffness 4 months after infection.
Collapse
Affiliation(s)
- K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - A Mitrakou
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Stamoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Andreadou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - M Tsoumani
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Thomas
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - A Antoniadou
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - MA Dimopoulos
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| |
Collapse
|
11
|
Lombardo R, Tzelves L, Geraghty R, Davis N, Neisius A, Petřík A, Gambaro G, Türk C, Somani B, Skolarikos A, Thomas K. What is the ideal follow up after kidney stone treatment? A systematic review and follow-up algorithm from the European Association of Urology urolithiasis panel. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
Tzelves L, Geraghty R, Lombardo R, Davis N, Neisius A, Petřík A, Gambaro G, Türk C, Thomas K, Somani B, Skolarikos A. Duration of follow-up and timing of discharge in adult patients with urolithiasis after surgical or medical intervention: A systematic review and meta-analysis from the European Association of Urology Guideline Panel on Urolithiasis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Extermann M, Walko C, Mishra A, Thomas K, Cao B, Chon H, Critea M, Berglund A, Chem J, Cubitt C, Gomes A, Hoffman M, Kim J, Marchion D, Petersson F, Sansil S, Sehovic M, Shahzad M, Welsh E, Zhang Y. Worsening of ovarian cancer prognosis with age: an exploration of pharmacokinetics, body composition, and biology. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00338-6] [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]
|
14
|
Parker D, Hudson P, Tieman J, Thomas K, Saward D, Ivynian S. Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives. Aust J Prim Health 2021; 27:473-478. [PMID: 34802508 DOI: 10.1071/py21019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.
Collapse
Affiliation(s)
- D Parker
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - P Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia; and Vrije University, Brussels, Belgium
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - K Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - D Saward
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - S Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; and Corresponding author.
| |
Collapse
|
15
|
Ikonomidis I, Kountouri A, Mitrakou A, Thymis J, Katogiannis K, Korakas E, Varlamos C, Bamias A, Thomas K, Andeadou I, Tsoumani M, Kavatha D, Antoniadou A, Dimopoulos M, Lambadiari V. COVID-19 patients present impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation resembling those observed in hypertensives four months after infection. Eur Heart J 2021. [PMCID: PMC8524639 DOI: 10.1093/eurheartj/ehab724.061] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/Introduction COVID-19 infection has been associated with increase arterial stiffness, endothelial dysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have been suggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation after COVID-19 infection. Purpose The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial, coronary, and myocardial function markers four months after SARS-CoV-2 infection. Methods We conducted a case-control prospective study, including 70 patients four months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness b) flow-mediated dilation (FMD), c) coronary Flow Reserve (CFR) by Doppler echocardiography d) pulse wave velocity (PWV) and central systolic (SBP) e) global LV longitudinal strain (GLS) by speckle tracking imaging and f) malondialdehyde (MDA) as oxidative stress marker. Results COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively), but lower CFR and FMD than controls (3.42±0.65, p=0.0135 9.06±2.11%, p=0.002 respectively) Both COVID-19 and hypertensive group had greater PBR than controls (PBR5–25: 2.07±0.15 μm and 2.07±0.26 μm p=0.8 vs 1.89±0.17 μm, p=0.001). COVID-19 patients and hypertensives had higher PWV and central SBP than controls (PWVcf 12.09±2.50 and 11.92±2.94, p=0.7 vs 10.04±1.80 m/sec, p=0.036). COVID-19 patients and hypertensives had impaired values of GLS compared to controls (−19.50±2.56% and −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020). Increased PBR5–25 was associated with increased SBP central which in turn was related with impaired GLS (p<0.05). MDA was found increased in COVID-19 patients compared to both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50 nmole/L, p=0.001). Conclusions SARS-CoV-2 may cause impaired coronary microcirculatory, endothelial and vascular deregulation which remain four months after initial infection and are associated with reduced cardiac performance. The 10-fold increase of MDA compared to healthy individuals four months after COVID-19 infection indicate oxidative stress as possible pathophysiological mechanism. FUNDunding Acknowledgement Type of funding sources: None.
Collapse
Affiliation(s)
- I Ikonomidis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - E Korakas
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Varlamos
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - A Bamias
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Andeadou
- National & Kapodistrian University of Athens Medical School, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens Medical School, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - D Kavatha
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M.A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
16
|
Grover S, Raj S, Russell B, Thomas K, Nair R, Thurairaja R, Khan MS, Malde S. 733 Long-Term Outcomes of Outpatient Laser Ablation for Recurrent Non-Muscle Invasive Bladder Cancer: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Non-muscle-invasive bladder cancer (NMIBC) is the most prevalent form of bladder cancer, predominantly affecting the elderly population. The most common treatment for recurrent NMIBC is transurethral resection of the bladder tumour (TURBT), which carries a risk of perioperative morbidity and mortality in this often-co-morbid population. Outpatient laser ablation of low-grade NMIBC recurrences is a minimally invasive treatment option, but long-term efficacy is poorly reported.
Method
We retrospectively reviewed the case notes of all patients treated with Holmium:YAG laser ablation from 2008-2016. Data regarding patient demographics, original histology, dates of procedures, follow-up time, recurrence, progression, and complications were recorded.
Results
A total of 199 procedures were performed on 97 patients (mean age of 83.56), 73 (75.3%) of which originally had low-grade (G1 or G2) tumours. Overall, 55 (56.7%) patients developed tumour recurrence at long-term follow-up (mean 5.36 years), and only 9 (9.3%) patients had tumour progression to a higher stage or grade, but there was no progression to muscle-invasive disease. The median recurrence-free, progression-free and overall survival times were 1.69 years (95% CI 1.20-2.25), 5.70 years (95% CI 4.10-7.60) and 7.60 years (95% CI 4.90-8.70), respectively. No patients required emergency inpatient admission after laser ablation for any associated complications.
Conclusions
Office-based Holmium: YAG laser ablation is an oncologically-safe method of managing recurrent low-grade non-muscle-invasive bladder cancer in the long-term, with no patients progressing to muscle-invasive disease. Furthermore, the procedure is safe, and no significant complications were seen in this elderly and co-morbid population.
Collapse
Affiliation(s)
- S Grover
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - S Raj
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - B Russell
- Translational Oncology and Urology Research, King's College London, London, United Kingdom
| | - K Thomas
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Nair
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Thurairaja
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - M S Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - S Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
17
|
Cushnie D, Fisher C, Hall H, Johnson M, Christie S, Bailey C, Phan P, Abraham E, Glennie A, Jacobs B, Paquet J, Thomas K. Mental health improvements after elective spine surgery: a Canadian Spine Outcome Research Network (CSORN) study. Spine J 2021; 21:1332-1339. [PMID: 33831545 DOI: 10.1016/j.spinee.2021.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spine patients have a higher rate of depression then the general population which may be caused in part by levels of pain and disability from their spinal disease. PURPOSE Determination whether improvements in health-related quality of life (HRQOL) resulting from successful spine surgery leads to improvements in mental health. STUDY DESIGN/SETTING The Canadian Spine Outcome Research Network prospective surgical outcome registry. OUTCOME MEASURES Change between preoperative and postoperative SF12 Mental Component Score (MCS). Secondary outcomes include European Quality of Life (EuroQoL) Healthstate, SF-12 Physical Component Score (PCS), Oswestry Disability Index (ODI), Patient Health Questionaire-9 (PHQ9), and pain scales. METHODS The Canadian Spine Outcome Research Network registry was queried for all patients receiving surgery for degenerative thoracolumbar spine disease. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement in postoperative disability (ODI) and secondary measures. Multivariate analysis examined factors predictive of MCS improvement. RESULTS Eighteen hospitals contributed 3222 eligible patients. Worse ODI, EuroQoL, PCS, back pain and leg pain correlated with worse MCS at all time points. Overall, patients had an improvement in MCS that occurred within 3 months of surgery and was still present 24 months after surgery. Patients exceeding Minimally Clinically Important Differences in ODI had the greatest improvements in MCS. Major depression prevalence decreased up to 48% following surgery, depending on spine diagnosis. CONCLUSIONS Large scale, real world, registry data suggests that successful surgery for degenerative lumbar disease is associated with reduction in the prevalence of major depression regardless of the specific underlaying diagnosis. Worse baseline MCS was associated with worse baseline HRQOL and improved postoperatively with coincident improvement in disability, emphasizing that mental wellness is not a static state but may improve with well-planned spine surgery.
Collapse
Affiliation(s)
- D Cushnie
- McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8.
| | - C Fisher
- University of British Columbia, 6th floor, 818 West 10th Avenue, Vancouver, British Columbia, Canada, V5Z 1M9
| | - H Hall
- University of Toronto, 494851 Traverston Road, Markdale, Ontario, Canada, N0C 1H0
| | - M Johnson
- University of Manitoba, AD401 - 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9
| | - S Christie
- Dalhousie University, Department of Surgery (Neurosurgery), Halifax, Nova Scotia, Canada, B3H 4R2
| | - C Bailey
- Western University, 800 Commissioners Rd. E., E1-317London, Ontario, Canada, N6A 5W9
| | - P Phan
- University of Ottawa, 1053 Carling Ave, Ottawa, Ontario, Canada, K1Y 4E9
| | - E Abraham
- Dalhousie University, 555 Somerset St, Suite 200, Saint John, New Brunswick, Canada, E2K 4X2
| | - A Glennie
- Dalhousie University, Department of Surgery (Neurosurgery), Halifax, Nova Scotia, Canada, B3H 4R2
| | - B Jacobs
- University of Calgary, Foothills Medical Centre, 1403 - 29th Street NW Calgary, AB, Canada T2N 2T9
| | - J Paquet
- CHU de Québec-Université Laval, 1401 18e rue, Québec City, Quebec, Canada, G1J 1Z4
| | - K Thomas
- University of Calgary, Foothills Medical Centre, 1403 - 29th Street NW Calgary, AB, Canada T2N 2T9
| |
Collapse
|
18
|
Maitland K, Kiguli S, Olupot-Olupot P, Hamaluba M, Thomas K, Alaroker F, Opoka RO, Tagoola A, Bandika V, Mpoya A, Mnjella H, Nabawanuka E, Okiror W, Nakuya M, Aromut D, Engoru C, Oguda E, Williams TN, Fraser JF, Harrison DA, Rowan K. Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia. Intensive Care Med 2021; 47:566-576. [PMID: 33954839 PMCID: PMC8098782 DOI: 10.1007/s00134-021-06385-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
Purpose The life-saving role of oxygen therapy in African children with severe pneumonia is not yet established. Methods The open-label fractional-factorial COAST trial randomised eligible Ugandan and Kenyan children aged > 28 days with severe pneumonia and severe hypoxaemia stratum (SpO2 < 80%) to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO: standard care) and hypoxaemia stratum (SpO2 80–91%) to HFNT or LFO (liberal strategies) or permissive hypoxaemia (ratio 1:1:2). Children with cyanotic heart disease, chronic lung disease or > 3 h receipt of oxygen were excluded. The primary endpoint was 48 h mortality; secondary endpoints included mortality or neurocognitive sequelae at 28 days. Results The trial was stopped early after enrolling 1852/4200 children, including 388 in the severe hypoxaemia stratum (median 7 months; median SpO2 75%) randomised to HFNT (n = 194) or LFO (n = 194) and 1454 in the hypoxaemia stratum (median 9 months; median SpO2 88%) randomised to HFNT (n = 363) vs LFO (n = 364) vs permissive hypoxaemia (n = 727). Per-protocol 15% of patients in the permissive hypoxaemia group received oxygen (when SpO2 < 80%). In the severe hypoxaemia stratum, 48-h mortality was 9.3% for HFNT vs. 13.4% for LFO groups. In the hypoxaemia stratum, 48-h mortality was 1.1% for HFNT vs. 2.5% LFO and 1.4% for permissive hypoxaemia. In the hypoxaemia stratum, adjusted odds ratio for 48-h mortality in liberal vs permissive comparison was 1.16 (0.49–2.74; p = 0.73); HFNT vs LFO comparison was 0.60 (0.33–1.06; p = 0.08). Strata-specific 28 day mortality rates were, respectively: 18.6, 23.4 and 3.3, 4.1, 3.9%. Neurocognitive sequelae were rare. Conclusions Respiratory support with HFNT showing potential benefit should prompt further trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06385-3.
Collapse
Affiliation(s)
- K Maitland
- Department of Infectious Disease and and Institute of Global Health and Innovation, Division of Medicine, Imperial College, London, UK. .,Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.
| | - S Kiguli
- School of Medicine, Makerere University and Mulago Hospital Kampala, Kampala, Uganda
| | - P Olupot-Olupot
- Faculty of Health Sciences, Mbale Campus and Mbale Regional Referral Hospital Mbale (POO, WO), Busitema University, Mbale, Uganda
| | - M Hamaluba
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Thomas
- Intensive Care National Audit and Research Centre, London, UK
| | - F Alaroker
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - R O Opoka
- School of Medicine, Makerere University and Mulago Hospital Kampala, Kampala, Uganda.,Jinja Regional Referral Hospital Jinja, Jinja, Uganda
| | - A Tagoola
- Jinja Regional Referral Hospital Jinja, Jinja, Uganda
| | - V Bandika
- Coast General District Hospital, Mombasa, Kenya
| | - A Mpoya
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - H Mnjella
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - E Nabawanuka
- School of Medicine, Makerere University and Mulago Hospital Kampala, Kampala, Uganda
| | - W Okiror
- Faculty of Health Sciences, Mbale Campus and Mbale Regional Referral Hospital Mbale (POO, WO), Busitema University, Mbale, Uganda
| | - M Nakuya
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - D Aromut
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - C Engoru
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - E Oguda
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - T N Williams
- Department of Infectious Disease and and Institute of Global Health and Innovation, Division of Medicine, Imperial College, London, UK.,Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - J F Fraser
- Critical Care Research Group and Intensive Care Service, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - D A Harrison
- Intensive Care National Audit and Research Centre, London, UK
| | - K Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | | |
Collapse
|
19
|
Vilenchik V, Thomas K, Baker L, Hitchens E, Keith D. Laser therapy is a safe and effective treatment for unwanted hair in adults undergoing male to female sex reassignment. Clin Exp Dermatol 2021; 46:541-543. [PMID: 33007103 DOI: 10.1111/ced.14466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
Reduction in unwanted facial and body hair is an important goal in the process of sex reassignment. Laser treatment is a popular, well-established safe and effective method of reducing unwanted hair growth. In the UK a limited number of laser treatment and electrolysis sessions are publically funded for people undergoing sex reassignment. To date, published evidence on efficacy and adverse effects (AEs) has focused on treatment of women and men not undergoing sex reassignment. In the current study, data were collected prospectively from 2015 to 2020 at a UK regional laser centre. Patients were included if they were transgender women aged > 16 years old and seeking laser treatment for unwanted hair at any body site. The study demonstrated significant reductions in hair growth and significant patient satisfaction, with no AEs. Laser treatment is a safe and effective method of managing unwanted hair growth in the transgender transfeminine population.
Collapse
Affiliation(s)
- V Vilenchik
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - K Thomas
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Baker
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - E Hitchens
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D Keith
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
20
|
Thomas K, Smith C, Marsala A, Boudreaux J, Thiagarajan R, Ramirez R. P49.04 The use of Stereotactic Body Radiotherapy in Pulmonary Carcinoid Tumors: A Single Institution Retrospective Review. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.898] [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: 10/21/2022]
|
21
|
Wilkinson MJ, Snow H, Downey K, Thomas K, Riddell A, Francis N, Strauss DC, Hayes AJ, Smith MJF, Messiou C. CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry. BJS Open 2021; 5:6104886. [PMID: 33609385 PMCID: PMC7893466 DOI: 10.1093/bjsopen/zraa005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.
Collapse
Affiliation(s)
- M J Wilkinson
- Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK
| | - H Snow
- Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK
| | - K Downey
- Department of Radiology, The Royal Marsden Hospital, London, UK
| | - K Thomas
- Statistics Department, The Royal Marsden Hospital, London, UK
| | - A Riddell
- Department of Radiology, The Royal Marsden Hospital, London, UK
| | - N Francis
- Department of Pathology, The Royal Marsden Hospital (Honorary) and Charing Cross Hospital, London, UK
| | - D C Strauss
- Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK
| | - A J Hayes
- Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK.,Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - M J F Smith
- Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK
| | - C Messiou
- Department of Radiology, The Royal Marsden Hospital, London, UK.,Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| |
Collapse
|
22
|
Fritsch C, Gout JF, Haroon S, Towheed A, Chung C, LaGosh J, McGann E, Zhang X, Song Y, Simpson S, Danthi PS, Benayoun BA, Wallace D, Thomas K, Lynch M, Vermulst M. Genome-wide surveillance of transcription errors in response to genotoxic stress. Proc Natl Acad Sci U S A 2021; 118:e2004077118. [PMID: 33443141 PMCID: PMC7817157 DOI: 10.1073/pnas.2004077118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mutagenic compounds are a potent source of human disease. By inducing genetic instability, they can accelerate the evolution of human cancers or lead to the development of genetically inherited diseases. Here, we show that in addition to genetic mutations, mutagens are also a powerful source of transcription errors. These errors arise in dividing and nondividing cells alike, affect every class of transcripts inside cells, and, in certain cases, greatly exceed the number of mutations that arise in the genome. In addition, we reveal the kinetics of transcription errors in response to mutagen exposure and find that DNA repair is required to mitigate transcriptional mutagenesis after exposure. Together, these observations have far-reaching consequences for our understanding of mutagenesis in human aging and disease, and suggest that the impact of DNA damage on human physiology has been greatly underestimated.
Collapse
Affiliation(s)
- C Fritsch
- Department of Cellular and Molecular Biology, University of Pennsylvania, Philadelphia, PA 19104
| | - J-F Gout
- School of Life Sciences, Biodesign Center for Mechanisms of Evolution, Arizona State University, Tempe, AZ 85287
- Department of Biological Sciences, Mississippi State University, Mississippi State, MS 39762
| | - S Haroon
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | - A Towheed
- Touro College of Osteopathic Medicine, Middletown, NY 10940
| | - C Chung
- School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - J LaGosh
- School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - E McGann
- School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - X Zhang
- Bioinforx, Inc., Madison, WI 53719
| | - Y Song
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
| | - S Simpson
- Department of Molecular, Cellular and Biomedical Sciences, University of New Hampshire, Durham, NH 03824
| | - P S Danthi
- School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - B A Benayoun
- School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - D Wallace
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | - K Thomas
- Department of Molecular, Cellular and Biomedical Sciences, University of New Hampshire, Durham, NH 03824
| | - M Lynch
- School of Life Sciences, Biodesign Center for Mechanisms of Evolution, Arizona State University, Tempe, AZ 85287;
| | - M Vermulst
- School of Gerontology, University of Southern California, Los Angeles, CA 90089;
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| |
Collapse
|
23
|
Davies K, Thomas K, Barton L, Williams C, Aujayeb A, Premchand N. Idiopathic systemic capillary leak syndrome (Clarkson's disease) presenting with recurrent hypovolemic shock. Acute Med 2021; 20:74-77. [PMID: 33749696] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 49-year old male with a past medical history of myocardial infarction and compartment syndromes requiring fasciotomies presented on five occasions with hypovolemic shock. We describe his admissions and presumptive diagnoses which required large volumes of intravenous fluids, admission to intensive care for vasopressors and renal replacement therapy. The presentations were always precipitated by a prodrome of fatigue and pre-syncopal episodes. On his last admission, a diagnosis of Idiopathic systemic capillary leak syndrome (ISCLS), also known as Clarkson's Disease, was reached. He is currently receiving high dose intravenous immunoglobulins on a monthly basis.
Collapse
Affiliation(s)
- K Davies
- MBChB (Hons) MRes, Clinical Research Fellow in Rheumatology Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - K Thomas
- Advanced Critical Care Practitioner, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - L Barton
- Acute Medicine and Critical Care Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - C Williams
- Haematology Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - A Aujayeb
- Respiratory and Acute Medicine Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - N Premchand
- Acute Medicine and Infectious Diseases Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| |
Collapse
|
24
|
Pokorney S, Garonzik S, Chertow G, Washam J, Mussina K, Bansal N, Gadegbeku C, Garcia D, Lopes R, Mahaffey K, Middleton J, Thadhani R, Thomas K, Winkelmayer W, Granger C. Pharmacokinetics of apixaban in patients with end stage renal disease on hemodialysis and atrial fibrillation: results from the RENAL-AF trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Apixaban use is increasing for stroke prevention in patients with atrial fibrillation (AF) and end stage renal disease (ESRD) on hemodialysis. There is uncertainty as to the optimal dose in this population in part related to the limited available pharmacokinetic (PK) data.
Purpose
We comprehensively evaluated the PK of apixaban collected over 1 month of apixaban dosing in 63 patients with AF and ESRD on hemodialysis.
Methods
Patients with AF and ESRD on hemodialysis were randomized to warfarin versus apixaban within the RENAL-AF trial with 5 mg BID dosing, except for 2.5 mg BID in those age ≥80 years or weight ≤60 kg. The 5 mg BID dose could be reduced to 2.5mg BID for minor bleeding. Day 1 PK data was collected on all patients pre- and post-hemodialysis. Day 3 and 1 month pre- and post-hemodialysis PK samples were collected in 49 patients. The timing of apixaban dosing and hemodialysis relative to PK samples was recorded. Dosing history, hemodialysis, and PK samples were chronologically integrated with patient specific data such as body size, age, race and gender. This dataset was combined with the ARISTOTLE dataset, and the published PK model from ARISTOTLE describing exposures in the AF population was updated to incorporate an additional clearance term for hemodialysis. The model estimated apixaban exposures (AUC) in RENAL-AF were compared to ARISTOLTE AUC values.
Results
There were 285 PK concentrations collected among 63 patients in the RENAL-AF trial. Patients had median age 69 years with 41% women (N=26) and a median weight of 84 kg (49, 157). The median AUCs for patients with ESRD on hemodialysis were 5,452 and 2,990 for patients treated with 5mg BID and 2.5mg BID doses, respectively. The median AUCs for patients treated with 5mg BID from ARISTOTLE increased from 2,802 for patients with class 1 CKD to 5,863 for class 4 CKD, while they increased from 2,392 for class 1 CKD to 2,881 for class 4 CKD in patients treated with 2.5mg BID. The median AUC for patients with ESRD on hemodialysis were within 50% of the exposure of patients from ARISTOTLE for all classes of CKD for the 2.5mg BID dose and for classes 2, 3A, 3B, and 4 CKD for the 5mg BID dose (Figure).
Conclusions
The steady state apixaban exposure data in patients with AF and ESRD on hemodialysis were modestly higher but consistent with the results of non-ESRD patients from ARISTOTLE, using 5 mg BID unless patients had age ≥80 years or weight ≤60 kg. Additional clinical outcomes data on the use of apixaban in patients with AF and ESRD on hemodialysis are needed.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator sponsored grant from Bristol-Myers Squibb and Pfizer
Collapse
Affiliation(s)
- S Pokorney
- Duke University, Durham, United States of America
| | - S Garonzik
- Bristol Myers Squibb, Princeton, United States of America
| | - G.M Chertow
- Stanford University, Palo Alto, United States of America
| | - J.B Washam
- Duke University, Durham, United States of America
| | - K Mussina
- Frenova Renal Research, Waltham, United States of America
| | - N Bansal
- University of Washington, Seattle, United States of America
| | - C Gadegbeku
- Temple University School of Medicine, Philadelphia, United States of America
| | - D Garcia
- University of Washington, Seattle, United States of America
| | - R.D Lopes
- Duke University, Durham, United States of America
| | - K.W Mahaffey
- Stanford University, Palo Alto, United States of America
| | - J Middleton
- Duke University, Durham, United States of America
| | - R Thadhani
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - K.L Thomas
- Duke University, Durham, United States of America
| | - W Winkelmayer
- Baylor College of Medicine, Houston, United States of America
| | - C.B Granger
- Duke University, Durham, United States of America
| |
Collapse
|
25
|
Thomas K, Friedman S, Jorgensen T, Smith A, Lavi M. Enhancing Community Health Workers’ Nutritional Expertise via The ECHO Model. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
Thomas K, Cornell P, Zhang W, Carder P, Smith L, Hua C, Rahman M. The Relationship between State Regulations Related to Direct Care Staffing in Assisted Living and Residents’ Outcomes. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- K. Thomas
- Providence VA Medical Center Providence RI United States
| | - P. Cornell
- Providence VA Medical Center Providence RI United States
| | - W. Zhang
- Brown University Providence RI United States
| | - P. Carder
- Oregon Health & Science University ‐ Portland State University School of Public Health Portland OR United States
| | - L. Smith
- Portland State University Portland OR United States
| | - C. Hua
- Brown University Providence RI United States
| | - M. Rahman
- Brown University School of Public Health Providence RI United States
| |
Collapse
|
27
|
Rahman M, White E, Thomas K, Jutkowitz E. Rural‐Urban Differences in Survival and Health care Utilization Among Medicare Beneficiaries Diagnosed with Alzheimer’s Disease and Related Dementias. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- M. Rahman
- Brown University School of Public Health Providence RI United States
| | - E. White
- Brown University School of Public Health Providence RI United States
| | - K. Thomas
- Brown University School of Public Health Providence RI United States
| | - E. Jutkowitz
- Brown University School of Public Health Providence RI United States
| |
Collapse
|
28
|
Fashaw S, McCreedy E, Thomas K, Shireman T. AGING, DISABILITY, AND END‐OF‐LIFE. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- S. Fashaw
- Brown University Providence RI United States
| | - E. McCreedy
- School of Public Health Brown University Providence RI United States
| | - K. Thomas
- Providence VA Medical Center Providence RI United States
| | - T. Shireman
- School of Public Health Brown University Providence RI United States
| |
Collapse
|
29
|
Fashaw S, Thomas K. Assessing Racial‐, Ethnic‐, and Socioeconomic‐Disparities in Access to High‐Quality Home Health Agencies. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S. Fashaw
- Brown University Providence RI United States
| | - K. Thomas
- Providence VA Medical Center Providence RI United States
| |
Collapse
|
30
|
Smith L, Carder P, Bucy T, Winfree J, Brazier J, Zhang W, Kaskie B, Thomas K. Health Services Regulatory Analysis: A Novel Method to Connect Policy to Health Services. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- L. Smith
- Portland State University Portland OR United States
- Oregon Health & Science University ‐ Portland State University School of Public Health Portland OR United States
| | - P. Carder
- Portland State University Portland OR United States
- Oregon Health & Science University ‐ Portland State University School of Public Health Portland OR United States
| | - T. Bucy
- Portland State University Portland OR United States
- Oregon Health & Science University ‐ Portland State University School of Public Health Portland OR United States
| | - J. Winfree
- Portland State University Portland OR United States
| | - J. Brazier
- Brown University Providence RI United States
| | - W. Zhang
- Brown University Providence RI United States
| | - B. Kaskie
- University of Iowa Iowa City IA United States
| | - K. Thomas
- Brown University Providence RI United States
- Providence VA Medical Center Providence RI United States
| |
Collapse
|
31
|
Yuan Y, Price M, Thomas K, Van Houtven C, Garrido M. Veteran‐Directed Care Recipients Living in Rural Areas Have Fewer Incidents of Potentially Avoidable Health care Use Compared to Recipients of Other Purchased Care Services. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Y. Yuan
- PEPReC, Boston VA Healthcare System Boston MA United States
- Boston University School of Public Health Boston MA United States
| | - M. Price
- PEPReC, Boston VA Healthcare System Boston MA United States
| | - K. Thomas
- Brown University School of Public Health Providence RI United States
- Providence VA Medical Center Providence RI United States
| | - C. Van Houtven
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - M. Garrido
- PEPReC, Boston VA Healthcare System Boston MA United States
- Boston University School of Public Health Boston MA United States
| |
Collapse
|
32
|
Zhou G, Mein R, Game D, Rottenberg G, Bultitude M, Thomas K. Defining the inheritance of cystinuria: Is it always autosomal recessive? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
33
|
Bultitude M, Thomas K. ‘Cystinuria Support’ – a new dedicated forum for patients with the rare disease cystinuria. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
34
|
Azimi H, Klaassen AL, Thomas K, Harvey MA, Rainer G. Role of the Thalamus in Basal Forebrain Regulation of Neural Activity in the Primary Auditory Cortex. Cereb Cortex 2020; 30:4481-4495. [PMID: 32244254 DOI: 10.1093/cercor/bhaa045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/21/2022] Open
Abstract
Many studies have implicated the basal forebrain (BF) as a potent regulator of sensory encoding even at the earliest stages of or cortical processing. The source of this regulation involves the well-documented corticopetal cholinergic projections from BF to primary cortical areas. However, the BF also projects to subcortical structures, including the thalamic reticular nucleus (TRN), which has abundant reciprocal connections with sensory thalamus. Here we present naturalistic auditory stimuli to the anesthetized rat while making simultaneous single-unit recordings from the ventral medial geniculate nucleus (MGN) and primary auditory cortex (A1) during electrical stimulation of the BF. Like primary visual cortex, we find that BF stimulation increases the trial-to-trial reliability of A1 neurons, and we relate these results to change in the response properties of MGN neurons. We discuss several lines of evidence that implicate the BF to thalamus pathway in the manifestation of BF-induced changes to cortical sensory processing and support our conclusions with supplementary TRN recordings, as well as studies in awake animals showing a strong relationship between endogenous BF activity and A1 reliability. Our findings suggest that the BF subcortical projections that modulate MGN play an important role in auditory processing.
Collapse
Affiliation(s)
- H Azimi
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland
| | - A-L Klaassen
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland.,Department of Psychology, University of Fribourg, Fribourg CH-1700, Switzerland
| | - K Thomas
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland
| | - M A Harvey
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland
| | - G Rainer
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland
| |
Collapse
|
35
|
Havatza K, Togia K, Flouda S, Pieta A, Gioti O, Nikolopoulos D, Kapsala N, Ntourou A, Rapsomaniki P, Gerogianni T, Tseronis D, Aggelakos M, Karageorgas T, Katsimpri P, Bertsias G, Thomas K, Boumpas D, Fanouriakis A. FRI0170 THERAPEUTIC ΤARGETS AND QUALITY INDICATORS IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), DEFINED ACCORDING TO THE 2019 UPDATE OF THE EULAR RECOMMENDATIONS: DATA FROM THE “ATTIKON“ LUPUS COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6255] [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
Background:Targets of therapy and quality of care are receiving increased attention in the management of SLE, as outlined in the 2019 update of the EULAR recommendations for SLE treatment.Objectives:To assess compliance with quality indicators and attainment of treatment targets, according to recent EULAR recommendations, in the SLE cohort of “Attikon” Rheumatology Unit.Methods:100 consecutive SLE patients followed for at least one year were. A 30 item Quality Indicator Set (QIS) was developed, according to the 2019 EULAR recommendations for SLE, to include laboratory tests for diagnosis and monitoring, evaluation of disease activity and damage using validated indices, use of patient-reported outcomes, counselling for women’s health and reproduction issues, attainment of targets of therapy [remission or low disease activity state (LLDAS) with low-dose glucocorticoids (GC, ≤7.5mg/day prednizone) and hydroxychloroquine (HCQ dose≤5mg/kg/day)], prevention of disease flares and prevention and management of co-morbidities. Chart review and patient interview was performed to assess the degree of compliance with each item of the QIS and achievement of treatment targets.Results:Disease activity was monitored by means of validated indices in 31% and antiphospholipid antibody testing during the first 6 months from diagnosis was performed in 58.8% of patients. Sustained remission (defined as remission of a sustained period of 12 months) or LLDAS was achieved by only 3% and 22% respectively; in contrast, other targets of therapy, such as ≤1 minor flares during last year, were achieved by 85% (43% had complete absence of flares), with 90.2% of patients receiving low-dose GC and 81.8% corrected HCQ dose. Fertility and pregnancy counselling were offered in 40% (12/30 eligible women) and 63.3% (19/30) of patients, respectively, while 65.4% had a Pap Test and only 3 of 32 eligible patients had received the HPV vaccine. Annual lipid status was assessed in 43% and counselling for smoking cessation in 44.6%. Flu vaccination was performed in 77%, while pneumococcal (including both of the pneumococcal vaccines) and herpes-zoster vaccination, were given in 32.7% and 2% (1/44 eligible patients) respectively.Conclusion:Our real-life data suggest low vaccination rates (excluding flu) and suboptimal management of cardiovascular risk factors in lupus patients. While the majority of patients received the suggested doses of GC and HCQ, only one quarter of patients achieved remission or LLDAS. There is an unmet need for new therapies in SLE to improve therapy targets.References:[1]Arora S, Sequeira W, Yazdany J, Jolly M, “Does Systemic Lupus Erythematosus Care Provided in a Lupus Clinic Result in Higher Quality of Care Than That Provided in a General Rheumatology Clinic?”, Arthritis Care Res. 2018 Dec;70(12):1771-1777. doi: 10.1002/acr.23569. Epub 2018 Nov 10.Disclosure of Interests:KATERINA HAVATZA: None declared, KONSTANTINA TOGIA: None declared, Sofia Flouda: None declared, Antigoni Pieta: None declared, Ourania Gioti: None declared, Dionysis Nikolopoulos: None declared, Noemin Kapsala: None declared, Aliki Ntourou: None declared, Panagiota Rapsomaniki: None declared, Thaleia Gerogianni: None declared, Dimitrios Tseronis: None declared, Michail Aggelakos: None declared, Theofanis Karageorgas: None declared, PELAGIA KATSIMPRI: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Konstantinos Thomas: None declared, DIMITRIOS BOUMPAS Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Antonis Fanouriakis Paid instructor for: Paid instructor for Enorasis, Amgen, Speakers bureau: Paid speaker for Roche, Genesis Pharma, Mylan
Collapse
|
36
|
Thomas K, Lazarini A, Kaltsonoudis E, Drosos A, Repa A, Sidiropoulos P, Fragkiadaki K, Tektonidou M, Sfikakis P, Tsatsani P, Gazi S, Katsimbri P, Boumpas D, Argyriou E, Boki K, Evangelatos G, Iliopoulos A, Karagianni K, Sakkas L, Melissaropoulos K, Georgiou P, Grika E, Vlachoyiannopoulos P, Dimitroulas T, Garyfallos A, Georganas C, Vounotrypidis P, Ntelis K, Areti M, Kitas GD, Vassilopoulos D. AB1201 INCREASING RATES OF INFLUENZA VACCINATION COVERAGE IN RHEUMATOID ARTHRITIS PATIENTS: DATA FROM A MULTICENTER, LONGITUDINAL COHORT STUDY OF 1,406 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Despite the increased incidence of influenza infection in rheumatoid arthritis (RA) patients, vaccination coverage has been shown to be suboptimal. Prospective data regarding the current rate and predictors of influenza vaccination adherence in RA patients are limited.Objectives:To calculate the current rate and predictors of influenza vaccination in a real-life, prospective, longitudinal RA cohort.Methods:Data regarding demographics, disease characteristics, treatments and co-morbidities from a multi-center, longitudinal cohort of Greek RA patients were collected at baseline and ~ 3 years later. Disease and patient characteristics were compared between patients with at least one influenza vaccine administration and non-vaccinated ones, during the 3 year follow-up period.Results:From a cohort of 1,569 RA patients, 1,406 with available vaccination data at baseline and 3 years later (mean interval: 2.9 years) were included; (women: 80.4%, mean age: 61.8 years, mean disease duration: 9.7 years, RF and/or anti-CCP positive: 50.4%, mean DAS-28 = 3.33, mean HAQ: 0.44, bDMARD use: 44.8%). At baseline, 54.2% of patients reported influenza vaccination in the past (31.8% during the previous season), while during the 3 year follow-up period, 81% had ≥1 influenza vaccinations (p=<0.001). Patients who received ≥1 influenza vaccine were older (63.5 vs. 54.7 years, p<0.001), were more likely to be seropositive (59.2% vs. 45.2%, p<0.001), had higher HAQ (0.46 vs. 0.36, p=0.02) and BMI (27.7 vs. 26.9, p=0.02) at baseline, more likely to be treated with bDMARDs (46.8% vs. 36.4%, p<0.001) and more likely to have chronic lung disease (9.7% vs. 5.3%, p=0.02), dyslipidemia (36.4% vs. 24.2%, p<0.001), hypertension (46.1% vs. 29.2%, p<0.001) and to report vaccination against influenza the previous season before baseline evaluation (34.9% vs. 18.2%, p<0.001). By multivariate analysis, history of influenza vaccination during the last season before baseline (OR=1.87, CI: 1.27-2.74, p=0.001), bDMARD treatment (OR=1.51, CI: 1.07-2.13, p=0.018) and age (OR=1.05, CI: 1.04-1.06, p<0.001) were independent predictors of influenza vaccination.Conclusion:In this ongoing, longitudinal, prospective, real-life RA cohort study, a significant increase in the influenza vaccination coverage was noted (from 53% to 81%). Influenza vaccination was independently associated with recent history of influenza vaccination, older age, and bDMARD treatment.Acknowledgments:Supported by grants from the Greek Rheumatology Society and Professional Association of Rheumatologists.Disclosure of Interests:Konstantinos Thomas: None declared, Argyro Lazarini: None declared, Evripidis Kaltsonoudis: None declared, Alexandros Drosos: None declared, ARGYRO REPA: None declared, Prodromos Sidiropoulos: None declared, Kalliopi Fragkiadaki: None declared, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Panagiota Tsatsani: None declared, Sousana Gazi: None declared, Pelagia Katsimbri: None declared, Dimitrios Boumpas: None declared, Evangelia Argyriou: None declared, Kyriaki Boki: None declared, Gerasimos Evangelatos: None declared, Alexios Iliopoulos: None declared, Konstantina Karagianni: None declared, Lazaros Sakkas: None declared, Konstantinos Melissaropoulos: None declared, Panagiotis Georgiou: None declared, Eleftheria Grika: None declared, PANAYIOTIS VLACHOYIANNOPOULOS: None declared, Theodoros Dimitroulas: None declared, Alexandros Garyfallos Grant/research support from: MSD, Aenorasis SA, Speakers bureau: MSD, Novartis, gsk, Constantinos Georganas: None declared, Periklis Vounotrypidis: None declared, Konstantinos Ntelis: None declared, Maria Areti: None declared, George D Kitas: None declared, Dimitrios Vassilopoulos: None declared
Collapse
|
37
|
Landewé RBM, Van der Heijde D, Dougados M, Baraliakos X, Van den Bosch F, Gaffney K, Bauer L, Hoepken B, De Peyrecave N, Thomas K, Gensler LS. OP0103 DOES GENDER, AGE OR SUBPOPULATION INFLUENCE THE MAINTENANCE OF CLINICAL REMISSION IN AXIAL SPONDYLOARTHRITIS FOLLOWING CERTOLIZUMAB PEGOL DOSE REDUCTION? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2361] [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
Background:Previous studies have shown that withdrawing tumour necrosis factor inhibitors (TNFi) in patients (pts) with axial spondyloarthritis (axSpA) who have achieved sustained remission often leads to relapse.1However, none have formally tested TNFi dose reduction strategies in a broad axSpA population or evaluated whether relapse following TNFi dose reduction and withdrawal is associated with a specific demographic subgroup.Objectives:C-OPTIMISE evaluated the percentage of pts without flare after TNFi dose continuation, reduction or withdrawal in adults with early axSpA treated with the Fc-free, PEGylated TNFi certolizumab pegol (CZP). Here, we analyse whether responses to reduced maintenance dose were comparable in pts stratified by axSpA subpopulation, gender and age.Methods:C-OPTIMISE (NCT02505542) was a multicentre, two-part phase 3b study in adults with early (<5 years’ symptom duration) active axSpA (stratified for radiographic [r]- and non-radiographic [nr]- axSpA). Pts received CZP 200 mg every 2 weeks (wks) (Q2W; 400 mg loading dose at Wks 0, 2 and 4) during the open-label induction period. At Wk 48, pts in sustained remission (Ankylosing Spondylitis Disease Activity Score [ASDAS] <1.3 at Wk 32 or 36 [if ASDAS <1.3 at Wk 32, it must be <2.1 at Wk 36, or vice versa] and at Wk 48) were randomised to double-blind full maintenance dose (CZP 200 mg Q2W); reduced maintenance dose (CZP 200 mg every 4 wks [Q4W]) or placebo (PBO) for a further 48 wks (maintenance period). The primary endpoint was the percentage of pts not experiencing a flare (ASDAS ≥2.1 at two consecutive visits or ASDAS >3.5 at any timepoint) during Wks 48–96. Analyses were conducted on subgroups according to axSpA subpopulation, gender and age ≤/> the median age of the randomised set (32 years).Results:During the 48-wk induction period, 43.9% of patients (323/736) achieved sustained remission and 313 pts entered the 48-wk maintenance period (r/nr-axSpA: 168/145 pts; males/females: 247/66 pts; age ≤32/>32: 165/148 pts). During the maintenance period, responses in r- and nr-axSpA pts were comparable across all three randomised arms. 83.9% r-axSpA and 83.3% nr-axSpA pts receiving the full CZP maintenance dose did not experience a flare, and in the reduced maintenance dose arm 82.1% r-axSpA and 75.5% nr-axSpA pts did not experience a flare. In the PBO group this was reduced to 17.9% and 22.9%, respectively. Similar responses were seen in pts stratified by gender or age, with substantially higher percentages of pts randomised to CZP full or reduced maintenance dose remaining free of flares compared to PBO in all subgroups (Figure).Conclusion:The results of C-OPTIMISE indicate that a reduced maintenance dose is suitable for pts with axSpA who achieve sustained remission following 1 year of CZP treatment, regardless of axSpA subpopulation, gender or age. Complete treatment withdrawal is not recommended due to the high risk of flare.References:[1]Landewe R. Lancet 2018;392:134–44.Acknowledgments:This study was funded by UCB Pharma. Editorial services were provided by Costello MedicalDisclosure of Interests:Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Lars Bauer Employee of: UCB Pharma, Bengt Hoepken Employee of: UCB Pharma, Natasha de Peyrecave Employee of: UCB Pharma, Karen Thomas Employee of: UCB Pharma, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB
Collapse
|
38
|
Panopoulos S, Thomas K, Georgiopoulos G, Boumpas D, Katsiari C, Bertsias G, Drosos A, Boki K, Dimitroulas T, Garyfallos A, Papagoras C, Katsimpri P, Tziortziotis A, Adamichou C, Kaltsonoudis E, Argyriou E, Vosvotekas G, Sfikakis P, Vassilopoulos D, Tektonidou M. FRI0147 PREVALENCE OF COMORBIDITIES IN ANTIPHOSPHOLIPID SYNDROME VERSUS RHEUMATOID ARTHRITIS: A MULTICENTRE, AGE- AND SEX-MATCHED STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1883] [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
Background:Comorbidities in rheumatic diseases (RDs) have been associated with increased morbidity and mortality. Evidence on prevalence of comorbidities in antiphospholipid syndrome (APS) and its difference from high comorbidity burden RDs is limited.Objectives:To compare the prevalence of common comorbidities between APS [primary (PAPS) and Systemic lupus erythematosus (SLE)-APS] and Rheumatoid arthritis (RA) patients.Methods:326 APS patients from the Greek registry (237 women, mean age 48.7±13.4 years, 161 PAPS) were matched 1:2 for age and sex with 652 RA patients from Greek RA Registry. Prevalence of cardiovascular (CV) risk factors, stroke, coronary artery disease (CAD), osteoporosis, diabetes mellitus (DM), Chronic obstructive pulmonary disease (COPD), depression and neoplasms were compared between APS and RA using logistic regression analysis.Results:Regarding CV burden, hyperlipidemia and obesity (ΒMI≥30) were comparable while hypertension, smoking, CAD and stroke were more prevalent in APS compared to RA patients (Table 1). Osteoporosis and depression were more frequent in APS while DM, COPD and neoplasms were comparable between two groups. Comparison of APS subgroups to 1:2 matched RA patients revealed that smoking and stroke were more prevalent in PAPS and SLE-APS vs RA. Hypertension, CAD and osteoporosis were more prevalent only in SLE-APS vs. RA while DM was less prevalent in PAPS vs. RA patients.Table 1.Comparison of comorbidities between Antiphospholipid syndrome (APS) vs. matched Rheumatoid Arthritis (RA) patients and between primary APS (PAPS) or Systemic Lupus Erythematosus-APS (SLE-APS) vs matched RA patientsAPSRAOR*PAPSRAORSLE-APSRAORn (%)326652161322165330Hypertension97 (29.8)136 (21)1.61 (1.19-2.18)40 (25)75 (23.3)1.09 (0.70-1.69)57 (34.6)61 (18.5)2.33 (1.52-3.56)Smoking175 (53.7)264 (40.5)1.70 (1.30-2.22)87 (54)142 (44)1.49 (1.02-2.18)88 (53.3)122 (37)1.95 (1.33-2.85)Hyperlipidemia79 (24.2)135 (20.7)1.23 (0.89-1.68)40 (24.8)62 (19.3)1.39 (0.88-2.18)39 (23.6)73 (22)1.09 (0.70-1.70)Obesity48 (20.5)105 (19.5)1.06 (0.73-1.56)20 (17)51 (19)0.86 (0.49-1.52)28 (24)54 (19.7)1.28 (0.76-2.15)Stroke±66 (20.3)9 (1.4)13.8 (6.5-29.1)36 (22.4)4 (1.2)19.9 (6.6-59.9)30 (18.2)5 (1.5)7.8 (2.7-22.6)Coronary disease±16 (4.9)13 (2)3.14 (1.17-8.45)2 (1.2)7 (2.2)0.46 (0.04-4.77)14 (8.5)6 (1.8)10.9 (2.7-44.3)Osteoporosis×66 (20.3)92 (14)1.45 (1.01-2.06)19 (11.8)42 (13)0.96 (0.54-1.73)47 (28.5)50 (15)1.91 (1.20-3.05)Diabetes×18 (5.5)58 (9)0.58 (0.33-1.01)5 (3)29 (9)0.34 (0.13-0.89)13 (8)29 (9)0.88 (0.44-1.79)COPD≠11 (3.4)14 (2.2)1.26 (0.56-2.84)3 (1.9)6 (2)0.96 (0.23-4.0)8 (5)8 (2.4)1.28 (0.44-3.72)Depression#53 (16.3)66 (10)1.70 (1.15-2.53)23 (14)30 (9.3)1.69 (0.93-3.05)30 (18.2)36 (10.9)1.65 (0.96-2.84)Neoplasms˅14 (4.3)27 (4.1)1.05 (0.54-2.06)5 (3)12 (3.7)0.84 (0.28-2.52)9 (5.5)15 (4.6)1.31 (0.55-3.1)*OR: Odds ratio, crude or adjusted for: ± age, sex, smoking, hypertension, hyperlipidemia, BMI, corticosteroid (Cs) duration × Cs duration ≠ smoking, Cs duration #sex, disease duration, Cs duration ˅ age, disease durationConclusion:Comorbidity burden in APS (PAPS and SLE-APS) is comparable or even higher to that in RA, entailing a high level of diligence for CV risk prevention, awareness for depression and corticosteroid exposure minimization.Disclosure of Interests:Stylianos Panopoulos: None declared, Konstantinos Thomas: None declared, Georgios Georgiopoulos: None declared, Dimitrios Boumpas Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Christina Katsiari: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Alexandros Drosos: None declared, Kyriaki Boki: None declared, Theodoros Dimitroulas: None declared, Alexandros Garyfallos Grant/research support from: MSD, Aenorasis SA, Speakers bureau: MSD, Novartis, gsk, Charalambos Papagoras: None declared, PELAGIA KATSIMPRI: None declared, Apostolos Tziortziotis: None declared, Christina Adamichou: None declared, Evripidis Kaltsonoudis: None declared, Evangelia Argyriou: None declared, GEORGIOS VOSVOTEKAS Grant/research support from: MSD, Janssen, Consultant of: MSD, Novartis, Roche, UCB pharma, Bristol-Myers Squibb, AbbVie, Speakers bureau: UCB pharma, Menarini, Bristol-Myers Squibb, MSD, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Dimitrios Vassilopoulos: None declared, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer
Collapse
|
39
|
Karampeli M, Thomas K, Tseronis D, Aggelakos M, Kassara D, Havatza K, Flouda S, Nikolopoulos D, Pieta A, Tzavara V, Katsimbri P, Boumpas D, Karageorgas T. AB1216 INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES (IPAF): A SINGLE CENTER, PROSPECTIVE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Interstitial pneumonia with autoimmune features (IPAF)1describes a group of patients with interstitial lung disease and autoimmune features who do not meet the classification criteria for a specific connective tissue disease. Limited data regarding IPAF are available so far.Objectives:To identify the epidemiological and clinical characteristics of patients with IPAF and to observe disease progression, response to treatment and frequency of infections in 1-year follow-up period.Methods:Thirty-nine patients from ‘Attikon’ University Hospital of Athens fulfilling the IPAF criteria were enrolled. Clinical and laboratory findings, comorbidities, medications, pulmonary outcomes assessed with repeated pulmonary function tests (PFTs) and chest HRCT and complications in a 1-year follow-up period were documented for each patient. Univariate models were performed in order to identify determinants of infection and clinically significant difference in PFTs (defined as change of ≥ 10% in FVC and/or ≥ 15% in DLCO).Results:The mean age at the time of IPAF diagnosis was 63.2 (±11) years and 62% of the patients were female. The most common clinical features included in the IPAF criteria were arthritis (82%) and Raynaud’s phenomenon (26%). A morbilliform and/or polymorphic rash of the face, neck and extremities (not included in the IPAF criteria) was noted in 54% of patients. ANA (59%) and anti–Ro (21%) were the most common auto-antibodies. Non-specific Interstitial Pneumonia (NSIP) was the most prevalent radiological pattern (61.5%) as shown in table 1. Treatment comprised corticosteroids and immunosuppressants including hydroxychloroquine, methotrexate, azathioprine, mycophenolate and cyclophosphamide. PFTs following treatment at 6 and 12 months from baseline showed a trend of improvement (Table 2, p> 0.05). At 1 year from baseline, 20.5% of patients showed a clinically significant deterioration while 25% had a clinically significant improvement. Infections were observed in 23.1% of patients during the first semester and in 12.8% during the second semester of the follow-up period. All were respiratory tract infections and two patients (5.1%) required hospitalization. All infections occurred in patients with non-UIP pattern (p=0.02) which might be attributed to higher doses of corticosteroids used in these patients (mean initial prednisolone dose = 27 (±18) mg/d in patients with non-UIP pattern versus 17 (±16) mg/d in patients with UIP pattern, p=0.4).Table 1.Prevalence of HRCT patterns in 39 patients.Radiological patternNo (%)NSIP24 (61,5%)OP2 (5,1%)NSIP with OP overlap2 (5,1%)LIP1 (2,6%)UIP7 (18%)NSIP and UIP3 (7,7%)NSIP: Non-specific Interstitial Pneumonia, OP: Organizing Pneumonia, LIP: Lymphocytic Interstitial Pneumonia, UIP: Usual Interstitial Pneumonia.Table 2.PFTs at baseline, 6 and 12 months.PFTs (% of predicted value ± SD)Baseline6 months12 monthsP valueFVC79% (±19%)82% (±18%)84% (±17%)nsDLCO49% (±16%)52% (±17%)53% (±17%)nsConclusion:Rash is a common feature in IPAF and may be considered for inclusion into IPAF criteria. A trend of improvement in PFTs and a significant risk of respiratory tract infections mainly in the first semester of treatment and in patients with non-UIP radiological pattern were observed. Larger prospective studies are warranted in order to elucidate IPAF’s prognosis and to identify effective management approaches.References:[1]Fischer A, et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J 2015; 46: 976-987.Disclosure of Interests:Maria Karampeli: None declared, Konstantinos Thomas: None declared, Dimitrios Tseronis: None declared, Michail Aggelakos: None declared, Dimitra Kassara: None declared, Katerina Havatza: None declared, Sofia Flouda: None declared, Dionysis Nikolopoulos: None declared, Antigoni Pieta: None declared, Vasiliki Tzavara: None declared, Pelagia Katsimbri: None declared, Dimitrios Boumpas Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Theofanis Karageorgas: None declared
Collapse
|
40
|
Canizares M, Glennie RA, Perruccio AV, Abraham E, Ahn H, Attabib N, Christie S, Johnson MG, Nataraj A, Nicholls F, Paquet J, Phan P, Rasoulinejad P, Manson N, Hall H, Thomas K, Fisher CG, Rampersaud YR. Erratum to 'Patients' expectations of spine surgery for degenerative conditions: results from the Canadian Spine Outcomes and Research Network (CSORN)'. [Spine J. 2020;20(3):399-408]. Spine J 2020; 20:674. [PMID: 32081566 DOI: 10.1016/j.spinee.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Canizares
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - R A Glennie
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - A V Perruccio
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - E Abraham
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - H Ahn
- Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
| | - N Attabib
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - S Christie
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - M G Johnson
- Canadian Spine Outcomes and Research Network, Canada; University of Manitoba, Winnipeg, Manitoba, Canada
| | - A Nataraj
- Canadian Spine Outcomes and Research Network, Canada; University of Alberta, Edmonton, Alberta, Canada
| | - F Nicholls
- Canadian Spine Outcomes and Research Network, Canada; University of Calgary, Calgary, Alberta, Canada
| | - J Paquet
- Canadian Spine Outcomes and Research Network, Canada; Universite Laval, Quebec City, Quebec, Canada
| | - P Phan
- Canadian Spine Outcomes and Research Network, Canada; The Ottawa Hospital - Civic Campus, Ottawa, Ontario, Canada
| | - P Rasoulinejad
- Canadian Spine Outcomes and Research Network, Canada; Western University, London Health Sciences, London, Ontario, Canada
| | - N Manson
- Canadian Spine Outcomes and Research Network, Canada; Dalhousie University, Saint John, New Brunswick, Canada
| | - H Hall
- Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
| | - K Thomas
- Canadian Spine Outcomes and Research Network, Canada; University of Calgary, Calgary, Alberta, Canada
| | - C G Fisher
- Canadian Spine Outcomes and Research Network, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Y R Rampersaud
- The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Canadian Spine Outcomes and Research Network, Canada; University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Panopoulos S, Chatzidionysiou Κ, Tektonidou MG, Bournia VK, Drosos AA, Liossis SNC, Dimitroulas T, Sakkas L, Boumpas D, Voulgari PV, Daoussis D, Thomas K, Georgiopoulos G, Vosvotekas G, Garyfallos Α, Sidiropoulos P, Bertsias G, Vassilopoulos D, Sfikakis PP. Treatment modalities and drug survival in a systemic sclerosis real-life patient cohort. Arthritis Res Ther 2020; 22:56. [PMID: 32293545 PMCID: PMC7092571 DOI: 10.1186/s13075-020-2140-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND European data indicate that systemic sclerosis (SSc)-related death rates are increasing, thus raising concerns about SSc's optimal management. Herein, we describe current treatment modalities and drug survival in a real-life SSc cohort. METHODS Details on immunosuppressive/antiproliferative (methotrexate, mycophenolate, cyclophosphamide, azathioprine, rituximab, tocilizumab) and vasoactive agent [(endothelin receptor antagonists (ERAs), sildenafil, iloprost, and calcium channel blockers (CCB)] administration during the disease course (11.8 ± 8.4 years, mean + SD) of 497 consecutive patients examined between 2016 and 2018 were retrospectively recorded. Drug survival was assessed by Kaplan-Meier analysis. RESULTS Methotrexate was the most frequently administered immunosuppressive/antiproliferative agent (53% of patients), followed by cyclophosphamide (26%), mycophenolate (12%), and azathioprine (11%). Regarding vasoactive agents, CCB had been ever administered in 68%, ERAs in 38%, iloprost in 7%, and sildenafil in 7% of patients; 23% of patients with pulmonary fibrosis had never received immunosuppressive/antiproliferative agents, 33% of those with digital ulcers had never received ERAs, iloprost, or sildenafil, whereas 19% of all patients had never received either immunosuppressive/antiproliferative or other than CCB vasoactive agents. Survival rates of methotrexate, cyclophosphamide, and mycophenolate differed significantly, being 84/75%, 59/43%, and 74/63% at 12/24 months, respectively, with inefficacy being the most frequent discontinuation cause. Conversely, CCB, ERAs, and sildenafil had high and comparable retention rates of 97/91%, 88/86%, and 80/80%, respectively. CONCLUSIONS Existing therapeutic limitations indicate that more evidence-based treatment is warranted for successful management of SSc. Vasculopathy seems to be managed more rigorously, but the low retention rates of immunosuppressive/antiproliferative drugs suggest that effective and targeted disease-modifying agents are warranted.
Collapse
Affiliation(s)
- S Panopoulos
- Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Κ Chatzidionysiou
- Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece
| | - M G Tektonidou
- Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece
| | - V K Bournia
- Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece
| | - A A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Stamatis-Nick C Liossis
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, Medical School, University of Patras, Patras, Greece
| | - T Dimitroulas
- 4th Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - L Sakkas
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - D Boumpas
- Joint Rheumatology Program, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - P V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - D Daoussis
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, Medical School, University of Patras, Patras, Greece
| | - K Thomas
- Joint Rheumatology Program, Clinical Immunology -Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - G Georgiopoulos
- Joint Rheumatology Program, Clinical Immunology -Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - G Vosvotekas
- 1st Department of Medicine, Aristotle University of Thessaloniki, School of Medicine, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Α Garyfallos
- 4th Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Sidiropoulos
- Department of Clinical Rheumatology, Clinical Immunology and Allergy, Faculty of Medicine-University of Crete, Heraklion, Greece
| | - G Bertsias
- Department of Clinical Rheumatology, Clinical Immunology and Allergy, Faculty of Medicine-University of Crete, Heraklion, Greece
| | - D Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology -Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - P P Sfikakis
- Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece
| |
Collapse
|
42
|
Parikh N, Sikaria D, Wallach W, Thomas K. Abstract No. 516 Reproducibility of in vivo ablation zone using a single microwave ablation system. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.577] [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] Open
|
43
|
Sweetman S, Sharkey A, Thomas K, Dhesi J. Reduction of last-minute cancellations in elective urology surgery: A quality improvement study. Int J Surg 2020; 74:29-33. [DOI: 10.1016/j.ijsu.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
|
44
|
Tan MP, Harris V, Warren-Oseni K, McDonald F, McNair H, Taylor H, Hansen V, Sharabiani M, Thomas K, Jones K, Dearnaley D, Hafeez S, Huddart RA. The Intensity-Modulated Pelvic Node and Bladder Radiotherapy (IMPART) Trial: A Phase II Single-Centre Prospective Study. Clin Oncol (R Coll Radiol) 2020; 32:93-100. [PMID: 31400946 PMCID: PMC6966321 DOI: 10.1016/j.clon.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/20/2022]
Abstract
AIMS Node-positive bladder cancer (NPBC) carries a poor prognosis and has traditionally been treated palliatively. However, surgical series suggest that a subset of NPBC patients can achieve long-term control after cystectomy and lymph node dissection. There is little published data regarding the use of radiotherapy to treat NPBC patients. This is in part due to concerns regarding the toxicity of whole-pelvis radiotherapy using conventional techniques. We hypothesised that, using intensity-modulated radiotherapy (IMRT), the pelvic nodes and bladder could be treated within a radical treatment volume with acceptable toxicity profiles. MATERIALS AND METHODS The Intensity-modulated Pelvic Node and Bladder Radiotherapy (IMPART) trial was a phase II single-centre prospective study designed to assess the feasibility of delivering IMRT to treat the bladder and pelvic nodes in patients with node-positive or high-risk node-negative bladder cancer (NNBC). The primary end point was meeting predetermined dose constraints. Secondary end points included acute and late toxicity, pelvic relapse-free survival and overall survival. RESULTS In total, 38 patients were recruited and treated between June 2009 and November 2012; 22/38 (58%) had NPBC; 31/38 (81.6%) received neoadjuvant chemotherapy; 18/38 (47%) received concurrent chemotherapy; 37/38 (97%) patients had radiotherapy planned as per protocol. Grade 3 gastrointestinal and genitourinary acute toxicity rates were 5.4 and 20.6%, respectively. At 1 year, the grade 3 late toxicity rate was 5%; 1-, 2- and 5-year pelvic relapse-free survival rates were 55, 37 and 26%, respectively. The median overall survival was 1.9 years (95% confidence interval 1.1-3.8) with 1-, 2- and 5-year overall survival rates of 68, 50 and 34%, respectively. CONCLUSION Delivering IMRT to the bladder and pelvic nodes in NPBC and high-risk NNBC is feasible, with low toxicity and low pelvic nodal recurrence rates. Long-term control seems to be achievable in a subset of patients. However, relapse patterns suggest that strategies targeting both local recurrence and the development of distant metastases are required to improve patient outcomes.
Collapse
Affiliation(s)
- M P Tan
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Harris
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - F McDonald
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H McNair
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H Taylor
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Hansen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - M Sharabiani
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; The School of Public Health, Imperial College London, London, UK
| | - K Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; ICBARC, London, UK
| | - K Jones
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - D Dearnaley
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Hafeez
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - R A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
| |
Collapse
|
45
|
Alexander EJ, Murray JR, Morgan VA, Giles SL, Riches SF, Hazell S, Thomas K, Sohaib SA, Thompson A, Gao A, Dearnaley DP, DeSouza NM. Validation of T2- and diffusion-weighted magnetic resonance imaging for mapping intra-prostatic tumour prior to focal boost dose-escalation using intensity-modulated radiotherapy (IMRT). Radiother Oncol 2019; 141:181-187. [PMID: 31493904 PMCID: PMC6908966 DOI: 10.1016/j.radonc.2019.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE To assess the diagnostic accuracy and inter-observer agreement of T2-weighted (T2W) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for mapping intra-prostatic tumour lesions (IPLs) for the purpose of focal dose-escalation in prostate cancer radiotherapy. MATERIALS AND METHODS Twenty-six men selected for radical treatment with radiotherapy were recruited prospectively and underwent pre-treatment T2W+DW-MRI and 5 mm spaced transperineal template-guided mapping prostate biopsies (TTMPB). A 'traffic-light' system was used to score both data sets. Radiologically suspicious lesions measuring ≥0.5 cm3 were classified as red; suspicious lesions 0.2-0.5 cm3 or larger lesions equivocal for tumour were classified as amber. The histopathology assessment combined pathological grade and tumour length on biopsy (red = ≥4 mm primary Gleason grade 4/5 or ≥6 mm primary Gleason grade 3). Two radiologists assessed the MRI data and inter-observer agreement was measured with Cohens' Kappa co-efficient. RESULTS Twenty-five of 26 men had red image-defined IPLs by both readers, 24 had red pathology-defined lesions. There was a good correlation between lesions ≥0.5 cm3 classified "red" on imaging and "red" histopathology in biopsies (Reader 1: r = 0.61, p < 0.0001, Reader 2: r = 0.44, p = 0.03). Diagnostic accuracy for both readers for red image-defined lesions was sensitivity 85-86%, specificity 93-98%, positive predictive value (PPV) 79-92% and negative predictive value (NPV) 96%. Inter-observer agreement was good (Cohen's Kappa 0.61). CONCLUSIONS MRI is accurate for mapping clinically significant prostate cancer; diffusion-restricted lesions ≥0.5 cm3 can be confidently identified for radiation dose boosting.
Collapse
Affiliation(s)
- E J Alexander
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - J R Murray
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - V A Morgan
- The Institute of Cancer Research, Sutton, UK.
| | - S L Giles
- The Institute of Cancer Research, Sutton, UK.
| | - S F Riches
- The Institute of Cancer Research, Sutton, UK.
| | - S Hazell
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - K Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - S A Sohaib
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - A Thompson
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - A Gao
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - D P Dearnaley
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - N M DeSouza
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| |
Collapse
|
46
|
Schmidt JW, Vikram A, Thomas K, Arthur TM, Weinroth M, Parker J, Hanes A, Geornaras I, Morley PS, Wheeler TL, Belk KE. Antimicrobial Resistance in Retail Ground Beef with and Without a “Raised Without Antibiotics” Claim. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThe occurrences of human bacterial infections complicated by antimicrobial resistance (AMR) have increased in recent decades. Concerns have been raised that food-animal production practices that incorporate antimicrobials contribute significantly to human AMR exposures since food-animal production accounts for approximately 81% of U.S. antimicrobial consumption by mass. Although empirical studies comparing AMR levels in meat products, including ground beef, are scant ground beef products with Raised without Antibiotics (RWA) label claims are perceived to harbor less AMR than “conventional” (CONV) products with no label claims regarding antimicrobial use. The objective of this research was to determine AMR levels in retail ground beef with and without an RWA label claims.Materials and MethodsRetail ground beef samples were obtained from 6 U.S. cities. Samples were obtained on the following dates: 9/18/2017, 10/30/2017, 11/27/2017. 1/29/2018. 3/5/2018, and 6/11/2018. A total of 599 samples were obtained. Samples with a “Raised without Antibiotics” or USDA Organic claim (N = 299) were assigned to the RWA production system. Samples lacking a “Raised without Antibiotics” claim (N = 300) were assigned to the CONV production system. Each sample was cultured for the detection of five antimicrobial resistant bacteria (ARB). Genomic DNA was isolated from each sample and qPCR was used to determine the abundance of ten antimicrobial resistance genes (ARGs). The impacts of production system and city on ARB detection were assessed by the Likelihood-ratio chi-squared test. The impacts of production system and city on ARG abundance was assessed by two-way ANOVA.ResultsTetracycline-resistant Escherichia coli (CONV = 46.3%; RWA = 34.4%) and erythromycin-resistant Enterococcus (CONV = 48.0%; RWA = 37.5%) were more frequently (P < 0.01) detected in CONV. Detection of third generation cephalosporin-resistant E. coli (CONV = 5.7%; RWA = 1.0%), vancomycin-resistant Enterococcus (CONV = 0.0%; RWA = 0.0%) and methicillin-resistant Staphylococcus aureus (CONV = 1.3%; RWA = 0.7%) did not differ (P = 1.00). The blaCTX-M ARG was more abundant in CONV (2.4 vs. 2.1 log copies/gram, P = 0.01) but the tet(A) (2.4 vs. 2.5 log copies/gram, P = 0.02) and tet(M) (3.6 vs. 3.9 log copies/gram, P < 0.01) ARGs were more abundant in RWA. aadA1, blaCMY-2, mecA, erm(B), and tet(B) abundances did not differ significantly (Fig. 5) (P > 0.05). Abundances of aac (6’)-Ie-aph (2”)-Ia and blaKPC-2 were not analyzed since they were quantified in less than 5% of the samples.ConclusionU.S. retail CONV and RWA ground beef harbor generally similar levels of AMR since only 5 of 15 AMR measurements were statistically different between production systems. Three AMR measurements were higher in CONV, while 2 AMR measurements were higher in RWA. These results are in general agreement with a recently published study authored by our group that examined antimicrobial resistance in CONV and RWA ground beef obtained from U.S. foodservice suppliers (Vikram et al., J. Food Prot. 81:2007–2018. 2018.). Together these studies suggest that antimicrobial use during U.S. cattle production has minimal to no impact on human exposure to AMR via ground beef.Figure 5.
Collapse
Affiliation(s)
- J. W. Schmidt
- USDA, Agricultural Research Service U.S. Meat Animal Research Center
| | - A. Vikram
- USDA, Agricultural Research Service U.S. Meat Animal Research Center
| | - K. Thomas
- Colorado State University Animal Sciences
| | - T. M. Arthur
- USDA, Agricultural Research Service U.S. Meat Animal Research Center
| | | | - J. Parker
- Colorado State University Clinical Sciences
| | - A. Hanes
- Colorado State University Clinical Sciences
| | | | - P. S. Morley
- Texas A&M University College of Veterinary Medicine
| | - T. L. Wheeler
- USDA, Agricultural Research Service U.S. Meat Animal Research Center
| | - K. E. Belk
- Colorado State University Animal Sciences
| |
Collapse
|
47
|
DuBuske I, Thomas K, Schmidlin K. M289 SUCCESSFUL LONG TERM MANAGEMENT OF CHRONIC GRANULOMATOUS DISEASE WELL-CONTROLLED AT AGE 42. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Inkelis S, Thomas K, Bangen K, Weigand A, Thayer R, Delano-Wood L, Bondi M. A-42 Case of Persistent Amnestic Syndrome due to Small Right-Sided Retrosplenial Lacunes. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.42] [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: 11/13/2022] Open
Abstract
Abstract
Objective
Lesions to the retrosplenial cortex secondary to acute stroke or tumor have been shown to disrupt Papez’s circuit due to disconnection between the anterior thalamus and hippocampus, via the posterior cingulate, producing an amnestic syndrome. This case demonstrates how small but strategic lacunes in this region may produce memory deficits.
Method
The patient is a 52-year-old, right-handed, African-American woman with 18 years of education who reported memory changes over the last 8 years (e.g., misplacing items, forgetting details of conversations). Her medical history was notable for BMI of 31 and borderline diabetes. She completed structural magnetic resonance imaging 6 years prior to, and concordant with, her neuropsychological evaluation. Both scans showed two small (2-3 mm) right-sided retrosplenial lacunes, without evidence of hippocampal or global volume loss over the 6-year span.
Results
Her neurocognitive profile was characterized by impairments in both verbal (stories, word-list) and figural memory, with relative strengths in attention, processing speed, and executive functioning. Across memory measures, she performed in the low average-to-mildly impaired range on immediate recall, mildly-to-severely impaired range on delayed recall, and did not benefit from yes-no recognition format. She demonstrated additional features of an amnestic profile, including flat learning slope, recency effect, elevated cued recall intrusion errors, and very elevated false positive errors on recognition.
Conclusions
Findings expand upon the existing literature to show that chronic, small retrosplenial lacunes can disrupt the connection between the anterior thalamus and hippocampus, resulting in a clinical presentation of circumscribed memory impairment that persists years beyond acute vascular changes.
Collapse
|
49
|
Dsilva AA, Basheer A, Thomas K. Snake envenomation: is the 20 min whole blood clotting test (WBCT20) the optimum test for management? QJM 2019; 112:575-579. [PMID: 30918965 DOI: 10.1093/qjmed/hcz077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The 20 min whole blood clotting test (WBCT20) is a simple bedside test recommended by World Health Organization (WHO) to assess hemotoxic envenomation and guide administration of polyvalent anti-snake venom (ASV). However, reliability and validity of this test has not been well documented in literature. METHODS Sixty consecutive patients with history of snake bite were prospectively evaluated at a teaching hospital in India over 2 years. Envenomation was established by clinical and laboratory criteria. WBCT20 was done at 0, 4 and 12 h using standardized protocol. Prothrombin time (PT) with international normalized ratio (INR) was estimated at similar intervals to detect venom-induced consumption coagulopathy. Sensitivity, specificity and likelihood ratios (LR) were determined for WBCT20 using envenomation criteria as gold standard. WBCT20 was compared with PT/INR at cutoff values of ≥1.4 and ≥1.2. Two observers performed test-retest correlation to determine inter-observer variability of WBCT20. RESULTS . UNLABELLED Seventeen of 60 patients had evidence of hemotoxic envenomation. Four patients had combined neurotoxicity and hemotoxicity. Sensitivity and specificity of WBCT20 were 94 and 76%; positive and negative LR were 3.9 and 0.08, respectively. No inter-observer variability was noted. CONCLUSIONS WBCT20 is a highly sensitive test with excellent reliability for detecting envenomation. However, the false positive rate in this study was 24%. Asymptomatic snake bite patients with a positive WBCT20 but no corresponding clinical signs of envenomation should be tested using PT/INR before receiving ASV to prevent unnecessary waste of anti-venom.
Collapse
Affiliation(s)
- A A Dsilva
- From the Department of General Medicine, PIMS Hospital, Pondicherry
| | - A Basheer
- From the Department of General Medicine, PIMS Hospital, Pondicherry
| | - K Thomas
- From the Department of General Medicine, PIMS Hospital, Pondicherry
| |
Collapse
|
50
|
Osuna J, Thomas K, Edmonds E, Bangen K, Weigand A, Wong C, Cooper S, Bondi M. Subtle Cognitive Decline predicts progression to Mild Cognitive Impairment Above and Beyond Alzheimer’s Disease Risk Factors. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Early identification of those at risk for mild cognitive impairment (MCI) and Alzheimer’s disease (AD) is critical for early intervention. Recent work shows that subtle cognitive decline (SCD), operationally-defined using sensitive neuropsychological scores, predicts progression to MCI/AD and is associated with AD biomarkers. We aimed to determine whether SCD adds unique value in predicting progression to MCI/AD above and beyond other AD risk factors.
Method
547 cognitively unimpaired participants from the Alzheimer’s Disease Neuroimaging Initiative (359 without SCD; 188 with SCD) underwent neuropsychological testing and lumbar puncture. Participants were classified as SCD if they performed >1 SD below the demographically-adjusted mean on 1) two neuropsychological total scores in different cognitive domains, or 2) two memory test process scores (e.g., intrusion errors), or 3) one total score and one process score. Cox regressions examined whether SCD status predicted progression to MCI and AD within 5 years after adjusting for age, education, sex, MMSE, depressive symptoms, ischemia risk, apolipoprotein E genotype, and AD biomarker “positivity” based on the cerebrospinal fluid phosphorylated tau-to-β-amyloid ratio.
Results
SCD status predicted progression to MCI (HR = 2.74, 95% CI = 2.07-3.63, p < .001) and AD (HR = 2.20, 95% CI = 1.04-4.65, p = .04) within 5 years, even after including known AD risk factors in the model.
Conclusion
SCD conveys a 2-3 fold increased risk of progression to MCI/AD and is a unique predictor above and beyond risk factors that are commonly used in preclinical AD research. These findings support our novel SCD criteria as a cost-effective and non-invasive method for identifying those at risk for future cognitive decline.
Collapse
|