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Callejas BE, Flanigan K, Schlechte J, Sousa JA, Wang A, McDonald B, Paniconne R, McKay DM. A29 HIGH DIMENSIONAL SINGLE CELL ANALYSIS OF IL-4 TREATED MACROPHAGES REVEALS A HETEROGENIC PHENOTYPE AND THE ABSENCE OF CD206+ SUBSETS IN CROHN'S DISEASE PATIENTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991349 DOI: 10.1093/jcag/gwac036.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Individuals with IBD have a reduced quality of life and while treatment has improved, a cure remains elusive. Interleukin-4 differentiated macrophages (M(IL4)s) from healthy donors and IBD patients in remission promote epithelial wound repair and reduce the severity of colitis in a mouse model: findings that support the autologous transfer of M(IL4)s to treat IBD. However, issues remain if this novel therapy is to advance to clinical evaluation: a much greater understanding of the possible heterogeneity within the human M(IL4) population, the biology of any sub-groups therein and the biology of any M(IL4) subtypes is needed. Purpose To determine if cryopreservation, sex, and disease status in Crohn's disease (CD) impact the phenotype and function of M(IL4) Method Blood mononuclear cells were collected from healthy donors, and individuals with active CD or in remission (n=6/group), and differentiated to macrophages with GMP-grade recombinant human M-CSF (10 ng/ml, 7 days). Macrophages (2.5 x105) were activated with IL-4 (10ng/ml, 48h). Fresh and cryopreserved M(0) and M(IL4) were stained using a panel of 18 metal-conjugated antibodies. Data were acquired on a Helios CyTOFII mass cytometer. FCS files were imported into Cytobank for manual gating (viable CD45+CD3-CD19- singlet cell events) and exported for meta-clustering in R with the CATALYST package using the FlowSOM function with 10 metaclusters. Result(s) FlowSOM analysis on M(IL4) from healthy donors indicated clear differences between M(0) and M(IL4), with 8 metaclusters >1.5% of M(IL4)s: the most abundant metaclusters express high and intermediate CD206, PDL1, CD11b, CD33, CD64, HLA-DR and low CD14 levels. There were no significant differences in these M(IL4)s metaclusters between males and females, or fresh vs. cryopreserved cells using this characterization strategy. M(IL4) from patients with active CD, were markedly different with the absence of three high-intermediate CD206+PDL1+ metaclusters and a general lack of CD206+ metaclusters compared to healthy controls. Surprisingly, and despite M(IL4)s from CD patients in remission showing increased CD206 mRNA, CYTOF analysis revealed that the macrophages were more similar to those from individuals with active disease than those from healthy controls Conclusion(s) Here human macrophages activated with IL4 in vitro are revealed as a heterogeneous population, and subsets characterized by increased high CD206 expression are generally absent in active Crohn’s disease. Intriguing while prior experiments with M(IL4) from CD patients in remission reduced the severity of colitis in rag1-/- mice, the characterization of these cells via 18 protein markers indicates they are more like M(IL4)s from patients with active disease compared to healthy controls. While presenting autologous M(IL4) transfer as a novel approach for IBD, a much fuller understanding of the phenotype and function of M(IL4)s (and sub-populations therein) is required before this would become a therapeutic option Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- B E Callejas
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - K Flanigan
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - J Schlechte
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - J A Sousa
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - A Wang
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - B McDonald
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
| | - R Paniconne
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - D M McKay
- Gastrointestinal Research Group, Inflammation Research Network, Department of Physiology and Pharmacology, The Calvin Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary
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Vetter T, Bradley A, Nicolau S, Frair E, Gushchina L, Flanigan K. P.200 Automated quantification of dystrophin immunofluorescence in human and mouse muscle sections. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.355] [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: 11/06/2022]
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Nicolau S, Vetter T, Frair E, Bradley A, Flanigan K. FP.14 Dystrophin and satellite cell quantification in Duchenne and Becker muscular dystrophies. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.101] [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: 11/06/2022]
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Nicolau S, Vetter T, Bradley A, Frair E, Weiss R, Flanigan K. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vetter T, Bradley A, Frair E, Nicolau S, Flanigan K. DMD - BIOMARKERS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gushchina L, Bradley A, Vetter T, Frair E, Bellinger C, Simmons T, Rohan N, Wein N, Flanigan K. DMD - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gushchina L, Frair E, Rohan N, Bradley A, Simmons T, Chavan H, Waldrop M, Wein N, Flanigan K. DMD – ANIMAL MODELS & PRECLINICAL TREATMENT. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wein N, Simmons T, Rajakumar D, Lesman D, Li D, Gaffney C, Rafferty R, Huang N, Rodriguez Y, Young C, Spencer M, Flanigan K. DMD – ANIMAL MODELS & PRECLINICAL TREATMENT. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Iammarino M, Miller N, Alfano L, Powers B, Shannon K, Connolly A, Waldrop M, Tsao C, Sahenk Z, Flanigan K, Mendell J, Lowes L. OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Meyer A, Cottrell C, Reshmi S, Pfau R, Lee K, Mathew M, Corsmeier D, Jayaraman V, Dave-Wala A, Hashimoto S, Matthews T, Mouhlas D, Stein M, Waldrop M, Flanigan K. NEW GENES AND DISEASES / NGS & RELATED TECHNIQUES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meyer A, Arnold W, Waldrop M, Flanigan K. AUTOPHAGIC MYOPATHIES / MYOFIBRILLAR MYOPATHIES / DISTAL MYOPATHIES / POMPE DISEASE. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gushchina L, Grounds K, Huang H, Frair E, Schnell F, Hanson G, Simmons T, Wein N, Flanigan K. P.141PPMO-mediated skipping therapy of duplicated exon 2 in the DMD gene. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flanigan K, Wein N, Gushchina L, Waldrop M, Weiss R. P.140RNA-Seq shows an absence of off-target splicing effects in AAV9-U7snRNA mediated skipping of DMD exon 2. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miller N, Alfano L, Iammarino M, Moore-Clingenpeel M, Tsao C, Waldrop M, Flanigan K, Mendell J, Lowes L. EP.89Clinical trials in young boys and infants with DMD: how do you handle maturation? Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waldrop M, Lowes L, Toops J, Alfano L, Miller N, Iammarino M, Kotha K, Paul G, Moore-Clingenpeel M, Tsao C, Noritz G, Shell R, Flanigan K. P.365Clinical outcomes in patients with spinal muscular atrophy type 1, 2 or 3 after 1 year of nusinersen therapy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Flanigan K, Chicoine L, Cheatham J, Cheatham S, Simmons T, Lowes L, Iammarino M, Miller N, Alfano L, Rinaldi F, Waldrop M, Zygmunt D, Xu R, Martin P. DMD CLINICAL THERAPIES II. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.159] [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: 10/28/2022]
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Alfano L, Miller N, Iammarino M, Berry K, Moore-Clingenpeel M, Dugan M, Al-Zaidy S, Tsao C, Rodino-Klapac L, Waldrop M, Flanigan K, Mendell J, Lowes L. DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alfano L, Miller N, Iammarino M, Moore-Clingenpeel M, Lowes S, Dugan M, Waldrop M, Flanigan K, Noritz G, Tsao C, Al Zaidy S, Kissel J, Lowes L. SMA CLINICAL DATA, OUTCOME MEASURES AND REGISTRIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.117] [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: 10/28/2022]
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Castillo MI, Larsen E, Cooke M, Marsh NM, Wallis MC, Finucane J, Brown P, Mihala G, Carr PJ, Byrnes J, Walker R, Cable P, Zhang L, Sear C, Jackson G, Rowsome A, Ryan A, Humphries JC, Sivyer S, Flanigan K, Rickard CM. Integrated versus nOn-integrated Peripheral inTravenous catheter. Which Is the most effective systeM for peripheral intravenoUs catheter Management? (The OPTIMUM study): a randomised controlled trial protocol. BMJ Open 2018; 8:e019916. [PMID: 29764876 PMCID: PMC5961612 DOI: 10.1136/bmjopen-2017-019916] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) are frequently used in hospitals. However, PIVC complications are common, with failures leading to treatment delays, additional procedures, patient pain and discomfort, increased clinician workload and substantially increased healthcare costs. Recent evidence suggests integrated PIVC systems may be more effective than traditional non-integrated PIVC systems in reducing phlebitis, infiltration and costs and increasing functional dwell time. The study aim is to determine the efficacy, cost-utility and acceptability to patients and professionals of an integrated PIVC system compared with a non-integrated PIVC system. METHODS AND ANALYSIS Two-arm, multicentre, randomised controlled superiority trial of integrated versus non-integrated PIVC systems to compare effectiveness on clinical and economic outcomes. Recruitment of 1560 patients over 2 years, with randomisation by a centralised service ensuring allocation concealment. Primary outcomes: catheter failure (composite endpoint) for reasons of: occlusion, infiltration/extravasation, phlebitis/thrombophlebitis, dislodgement, localised or catheter-associated bloodstream infections. SECONDARY OUTCOMES first time insertion success, types of PIVC failure, device colonisation, insertion pain, functional dwell time, adverse events, mortality, cost-utility and consumer acceptability. One PIVC per patient will be included, with intention-to-treat analysis. Baseline group comparisons will be made for potentially clinically important confounders. The proportional hazards assumption will be checked, and Cox regression will test the effect of group, patient, device and clinical variables on failure. An as-treated analysis will assess the effect of protocol violations. Kaplan-Meier survival curves with log-rank tests will compare failure by group over time. Secondary endpoints will be compared between groups using parametric/non-parametric techniques. ETHICS AND DISSEMINATION Ethical approval from the Royal Brisbane and Women's Hospital Human Research Ethics Committee (HREC/16/QRBW/527), Griffith University Human Research Ethics Committee (Ref No. 2017/002) and the South Metropolitan Health Services Human Research Ethics Committee (Ref No. 2016-239). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000089336.
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Affiliation(s)
- Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marianne C Wallis
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Peter Brown
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Rachel Walker
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Prudence Cable
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Candi Sear
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gavin Jackson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anna Rowsome
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Ryan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Julie C Humphries
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Susan Sivyer
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Kathy Flanigan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Wein N, Simmons T, Gumienny F, Huang N, Heller K, Yurkoski J, Rodino-Klapac L, Muntoni F, Flanigan K. A single neonatal injection of an AAV9.U7snRNA virus mediating skipping of dmd exon 2 allows dystrophin expression preventing apparition of pathologic features in the Dup2 mouse one year post injection. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.339] [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: 10/18/2022]
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Waldrop M, Kaminoh J, Moore-Clingenpeel M, Flanigan K. Daily versus weekend steroid use in DMD: age at loss of ambulation is equivalent in a retrospective patient cohort. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miller N, Alfano L, Flanigan K, Al-Zaidy S, Tsao C, Mendell J, Lowes L. The 100-meter timed test: ability to detect change over time in Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.504] [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: 10/18/2022]
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Devenport S, Penton C, Salgado N, Wang H, Flanigan K, Janssen P, Montanaro F. Reduced Hedgehog signalling in Duchenne muscular dystrophy impairs muscle regeneration and function. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alfano L, Berry K, Miller N, Cripe L, Flanigan K, Mendell J, Lowes L. Evaluating the effect of a monetary incentive on performance of the 100-meter timed test in Duchenne muscular dystrophy. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kaye E, Mendell J, Rodino-Klapac L, Sahenk Z, Lowes L, Alfano L, Berry K, Gomez Ramirez A, Lewis S, Flanigan K, Cripe L, Al-Zaidy S, Duda P, Sazani P, Saoud J. Eteplirsen, a Phosphorodiamidate morpholino oligomer (PMO) for the treatment of Duchenne muscular dystrophy (DMD): Clinical update. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lowes L, Alfano L, Berry K, Flanigan K, Mendell J. Validity of ACTIVE for use across ambulatory abilities in Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wein N, Vulin A, Simmons T, Molza A, Gumienny F, Huang N, Delalande O, Ervasti J, Weiss R, Flanigan K. Early expression of ΔCH1 dystrophin isoform reverses or prevents muscular dystrophy in the Dup2 mouse. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bell A, Cochrane A, Courtice S, Flanigan K, Mathur M, Wilckens D. Strength in unity: the power of redesign to align the hospital team. AUST HEALTH REV 2014; 38:271-7. [PMID: 24870012 DOI: 10.1071/ah13160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 03/02/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of Queen Elizabeth II Jubilee Hospital (QEII) redesign project (QEII United) was to enhance timely access to an inpatient bed and maximise opportunities to value add during the inpatient episode of care. METHODS A tripartite relationship between the hospital team, system manager and external consultants. The team, QEII United, was formed to 'diagnose, solve and implement' change under the unifying metaphorical banner of a football team. A marketing strategy and communication plan targeted the key 'players' and outlined the 'game plan'. Baseline data were collected, analysed and reported in keeping with key aims. Strategies for systems improvement implementation were attached to key performance indicators (KPIs). RESULTS Thematic KPIs were developed to embed internal process change to reflect the contributions made towards the National Emergency Access Target (NEAT) at each stage of the patient journey. As such, access block of under 20%, morning discharge rates of 50% before midday, reduced length of stay for selected elective orthopaedic and general medical diagnostic related groupings (DRGs; i.e. relative stay index ≤1) and hospital in the home (HITH) utilisation rates 1.5% of all admissions were all met. Key to sustainability was the transfer of clinical redesign skills to hospital staff and the fostering of emergent ground up leadership. CONCLUSIONS QEII United's success has been underpinned by the development of themed solution areas developed by the hospital staff themselves. Robust baseline data analysis used in combination with nationally available benchmarking data provided a quantitative starting point for the work. The collaborative elements of the program re-energised the hospital team, who were kept informed by targeted communications, to establish quick wins and build trust and momentum for the more challenging areas.
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Affiliation(s)
- Anthony Bell
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
| | - Alastair Cochrane
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
| | - Sally Courtice
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
| | - Kathy Flanigan
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
| | - Mandeep Mathur
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
| | - Daniel Wilckens
- Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Qld 4108, Australia. ; ; ;
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Barrett L, Krishnaswamy S, Lamont P, Flanigan K, Davis M, Gooding R, Fletcher S, Wilton S. T.P.28 Pseudo-exon inactivation of the dystrophin gene: Ideal candidates for exon skipping. Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.193] [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: 10/28/2022]
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Kota J, Shilling C, Montgomery C, Lewis S, Bevan A, Shontz K, Kaminoh Y, Rosales X, Viollet L, Flanigan K, Clark R, Kaspar B, Sahenk Z, Mendell J. Adeno-Associated Viral (AAV)-Mediated Follistatin (FS) Gene Transfer Toxicology Studies in Preparation for Phase I Clinical Trial (SC02.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.sc02.004] [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] [Indexed: 11/15/2022] Open
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Kota J, Shilling C, Montgomery C, Lewis S, Bevan A, Shontz K, Kaminoh Y, Rosales X, Viollet L, Flanigan K, Clark R, Kaspar B, Sahenk Z, Mendell J. Adeno-Associated Viral (AAV)-Mediated Follistatin (FS) Gene Transfer Toxicology Studies in Preparation for Phase I Clinical Trial (PD6.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd6.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lowes L, Alfano L, Viollet L, Flanigan K, Mendell J. Moderate Walking Distances and Velocity Correlate with Function Comparable to 6 Minute Walk Test (S49.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s49.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Florence J, Connolly A, Miller JP, Malkus E, Schierbecker J, Siener C, Wulf C, Anand P, McDonald C, Goude E, Johnson L, Nicorici A, Day J, Karachunski P, Dalton J, Kelecic J, Paulson K, Naughton C, Lowes L, Alfano L, Viollet-Callendret L, Flanigan K, Mendell J, Darras B, Quigley J, Pasternak A, Shriber E, Parad R, MDA DMD Clinical Research Network. Outcomes Measure Reliability in Non Ambulatory Boys and Men with Duchenne Muscular Dystrophy (DMD): Results from the Muscular Dystrophy Association DMD Clinical Research Network (P04.085). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Connolly A, Florence J, Cradock M, Malkus E, Schierbecker J, Siener C, Wulf C, Anand P, Lowes L, Alfano L, Viollet-Callendret L, Flanigan K, Mendell J, McDonald C, Goude E, Johnson L, Nicorici A, Karachunski P, Day J, Dalton J, Farber J, Buser K, Darras B, Riley S, Schriber E, Parad R, Bushby K, Eagle M, MDA DMD Clinical Research Network. Motor and Cognitive Assessment of Infants and Young Boys with Duchenne Muscular Dystrophy; Results from the Muscular Dystrophy Association DMD Clinical Research Center Network (P04.084). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thrush P, Viollet L, Flanigan K, Mendell J, Allen H. Natural History of Cardiomyopathy in Duchenne Muscular Dystrophy and the Effects of Angiotensin-Converting Enzyme Inhibitor with or without -Blocker (S15.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s15.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Alfano L, Lowes L, Viollet L, Flanigan K, Mendell J. Functional Outcome Measures Correlated with Strength in Becker Muscular Dystrophy (P02.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Viollet L, Campbell K, Bremer W, Rankin C, Shilling C, Flanigan K, Walker C, Mendell J. Defining Dystrophin-Specific T Cells in DMD Population (S15.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s15.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Atkinson L, Reha A, Elfring G, Finkel R, Wong B, Flanigan K, McDonald C, Bushby K, Voit T, Spinella G, Cwik V, Miller L. T.P.5.01 Phase 2b Study of PTC124 in Duchenne/Becker muscular dystrophy (DMD/BMD): Demographic and other baseline data. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maiti B, Ferreiro A, Richard P, Flanigan K, Howard M. C.P.2.09 Patient missense mutations near the SEPN1 UGA-SEC codon can alter selenocysteine incorporation. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maiti B, Howard M, Flanigan K. G.P.3.08 Missense mutations in the dystrophin ZZ domain: Effects beyond beta dystroglycan binding? Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bönnemann C, Finkel R, Wong B, Flanigan K, Sampson J, Sweeney L, Reha A, Elfring G, Miller L, Hirawat S. G.P.3.05 Phase 2 study of PTC124 for nonsense mutation suppression therapy of Duchenne muscular dystrophy (DMD). Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.080] [Citation(s) in RCA: 4] [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: 11/16/2022]
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Zou Y, Schessl J, Lampe A, Hu Y, Jiménez-Mallebrera C, Schreiber G, Stolte-Dijkstra I, Fock A, Chu M, Bushby K, Weiss R, Flanigan K, Muntoni F, Bönnemann C. C.P.2.04 Skipping of exon 16 in COL6A3 is a recurrent mutation causing severe congenital muscular dystrophy type Ullrich. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.280] [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: 10/22/2022]
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Mamchaoui K, Bigot A, Jacquemin M, Flanigan K, Wright W, Butler-Browne G, Mouly V. G.P.16.01 Human cellular models for muscular disorders as tools to study pathophysiology and to develop therapeutic approaches. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.377] [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: 10/22/2022]
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Hu Y, Zou Y, Quijano-Roy S, Lampe A, Barois A, Tennekoon G, Finkel R, Flanigan K, Guicheney P, Chu ML, Ferreiro A, Bönnemann C. P.P.7 06 Pronounced phenotypic variability of heterozygote deletion mutations in collagen VI – Evidence for a UCMD-BM spectrum. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2006.05.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ho TW, Hsieh ST, Nachamkin I, Willison HJ, Sheikh K, Kiehlbauch J, Flanigan K, McArthur JC, Cornblath DR, McKhann GM, Griffin JW. Motor nerve terminal degeneration provides a potential mechanism for rapid recovery in acute motor axonal neuropathy after Campylobacter infection. Neurology 1997; 48:717-24. [PMID: 9065554 DOI: 10.1212/wnl.48.3.717] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We investigated the possible mechanisms of paralysis and recovery in a patient with the acute motor axonal neuropathy (AMAN) pattern of the Guillain-Barré syndrome. The AMAN pattern of GBS is characterized clinically by acute paralysis without sensory involvement and electrodiagnostically by low compound motor action potential amplitudes, suggesting axonal damage, without evidence of demyelination. Many AMAN patients have serologic or culture evidence of recent Campylobacter jejuni infection. Pathologically, the most severe cases are characterized by wallerian-like degeneration of motor axons affecting the ventral roots as well as peripheral nerves, but some fatal cases have only minor changes in the roots and peripheral nerves, and some paralyzed patients with the characteristic electrodiagnostic findings of AMAN recover rapidly. The mechanism of paralysis and recovery in such cases has been uncertain. A 64-year-old woman with culture-proven Campylobacter upsaliensis diarrhea developed typical features of AMAN. She improved quickly following plasmapheresis. Her serum contained IgG anti-GM1 antibodies. The lipopolysaccharide of the organism bound peanut agglutinin. This binding was blocked by cholera toxin, suggesting that the organism contained the Gal(beta1-3)GalNAc epitope of GM1 in its lipopolysaccharide. Motor-point biopsy showed denervated neuromuscular junctions and reduced fiber numbers in intramuscular nerves. In contrast, the sural nerve biopsy was normal and skin biopsy showed normal dermal and epidermal innervation. In AMAN the paralysis may reflect degeneration of motor nerve terminals and intramuscular axons. In addition, the anti-GM1 antibodies, which can bind at nodes of Ranvier, might produce failure of conduction. These processes are potentially reversible and likely to underlie the capacity for rapid recovery that characterizes some cases of AMAN.
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Affiliation(s)
- T W Ho
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Flanigan K, Gardner K, Alderson K, Galster B, Otterud B, Leppert MF, Kaplan C, Ptácek LJ. Autosomal dominant spinocerebellar ataxia with sensory axonal neuropathy (SCA4): clinical description and genetic localization to chromosome 16q22.1. Am J Hum Genet 1996; 59:392-9. [PMID: 8755926 PMCID: PMC1914712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The hereditary ataxias represent a clinically and genetically heterogeneous group of neurodegenerative disorders. Various classification schemes based on clinical criteria are being replaced as molecular characterization of the ataxias proceeds; so far, seven distinct autosomal dominant hereditary ataxias have been genetically mapped in the human genome. We report linkage to chromosome 16q22.1 for one of these genes (SCA4) in a five-generation family with an autosomal dominant, late-onset spinocerebellar ataxia; the gene is tightly linked to the microsatellite marker D16S397 (LOD score = 5.93 at theta = .00). In addition, we present clinical and electrophysiological data regarding the distinct and previously unreported phenotype consisting of ataxia with the invariant presence of a prominent axonal sensory neuropathy.
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Affiliation(s)
- K Flanigan
- Department of Neurology, University of Utah Medical Center, Salt Lake City 84112, USA
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