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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Sanchez R, Duncker D, Colley B, Doering M, Gummadi S, Perings C, Robertson M, Shroff G, Veltmann
C. The Heart Failure Optimization Study (HF-OPT): rationale and design. Herzschrittmacherther Elektrophysiol 2023; 34:52-58. [PMID: 36695885 PMCID: PMC9950163 DOI: 10.1007/s00399-022-00920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND According to the current guidelines, implantable cardioverter-defibrillators (ICD) for primary prevention in patients with heart failure and reduced ejection fraction (HFrEF) should not be considered until optimal guideline-directed medical therapy (GDMT) has been achieved for a minimum of 3 months. Optimization of GDMT often needs time beyond 3 months after diagnosis. The aim of the Heart Failure Optimization Study (HF-OPT) is to evaluate the recovery of left ventricular function beyond 3 months after diagnosis of newly diagnosed HFrEF. METHODS The HF-OPT multicenter study is comprised of two non-randomized phases (registry and study). During the first 90 days a wearable cardioverter-defibrillator (WCD) is prescribed and patients are enrolled in an observational pre-study registry. Registry subjects meeting inclusion criteria for the study portion at day 90 have ongoing left ventricular ejection fraction (LVEF) reassessment at 90, 180 and 360 days after the index hospital discharge, regardless of continued WCD use. Approximately 600 subjects will be enrolled in the study portion. Of those, one-third are anticipated to start the study phase at day 90 with reduced LVEF. The primary objective of this study is to observe the rate of recovery of LVEF > 35% between 90 and 180 days, while key secondary endpoints include mortality and WCD recorded arrhythmias and shocks. DISCUSSION The HF-OPT study will provide important information on the rate of additional recovery of LVEF > 35%, between 90 and 180 days, in newly diagnosed HF with reduced LVEF patients being titrated with GDMT. The results of the study may impact indications for primary prophylactic ICD implantation.
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Affiliation(s)
- R. Sanchez
- HCA Florida Heart Institute, St. Petersburg, FL USA
| | - D. Duncker
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - B. Colley
- Jackson Heart Clinic, Jackson, MS USA
| | - M. Doering
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - C. Perings
- Katholisches Klinikum Luenen, Luenen, Germany
| | | | - G. Shroff
- Baptist Heart Specialists, Jacksonville, FL USA
| | - C. Veltmann
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
- Center for Electrophysiology Bremen, Klinikum Links der Weser, Senator-Wessling-Str. 1, 28277 Bremen, Germany
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Hui S, Lim A, Koh E, Abasszade J, Morgan A, Tan PY, Lemoh C, Robertson M. Prevalence and prognostic significance of vitamin C deficiency in patients with acute upper gastrointestinal bleeding: a prospective cohort study. Aliment Pharmacol Ther 2023; 57:313-322. [PMID: 36514851 PMCID: PMC10108177 DOI: 10.1111/apt.17359] [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: 05/22/2022] [Revised: 06/20/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vitamin C is an essential dietary nutrient important for collagen synthesis, including within the gastrointestinal tract. AIM We aimed to document the prevalence of Vitamin C deficiency (VCD) in patients who present with upper gastrointestinal bleeding (UGIB) and its association with clinical outcomes. METHODS We conducted a prospective cohort study of patients presenting with UGIB. Fasting Vitamin C levels were collected at admission. Primary outcomes were the prevalence of VCD (Vitamin C level <23 μmol/L, severe VCD < 12 μmol/L) and a composite outcome of adverse events, stratified by VCD status. Secondary outcomes were prolonged hospitalisation and the need for ICU admission. RESULTS A total of 227 patients were included (mean age 64.5 years, males 63.9%). VCD was identified in 74 (32.6%) and severe deficiency in 32 (14.1%) patients. VCD was associated with a higher composite endpoint of AE (45.9% vs 24.8%, p < 0.01), higher in-hospital mortality (9.5% vs 1.3%, p < 0.01), increased prolonged admissions (62.2% versus 47.1%, p = 0.03) and increased rebleeding (17.6% vs 7.8%, p = 0.03), compared with patients with normal Vitamin C levels. Multivariate logistic regression models showed that VCD was independently associated with the composite endpoint of AE. CONCLUSION VCD is highly prevalent in patients with UGIB and associated with poorer outcomes, including higher mortality, rebleeding and length of stay. Interventional studies are required to determine the impact of early Vitamin C supplementation on clinical outcomes.
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Affiliation(s)
- Samuel Hui
- Department of Gastroenterology and Hepatology, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Medicine, Monash University School of Clinical Sciences, Clayton, Victoria, Australia
| | - Andy Lim
- Department of Medicine, Monash University School of Clinical Sciences, Clayton, Victoria, Australia
| | - Elaine Koh
- Department of Gastroenterology and Hepatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Joshua Abasszade
- Department of Gastroenterology and Hepatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Aparna Morgan
- Department of Gastroenterology and Hepatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Pei Y Tan
- Department of Medicine, Monash University School of Clinical Sciences, Clayton, Victoria, Australia
| | - Christopher Lemoh
- Department of Medicine, Monash University School of Clinical Sciences, Clayton, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology and Hepatology, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Medicine, Monash University School of Clinical Sciences, Clayton, Victoria, Australia
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Sanchez R, Duncker D, Colley B, Doering M, Gummadi S, Perings C, Robertson M, Shroff G, Veltmann C. Publisher Erratum: The Heart Failure Optimization Study (HF‑OPT): rationale and design. Herzschrittmacherther Elektrophysiol 2023; 34:91. [PMID: 36786850 PMCID: PMC9950152 DOI: 10.1007/s00399-023-00928-5] [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: 02/15/2023]
Affiliation(s)
- R. Sanchez
- HCA Florida Heart Institute, St. Petersburg, FL USA
| | - D. Duncker
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - B. Colley
- Jackson Heart Clinic, Jackson, MS USA
| | - M. Doering
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - C. Perings
- Katholisches Klinikum Luenen, Luenen, Germany
| | | | - G. Shroff
- Baptist Heart Specialists, Jacksonville, FL USA
| | - C. Veltmann
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany ,Center for Electrophysiology Bremen, Klinikum Links der Weser, Senator-Wessling-Str. 1, 28277 Bremen, Germany
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Clerc O, Datar Y, Cuddy SAM, Bianchi G, Taylor A, Benz D, Robertson M, Kijewski MF, Jerosh-Herold M, Kwong RY, Ruberg FL, Liao R, Di Carli MF, Falk RH, Dorbala S. Cardiomyocyte stretch mediates the relation between left ventricular amyloid burden and adverse outcomes in light chain amyloidosis: a 18F-florbetapir positron emission tomography study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with light chain (AL) amyloidosis and cardiac involvement have poor prognosis. Mayo stage accounts for severity of plasma cell dyscrasia and cardiac biomarker release, and provides powerful risk stratification. Myocardial amyloid burden can be quantified by 18F-florbetapir positron emission tomography (PET), but its prognostic value is not known.
Purpose
To test our hypothesis that (1) myocardial amyloid burden predicts adverse outcomes and (2) the relationship between amyloid burden and adverse outcomes is mediated by cardiomyocyte stretch and injury. Amyloid burden was estimated by left ventricular 18F-florbetapir retention index (RI) and cardiomyocyte stretch and injury by NT proBNP and troponin T respectively.
Methods
We performed 18F-florbetapir PET (median dose 9.05 mCi) in prospectively enrolled subjects with newly diagnosed AL amyloidosis with abnormal cardiac biomarkers or with normal cardiac biomarkers and normal left ventricular wall thickness (NCT02641145). Left ventricular RI was calculated as the activity concentration between 10 and 30 min. after injection divided by the integral of the left atrial blood time-activity curve from 0 to 20 min. RI was categorized as normal (<0.06/min, based on controls), increased (0.06–0.12/min), or high risk (>0.12/min, based on log-rank statistic maximization). Mayo stages I–IV were based on elevated serum cardiac biomarkers: NT-proBNP ≥1800 pg/ml, troponin T ≥0.025 ng/ml, and difference in free light chains ≥180 mg/l. Adverse outcomes of all-cause death or heart failure hospitalization were evaluated. Survival analysis was performed using Kaplan-Meier and Cox regression including Mayo stage and RI. Mediation analysis was used to elucidate the role of cardiomyocyte stretch (as NT-proBNP) and injury (as troponin T) in the association between amyloid burden estimated by RI and adverse outcomes.
Results
We studied 80 subjects with median age 62 years (IQR 57–67), 46 men (57%), 60 with abnormal cardiac biomarkers (75%), and median RI of 0.10/min (IQR 0.06–0.16). At follow-up (median 15 months), adverse outcomes occurred in 34 subjects (42%), with 17 deaths (21%) and 23 heart failure hospitalizations (29%). The incidence of adverse outcomes increased across Mayo stages from 9% to 44% (log-rank p<0.001), and across RI levels from 29% to 57% (log-rank p=0.037, Figure 1). In multivariable Cox regression, only Mayo stage independently predicted adverse outcomes (HR 2.0 [95% CI 1.4–3.0], p<0.001). Multivariable mediation analysis showed that 83% of the association between RI and adverse outcomes was mediated by NT-proBNP (p<0.001, Figure 2), without contribution from troponin T.
Conclusion
Myocardial amyloid burden estimated by F-18 florbetapir RI predicts adverse outcomes in AL amyloidosis, but not independently of Mayo stage. Cardiomyocyte stretch mediates the relationship between myocardial amyloid burden and adverse outcomes in AL amyloidosis.
Funding Acknowledgement
Type of funding sources: Private company.
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Affiliation(s)
- O Clerc
- Brigham and Women's Hospital , Boston , United States of America
| | - Y Datar
- Boston University School of Medicine , Boston , United States of America
| | - S A M Cuddy
- Brigham and Women's Hospital , Boston , United States of America
| | - G Bianchi
- Brigham and Women's Hospital , Boston , United States of America
| | - A Taylor
- Brigham and Women's Hospital , Boston , United States of America
| | - D Benz
- Brigham and Women's Hospital , Boston , United States of America
| | - M Robertson
- Brigham and Women's Hospital , Boston , United States of America
| | - M F Kijewski
- Brigham and Women's Hospital , Boston , United States of America
| | - M Jerosh-Herold
- Brigham and Women's Hospital , Boston , United States of America
| | - R Y Kwong
- Brigham and Women's Hospital , Boston , United States of America
| | - F L Ruberg
- Boston University School of Medicine , Boston , United States of America
| | - R Liao
- Stanford University Medical Center , Stanford , United States of America
| | - M F Di Carli
- Brigham and Women's Hospital , Boston , United States of America
| | - R H Falk
- Brigham and Women's Hospital , Boston , United States of America
| | - S Dorbala
- Brigham and Women's Hospital , Boston , United States of America
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Romero S, Lim AKH, Singh G, Kodikara C, Shingaki-Wells R, Chen L, Hui S, Robertson M. Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax. World J Gastroenterol 2022; 28:5175-5187. [PMID: 36188717 PMCID: PMC9516676 DOI: 10.3748/wjg.v28.i35.5175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic hydrothorax (HH) is an uncommon and difficult-to-manage complication of cirrhosis with limited treatment options.
AIM To define the clinical outcomes of patients presenting with HH managed with current standards-of-care and to identify factors associated with mortality.
METHODS Cirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 were retrospectively identified. HH was defined as pleural effusion in the absence of cardiopulmonary disease. The primary outcomes were overall and transplant-free survival at 12-mo after the index admission. Cox proportional hazards analysis was used to determine factors associated with the primary outcomes.
RESULTS Overall, 84 patients were included (mean age, 58 years) with a mean model for end-stage liver disease score of 29. Management with diuretics alone achieved long-term resolution of HH in only 12% patients. At least one thoracocentesis was performed in 73.8% patients, transjugular intrahepatic portosystemic shunt insertion in 11.9% patients and 33% patients received liver transplantation within 12-mo of index admission. Overall patient survival and transplant-free survival at 12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidney injury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increased risk of mortality.
CONCLUSION Cirrhotic patients with HH are a challenging population with a poor 12-mo survival despite current treatments. Current smoking and episodes of AKI are potential modifiable factors affecting survival. HH is often refractory of diuretic therapy and transplant assessment should be considered in all cases.
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Affiliation(s)
- Sarah Romero
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Andy KH Lim
- Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
| | - Gurpreet Singh
- Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Chamani Kodikara
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | | | - Lynna Chen
- Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Samuel Hui
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
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Nguyen P, Hui S, Robertson M. Hepatoid adenocarcinoma: A wolf in hepatocellular carcinoma's clothing. JGH Open 2022; 6:727-729. [PMID: 36262535 PMCID: PMC9575327 DOI: 10.1002/jgh3.12813] [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: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
Hepatoid adenocarcinoma (HAC) is a rare malignancy that may mimic hepatocellular carcinoma (HCC) given its hepatoid histologic appearance and production of alpha fetoprotein. Clinical management and prognosis of HAC varies considerably from HCC. We present two cases of metastatic HAC in a cirrhotic liver diagnosed after biopsy and histopathological evaluation. The cases underscore the importance of recognizing the limitations of diagnostic imaging and pursuing a biopsy where there is diagnostic uncertainty.
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Affiliation(s)
- Paul Nguyen
- Department of Gastroenterology and Hepatology Monash Health Clayton Victoria Australia
| | - Samuel Hui
- Department of Gastroenterology and Hepatology Monash Health Clayton Victoria Australia
- Department of Medicine Monash University Clayton Victoria Australia
| | - Marcus Robertson
- Department of Gastroenterology and Hepatology Monash Health Clayton Victoria Australia
- Department of Medicine Monash University Clayton Victoria Australia
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Keung CY, Morgan A, Le ST, Robertson M, Urquhart P, Swan MP. Survival outcomes and predictors of mortality, re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade. World J Hepatol 2022; 14:1584-1597. [PMID: 36157875 PMCID: PMC9453467 DOI: 10.4254/wjh.v14.i8.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute severe variceal bleeding (AVB) refractory to medical and endoscopic therapy is infrequent but associated with high mortality. Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding; treatments including vasoactive therapies, intravenous antibiotics, endoscopic variceal band ligation are routinely used, and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts. However, only a few studies from the current era exist to describe the practice of balloon tamponade, its outcomes, and predictors with a requirement for further updated information.
AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality, re-bleeding and complications.
METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube (SBT) were included for analysis. Patients were identified using coding for balloon tamponade. The primary outcome of this study was all-cause mortality at 6 wk after the index AVB. Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade. Predictors of these outcomes were determined using univariate and multivariate binomial regression.
RESULTS The all-cause mortality rates during admission and at 6-, 26- and 52 wk were 48.8%, 51.2% and 53.8%, respectively. Primary haemostasis was achieved in 91.3% and re-bleeding during hospitalisation occurred in 34.2%. Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease (MELD) score (OR 1.21, 95%CI 1.06-1.41, P = 0.006), advanced hepatocellular carcinoma (OR 11.51, 95%CI 1.61-82.20, P = 0.015) and re-bleeding (OR 13.06, 95%CI 3.06-55.71, P < 0.001). There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not survive 6 wk (76.0% vs 24%). Although mucosal trauma was the most common documented complication after SBT insertion (89.5%), serious complications from SBT insertion were uncommon (6.3%) and included 1 patient who died from oesophageal perforation.
CONCLUSION In refractory AVB, balloon tamponade salvage therapy is associated with high rates of primary haemostasis with low rates of serious complications. Re-bleeding and mortality however, remain high.
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Affiliation(s)
- Charlotte Y Keung
- Department of Gastroenterology, Monash Health, Melbourne 3168, Victoria, Australia
- Department of Gastroenterology, Eastern Health, Melbourne 3128, Victoria, Australia
- Department of Medicine, Monash University, Melbourne 3168, Victoria, Australia
| | - Aparna Morgan
- Department of Gastroenterology, Monash Health, Melbourne 3168, Victoria, Australia
| | - Suong T Le
- Department of Gastroenterology, Monash Health, Melbourne 3168, Victoria, Australia
- Department of Medicine, Monash University, Melbourne 3168, Victoria, Australia
- Monash Digital Therapeutics and Innovation Laboratory, Monash University, Melbourne 3168, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology, Monash Health, Melbourne 3168, Victoria, Australia
- Department of Medicine, Monash University, Melbourne 3168, Victoria, Australia
| | - Paul Urquhart
- Department of Gastroenterology, Eastern Health, Melbourne 3128, Victoria, Australia
| | - Michael P Swan
- Department of Gastroenterology, Monash Health, Melbourne 3168, Victoria, Australia
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Robertson M, Chung W, Liu D, Seagar R, O'Halloran T, Koshy AN, Horrigan M, Farouque O, Gow P, Angus P. Cardiac Risk Stratification in Liver Transplantation: Results of a Tiered Assessment Protocol Based on Traditional Cardiovascular Risk Factors. Liver Transpl 2021; 27:1007-1018. [PMID: 33606328 DOI: 10.1002/lt.26025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/13/2023]
Abstract
Coronary artery disease (CAD) confers increased perioperative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there are limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors. We peformed a single-center, prospective, observational study of consecutive adult patients undergoing LT assessment (2010-2017). Patients were stratified into low-risk (LR), intermediate-risk (IR), or high-risk (HR) cardiac groups and received standardized investigations with selective use of transthoracic echocardiography (TTE), dobutamine stress echocardiography (DSE), computed tomography coronary angiography (CTCA), and coronary angiography (CA). Primary outcomes were cardiac events (CEs) and cardiovascular death up to 30 days after LT. Overall, 569 patients were included, with 76 patients identified as LR, 256 as IR, and 237 as HR. Cardiac risk factors included diabetes mellitus (26.0%), smoking history (47.3%), hypertension (17.8%), hypercholesterolemia (7.2%), family (17.0%) or prior history of heart disease (6.0%), and obesity (27.6%). Of the patients, 42.0% had ≥2 risk factors. Overall compliance with the protocol was 90.3%. Abnormal findings on TTE, DSE, and CTCA were documented in 3, 23, and 44 patients, respectively, and 12 patients were not listed for transplantation following cardiac assessment (1 LR, 2 IR, and 9 HR). Moderate or severe CAD was identified in 25.4% of HR patients on CTCA following a normal DSE. CEs were recorded in 7 patients (1.2%), with 2 cardiovascular deaths (0.4%). Cardiac risk stratification based on traditional cardiac risk factors with the selective use of DSE, CTCA, and CA is a safe and feasible approach that results in a low perioperative cardiac event rate.
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Affiliation(s)
- Marcus Robertson
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - William Chung
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Dorothy Liu
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rosemary Seagar
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tess O'Halloran
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Anoop N Koshy
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Peter Angus
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
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10
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Keighley C, Garnham K, Harch SAJ, Robertson M, Chaw K, Teng JC, Chen SCA. Candida auris: Diagnostic Challenges and Emerging Opportunities for the Clinical Microbiology Laboratory. Curr Fungal Infect Rep 2021; 15:116-126. [PMID: 34178208 PMCID: PMC8220427 DOI: 10.1007/s12281-021-00420-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/24/2022]
Abstract
Purpose of Review This review summarises the epidemiology of Candida auris infection and describes contemporary and emerging diagnostic methods for detection and identification of C. auris. Recent Findings A fifth C. auris clade has been described. Diagnostic accuracy has improved with development of selective/differential media for C. auris. Advances in spectral databases of matrix-associated laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) systems have reduced misidentification. Direct detection of C. auris in clinical specimens using real time PCR is increasingly used, as is whole genome sequencing (WGS) to track nosocomial spread and to study phylogenetic relationships and drug resistance. Summary C. auris is an important transmissible, nosocomial pathogen. The microbiological laboratory diagnostic capacity has extended beyond culture-based methods to include PCR and WGS. Microbiological techniques on the horizon include the use of MALDI-TOF MS for early echinocandin antifungal susceptibility testing (AST) and expansion of the versatile and information-rich WGS methods for outbreak investigation.
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Affiliation(s)
- C Keighley
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Wollongong, NSW Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead, Sydney, Australia.,Southern.IML Pathology, Sonic Healthcare, Sydney, NSW Australia.,The University of Sydney, Camperdown, NSW 2605 Australia
| | - K Garnham
- Royal North Shore Hospital, New South Wales Health Pathology, Sydney, NSW Australia
| | - S A J Harch
- Department of Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia Australia.,Central Adelaide Local Health Network, Adelaide, South Australia Australia
| | - M Robertson
- Gosford Hospital, New South Wales Health Pathology, Gosford, NSW Australia
| | - K Chaw
- Pathology Queensland, Herston, QLD Australia
| | - J C Teng
- Melbourne Pathology, Sonic Healthcare, Melbourne, VIC Australia
| | - S C-A Chen
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Wollongong, NSW Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead, Sydney, Australia
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11
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Worland T, Bloom A, Robertson M. An Unusual Case of Small Bowel Obstruction. Gastroenterology 2021; 160:e12-e13. [PMID: 33039463 DOI: 10.1053/j.gastro.2020.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Thomas Worland
- Monash Health, Department of Gastroenterology, Melbourne, Australia.
| | - Ashley Bloom
- Monash Health, Department of Gastroenterology, Melbourne, Australia
| | - Marcus Robertson
- Monash Health, Department of Gastroenterology, Melbourne, Australia
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12
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Oliveira B, Barakat F, Robertson M, Ford I, Macdougall C, Okonko D. POS-281 Prognostic Significance of Erythropoiesis-Stimulating Agent Dose Requirements in PIVOTAL and its Implications for the Potential Mechanisms of IV Iron Benefit in Maintenance Haemodialysis Patients. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.296] [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] Open
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13
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Abasszade JH, Little R, Yeaman F, Robertson M, Bell S. Amoebic colitis: A case series of a recurring missed diagnosis. JGH Open 2021; 5:404-407. [PMID: 33732890 PMCID: PMC7936621 DOI: 10.1002/jgh3.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/11/2022]
Abstract
Entamoeba histolytica, a pathogenic protozoan that causes amoebiasis, remains the second leading cause of death from parasitic infections worldwide. We present a case series of patients presenting to metropolitan tertiary gastroenterology units in Melbourne, Australia, highlighting the complexities of diagnosing amoebic colitis and the potential for misdiagnosis. These cases illustrate four key lessons in the identification of amoebic colitis: (i) obtaining a thorough travel and exposure history, (ii) having a high index of suspicion, (iii) understanding the limitations of available investigations, and (iv) being aware that amoebic colitis may masquerade as other common conditions.
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Affiliation(s)
| | - Robert Little
- Department of GastroenterologyAlfred HealthMelbourneVictoriaAustralia
| | - Fiona Yeaman
- Department of GastroenterologyMonash HealthClaytonVictoriaAustralia
| | - Marcus Robertson
- Department of GastroenterologyMonash HealthClaytonVictoriaAustralia
- Department of MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sally Bell
- Department of GastroenterologyMonash HealthClaytonVictoriaAustralia
- Department of MedicineMonash UniversityMelbourneVictoriaAustralia
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14
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Hamilton C, Hamilton C, Robertson M, Arbaje A, Sheikh F, Bellantoni M. "What Is a Care Plan?": A Qualitative Assessment of Nursing Home Resident's Perspectives. J Am Med Dir Assoc 2021; 22:B18-B19. [PMID: 34287162 DOI: 10.1016/j.jamda.2021.01.089] [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]
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15
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Innes N, Johnson IG, Al-Yaseen W, Harris R, Jones R, Kc S, McGregor S, Robertson M, Wade WG, Gallagher JE. A systematic review of droplet and aerosol generation in dentistry. J Dent 2020; 105:103556. [PMID: 33359043 PMCID: PMC7834118 DOI: 10.1016/j.jdent.2020.103556] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This review aimed to identify which dental procedures generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. DATA RESOURCES Medline(OVID), Embase(OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science and LILACS databases were searched for eligible studies from each database's inception to May 2020 (search updated 11/08/20). Studies investigating clinical dental activities that generate aerosol using duplicate independent screening. Data extraction by one reviewer and verified by another. Risk of bias assessed through contamination measurement tool sensitivity assessment. STUDY SELECTION A total eighty-three studies met the inclusion criteria and covered: ultrasonic scaling (USS, n = 44), highspeed air-rotor (HSAR, n = 31); oral surgery (n = 11), slow-speed handpiece (n = 4); air-water (triple) syringe (n = 4), air-polishing (n = 4), prophylaxis (n = 2) and hand-scaling (n = 2). Although no studies investigated respiratory viruses, those on bacteria, blood-splatter and aerosol showed activities using powered devices produced greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator's torso, operator's arm and patient's body were especially affected. Heterogeneity precluded inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher (USS, HSAR, air-water syringe, air polishing, extractions using motorised handpieces); moderate (slow-speed handpieces, prophylaxis, extractions) and lower (air-water syringe [water only] and hand scaling). CONCLUSION Gaps in evidence, low sensitivity of measures and variable quality limit conclusions around contamination for procedures. A hierarchy of contamination from procedures is proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. CLINICAL SIGNIFICANCE This manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the common binary AGP or non-AGP perspective. The findings inform discussion around AGPs and direct future research to support knowledge and decision making around COVID-19 and dental procedures.
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Affiliation(s)
- N Innes
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - I G Johnson
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - W Al-Yaseen
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - R Harris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - R Jones
- Education, Scholarship and Innovation, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, UK
| | - S Kc
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
| | - S McGregor
- Library & Learning Centre, University of Dundee, Dundee, UK
| | - M Robertson
- Child Dental and Oral Health, School of Dentistry, University of Dundee, Dundee, UK
| | - W G Wade
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
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16
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Burch A, Sears S, Doring M, Gummadi S, Robertson M, Sanchez R, Shroff G, Veltmann C. Change in health-related quality of life among patients with a reduced ejection fraction initiating guideline-directed medical therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Management of patients with heart failure (HF) should include patient reported outcomes (PROs). The Kansas City Cardiomyopathy Questionnaire is self-administered with subscales to evaluate HF symptom burden, physical limitations, social limitations (recreational participation), and quality of life (QoL). Change in PROs among newly diagnosed patients with HF and reduced ejection fraction (HFrEF) prescribed a wearable cardioverter defibrillator (WCD) and initiating guideline-directed medical therapy (GDMT) has not been assessed.
Purpose
Examine PROs over 180 days of receiving GDMT for newly diagnosed HFrEF.
Methods
Patients (n=93, 75.3% male) were enrolled ≤10 days post-hospitalization for new onset HF; all patients had an EF ≤35% and were prescribed a WCD. Health status, as measured by PRO was assessed at baseline, day 90, and day 180. Controlling for age and EF at baseline, changes in PROs over the 180-day study period were evaluated using repeated measures modeling. Pairwise comparisons with Bonferroni adjustments were used to compare adjacent timepoints. Higher scores reflect better health status.
Results
After controlling for age (mean 56±13.4) and baseline EF (mean 22±7.7) improvements in health status were observed. From baseline to day 90, physical limitation, symptom frequency, QoL, and the summary score all increased (Δ: 17.8, 23.7, 28.4, 23.7, respectively; all p's <0.05). From day 90 to day 180, only QoL continued to improve (Δ 7.5, p=0.001). Change in social limitations over time was not significant (p=0.42).
Conclusion
Patients report improved health status in the months following a new diagnosis of HFrEF when prescribed a WCD and GDMT.
Change in Quality of Life
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Burch
- East Carolina University, Greenville, United States of America
| | - S.F Sears
- East Carolina University, Greenville, United States of America
| | - M Doring
- Leipzig Heart Institute GmbH, Leipzig, Germany
| | - S Gummadi
- Cardiovascular Institute of Central Florida, Ocala, United States of America
| | - M Robertson
- Trinity Medical, Buffalo, United States of America
| | - R Sanchez
- The Heart Institute, Saint Petersburg, United States of America
| | - G Shroff
- Baptist Heart Specialists, Jacksonville, United States of America
| | - C Veltmann
- Medizinische Hochschule Hannover, Hannover, Germany
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17
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Robertson M, Ng J, Abu Shawish W, Swaine A, Skardoon G, Huynh A, Deshpande S, Low ZY, Sievert W, Angus P. Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding. Dig Endosc 2020; 32:761-768. [PMID: 31863515 DOI: 10.1111/den.13577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/09/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. METHODS International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48-month period. Patients were risk-stratified using AIMS65, Rockall, pre-endoscopy Rockall, Child-Pugh, Model for End-stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6-week mortality and inpatient rebleeding. RESULTS Two hundred and twenty-three patients were included. Inpatient and 6-week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver-operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre-Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child-Pugh: 0.78). AIMS65 score ≥3 best defined high- and low-risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre-Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child-Pugh: 0.60). CONCLUSIONS AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.
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Affiliation(s)
- Marcus Robertson
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia.,Department of Gastroenterology, Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Jonathan Ng
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | | | - Adrian Swaine
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | - Gillian Skardoon
- Department of Gastroenterology, Monash Health, Clayton, Australia
| | - Andrew Huynh
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia
| | | | - Zi Yi Low
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia
| | - William Sievert
- Department of Gastroenterology, Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Peter Angus
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
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18
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Bohra A, Worland T, Hui S, Terbah R, Farrell A, Robertson M. Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care. World J Gastroenterol 2020; 26:2221-2231. [PMID: 32476788 PMCID: PMC7235207 DOI: 10.3748/wjg.v26.i18.2221] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/27/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.
AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.
METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over 46-mo (2012–2016) were identified via pharmacy dispensing records. Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded. Medical records were reviewed to determine baseline characteristics and survival. The Kaplan-Meier method was used to calculate survival probability. Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis. The primary outcome was 12-mo mortality following commencement of Rifaximin.
RESULTS 188 patients were included. Median age was 57 years (IQR 50-65), 71% were male and median model for end stage liver disease and Child Pugh scores were 25 (IQR 18-31) and 11 (IQR 9-12) respectively. The most common causes of cirrhosis were alcohol (62%), hepatitis C (31%) and non-alcoholic fatty liver disease (20%). A precipitating cause for HE was found in 92% patients with infection (43%), GI bleeding (16%), medication non-compliance (15%) and electrolyte imbalance (14%) the most common. During a mean follow up period of 12 ± 13 mo 107 (57%) patients died and 32 (17%) received orthotopic liver transplantation. The most common causes of death were decompensated chronic liver disease (57%) and sepsis (19%). The probability of survival was 44% and 35% at 12- and 24-mo respectively. At multivariate analysis a model for end stage liver disease > 15 and international normalised ratio reached statistical significance in predicting mortality.
CONCLUSION Despite advances made in the management of HE patients continue to have poor survival. Thus, in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered.
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Affiliation(s)
- Anuj Bohra
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Thomas Worland
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Samuel Hui
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Ryma Terbah
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Ann Farrell
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
| | - Marcus Robertson
- Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
- Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
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19
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Leon M, Carrubba A, Robertson M, Dinh T. 79: Avoiding oophorectomy in acute ovarian torsion. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Gokal R, Mistry CD, Peers E, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Dharmasena D, Hourhane G, Howarth D, Boyes R, Clisby L, Beran Y. A United Kingdom Multicenter Study of Icodextrin in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089401402s03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While glucose remains the only osmotic agent used universally for peritoneal dialysis, its various shortcomings for the long dwell equilibration continuous ambulatory peritoneal dialysis (CAPD) has led to a search for alternative agents. The large molecular weight group has been of interest, because these agents theoretically would lead to greater ultrafiltration and a better metabolic profile. Mostsubstances (dextrans, charged macromolecules) have been found unsuitable for reasons of insolubility, allergenicity, and peritoneal toxicity. Short-chain polypeptides have been studied in humans, but the experience is limited, and there is the potential for allergenicity with long-term use. The only large molecular weight agent that has been studied in some detail but hitherto in one center only and in a limited number of patients is glucose polymer (generic name, icodextrin). Because of the promise shown by these initial studies, a randomized controlled multicenter investigation of icodextrin in CAPD (MIDAS Study Group) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 12 hours) use of a slightly hypo-osmolar solution (282 mOsm/ kg) with 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges. Over a 6-month period 209 patients from 11 centers in the United Kingdom were randomized, with 106 allocated to receive icodextrin (study group) and 103 to remain on glucose (control group). One hundred and thirty-eight patients completed the 6-month study (71 control, 67 study). The mean net ultrafiltration overnight with icodextrin was 3.5 times greater than 1.36% at 8 hours and 5.5 times greater at 12 hours (p<0.0001), but no different from that of 3.86% glucose at 8 and 12 hours (although for the latter dwell the net mean ultrafiltration volume was greater by about 140 mL). Biochemical profiles were no different except for a small fall in serum sodium and chloride in the icodextrin group. The mean serum maltose rose to a steady-state level of 1.2 g/L within 2 weeks and remained stable. The mean carbohydrate absorbed for icodextrin (29±5 g) was lower than with 3.86% glucose (62±5 g). The use of icodextrin did not increase the incidence of peritonitis, nor did it alter its outcome, affect uptake of icodextrin from the peritoneum, alter serum osmolality or sodium levels. There were no adverse effects associated with the use of icodextrin, and the overall CAPD-related symptom score was significantly better for icodextrin than control subjects. This study and subsequent extensive use and clinical experience has demonstrated that the daily use of an iso-osmolar icodextrin solution is generally well tolerated, effective, and could replace the overnight use of hyperosmotic glucose solution. Its use was of equal efficacy in peritonitis and in diabetic patients. The elevated levels of maltose did not appear to have any clinical side effects.
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Affiliation(s)
- Ram Gokal
- Manchester RoyalInfirmary, Manchester
| | | | | | | | - S. Smith
- (Northern General Hospital, Sheffield)
| | | | | | | | | | | | | | - J. McKain
- (Queen Elizabeth Hospital, Birmingham)
| | | | | | | | | | - J. Walls
- (Leicester General Hospital, Leicester)
| | - C. Orton
- (Leicester General Hospital, Leicester)
| | | | - J. Grieves
- (Royal Victoria Hospital, NewcastleUpon-Tyne)
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21
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Gokal R, Mistry CD, Peers EM, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Olubodun J, Jackson F, Dharmasena D, Hourahane G, Howarth D, Boyes R, Clisby L, Beran Y. Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089501506s07] [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] [Indexed: 11/15/2022] Open
Abstract
Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patientyear, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patientyear, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
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Affiliation(s)
| | - Ram Gokal
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Chandra D. Mistry
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Elizabeth M. Peers
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | | | - S. Smith
- Northern General Hospital, Sheffield
| | | | | | | | | | | | | | - J. McKain
- Queen Elizabeth Hospital, Birmingham
| | | | | | | | | | - J. Walls
- Leicester General Hospital, Leicester
| | - C. Orton
- Leicester General Hospital, Leicester
| | | | - J. Grieves
- Royal Victoria Hospital, Newcastle-upon Tyne
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Innes N, Clarkson J, Douglas G, Ryan V, Wilson N, Homer T, Marshman Z, McColl E, Vale L, Robertson M, Abouhajar A, Holmes R, Freeman R, Chadwick B, Deery C, Wong F, Maguire A. Child Caries Management: A Randomized Controlled Trial in Dental Practice. J Dent Res 2019; 99:36-43. [DOI: 10.1177/0022034519888882] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).
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Affiliation(s)
- N.P. Innes
- School of Dentistry, University of Dundee, Dundee, UK
| | - J.E. Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | | | - V. Ryan
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - N. Wilson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - T. Homer
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Z. Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - E. McColl
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - L. Vale
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - M. Robertson
- School of Dentistry, University of Dundee, Dundee, UK
| | - A. Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - R.D. Holmes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - R. Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - B. Chadwick
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C. Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - F. Wong
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - A. Maguire
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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23
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Feldsine PT, Lienau AH, Leung SC, Mui LA, Aguilar G, Aharchi J, Aldridge I, Arling V, Bitner B, Bullard C, Carlson P, Cox C, Deiss K, Dillon J, Dombroski P, Ellingson J, Fitzgerald S, Forgey R, Gailbreath K, Gallagher D, Geftman V, Herbst K, Hillis P, Johnson M, Koch S, Lewis D, Luepke J, Martensen D, McDonagh S, McGovern B, Moon B, Moreland L, Murray L, Richter D, Robertson M, Rogers P, Rucker C, Sacca J, Siu MC, Smith C, Smith J, Stoltzfus E, Summers C, Taylor B, Toth J, Vess R, White S, Witt JL, Young S. Method Extension Study to Validate Applicability of AOAC Official Method 997.03 Visual Immunoprecipitate Assay (VIP®) for Listeria monocytogenes and Related Listeria spp. from Environmental Surfaces: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Test portions from 3 environmental surface types, representative of typical surfaces found in a food production facility, were analyzed by the Visual Immunoprecipitate assay (VIP®) and the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) culture method for Listeria monocytogenes and related Listeria species. In all cases, naturally contaminated environmental test samples were collected from an actual food production facility by sponge or swab. Test samples from concrete surfaces were collected by both swab and sponge; sponge test samples were collected from rubber surfaces, and swabs were used to sample steel surfaces. Test portions from each surface type were simultaneously analyzed by both methods. A total of 27 laboratories, representing government agencies as well as private industry in both the United States and Canada, participated in the study. During this study, a total of 615 test portions and controls was analyzed and confirmed, of which 227 were positive and 378 were negative by both methods. Nine test portions were positive by culture, but negative by the VIP. Five test portions were negative by culture, but positive by the VIP. Four test portions were negative by VIP and by culture, but confirmed positive when VIP enrichment broths were subcultured to selective agars. The data reported here indicate that the VIP method and the USDA/FSIS culture method are statistically equivalent for detection of L. monocytogenes and related Listeria species from environmental surfaces taken by sponges or swabs.
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Affiliation(s)
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | | | - Linda A Mui
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
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24
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McClure T, Robertson M. High-Dose Oral Garlic is Associated with a Decrease in Intrapulmonary Shunting in Severe Hepatopulmonary Syndrome. Hepatol Commun 2019; 3:1556-1558. [PMID: 31701077 PMCID: PMC6824068 DOI: 10.1002/hep4.1432] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tess McClure
- Liver Transplant Unit Austin Hospital Heidelberg Victoria Australia.,University of Melbourne Parkville Victoria Australia
| | - Marcus Robertson
- Liver Transplant Unit Austin Hospital Heidelberg Victoria Australia.,Monash University Clayton Victoria Australia
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25
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Al Ja'bari A, Robertson M, El‐Boghdadly K, Albrecht E. A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy. Anaesthesia 2019; 74:1277-1281. [DOI: 10.1111/anae.14769] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 01/28/2023]
Affiliation(s)
- A. Al Ja'bari
- Department of Anaesthesia Lausanne University Hospital LausanneSwitzerland
| | - M. Robertson
- Department of Anaesthesia Lausanne University Hospital LausanneSwitzerland
| | - K. El‐Boghdadly
- Department of Anaesthesia Guy's and St. Thomas’ NHS Foundation Trust LondonUK
- King's College London UK
| | - E. Albrecht
- Department of Anaesthesia Lausanne University Hospital Lausanne Switzerland
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26
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Diefenbach C, Hong F, Ambinder R, Cohen J, Robertson M, David K, Advani R, Fenske T, Barta S, Palmisano N, Svoboda J, Morgan D, Karmali R, Kahl B, Ansell S. EXTENDED FOLLOW-UP OF A PHASE I TRIAL OF IPILIMUMAB, NIVOLUMAB AND BRENTUXIMAB VEDOTIN IN RELAPSED HODGKIN LYMPHOMA: A TRIAL OF THE ECOG-ACRIN RESEARCH GROUP (E4412). Hematol Oncol 2019. [DOI: 10.1002/hon.83_2629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.S. Diefenbach
- Hematology-Oncology; Perlmutter Cancer Center at NYU Langone Health; New York United States
| | - F. Hong
- ECOG-ACRIN Biostatistics Center; Dana Farber Cancer Institute; Boston United States
| | - R. Ambinder
- Sidney Kimmel Cancer Center; Johns Hopkins University; Baltimore MD United States
| | - J. Cohen
- Winship Cancer Institute; Emory University; Atlanta United States
| | - M. Robertson
- Hematology-Oncology; Indiana Unversity School of Medicine; Indianapolis United States
| | - K. David
- Hematology-Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - R. Advani
- Oncology; Stanford Cancer Institute; San Francisco United States
| | - T. Fenske
- Hematology-Oncology; Froedtert and the Medical College of Wisconsin; Milwaukee United States
| | - S. Barta
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - N. Palmisano
- Hematology-Oncology; Thomas Jefferson University Hospital; Philadelphia United States
| | - J. Svoboda
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - D. Morgan
- Hematology-Oncology; Vanderbilt Ingram Henry Cancer Center; Nashville United States
| | - R. Karmali
- Feinberg School of Medicine; Northwestern University; Chicago United States
| | - B. Kahl
- Oncology; Washington University School of Medicine; St. Louis United States
| | - S. Ansell
- Hematology-Oncology; Mayo Clinic; Rochester United States
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27
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Cossentine J, Robertson M, Xu D. Biological Activity of Bacillus thuringiensis in Drosophila suzukii (Diptera: Drosophilidae). J Econ Entomol 2019; 109:1071-1078. [PMID: 27106227 DOI: 10.1093/jee/tow062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/26/2016] [Indexed: 05/21/2023]
Abstract
Whole-culture extracts of Bacillus thuringiensis Berliner strains were assayed against larval and adult Drosophila suzukii (Matsumura), an important invasive pest of many thin-skinned soft fruit crops in North America. Of the 22 serovars tested versus larval D. suzukii , strains of Bacillus thuringiensis var. thuringiensis , kurstaki , thompsoni , bolivia , and pakistani caused high (75 to 100%) first-instar mortalities. Pupal mortality, measured as a failure of adults to emerge, varied with serovar. The first D. suzukii instar was the most susceptible of the three larval instars to B. thuringiensis var. kurstaki HD-1. Larval D. suzukii are shielded from crop treatments, as they develop under the skin of infested fruit, and adults would be a more vulnerable target for an efficacious strain of B. thuringiensis . Only one of the 21 B. thuringiensis serovars, var. thuringiensis , prepared as oral suspensions in sucrose for adult D. suzukii ingestion resulted in significant, albeit low mortality within 7 d. It is not a candidate for use in pest management, as it produces β -exotoxin that is toxic to vertebrates.
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Affiliation(s)
- J Cossentine
- Summerland Research and Development Centre, Agriculture and Agri-Food Canada, 4200 Hwy. 97, Summerland, BC, Canada, V0H 1Z0
| | - M Robertson
- Summerland Research and Development Centre, Agriculture and Agri-Food Canada, 4200 Hwy. 97, Summerland, BC, Canada, V0H 1Z0
| | - D Xu
- Saint-Jean-sur-Richelieu Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Blvd., St-Jean-sur-Richelieu, QC, Canada, J3B 3E6
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28
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Leon M, Bautista K, Robertson M, Pettit P, Destephano C. Minimally Invasive Surgical Management of Vesico-Vaginal Fistula after a Robotic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.231] [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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29
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Smith M, Wilson M, Robertson M, Padilla H, Zuercher H, Vandenberg R, Lorig K, DeJoy D. IMPACT OF A DISEASE SELF-MANAGEMENT PROGRAM ON EMPLOYEE HEALTH AND WORK PERFORMANCE: INTRODUCING WORKPLACE CDSMP. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Smith
- Texas A&M School of Public Health
| | | | | | | | | | | | - K Lorig
- Self-Management Resource Center
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30
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Abstract
Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.
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Affiliation(s)
- F Schwendicke
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Robertson
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
| | - C Splieth
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - R Santamaria
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - N Innes
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
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31
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Mo A, Testro A, French J, Robertson M, Angus P, Grigg A. Early radiological intervention and haematology screening is associated with excellent outcomes in Budd-Chiari syndrome. Intern Med J 2018; 47:1361-1367. [PMID: 28675622 DOI: 10.1111/imj.13544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Budd-Chiari syndrome (BCS) is a rare and life-threatening disorder, resulting from thrombosis of the hepatic veins. Various treatments, including pharmacological, radiological and surgical interventions, have been used. AIM To describe retrospectively our institution's experience with management of patients with BCS. METHODS A retrospective study of all cases of primary Budd-Chiari syndrome presenting to our institution between January 2000 and August 2012 was performed. Patients with secondary Budd-Chiari syndrome due to malignancy or local mass compression were excluded. RESULTS Between 2000 and 2012, 27 patients with primary BCS presented with a median Rotterdam score of 1.16 (range: 0.07-2.11). A total of 24 patients (89%) had at least one risk factor, with the commonest being myeloproliferative neoplasm (MPN), detected in 17 of 24 (71%) of the tested patients, including four patients with normal blood counts at diagnosis. All patients were anticoagulated with warfarin or low-molecular-weight heparin (LMWH). A total of 25 (92.6%) patients also had primary radiological interventions, consisting of transjugular intrahepatic portosystemic shunt (TIPS) in 18 (67%) patients and/or angioplasty/stenting in 11 (40%). A total of 14 patients developed TIPS stenoses, requiring a median of 1.5 (range: 1-14) revisions. No patient developed TIPS failure requiring alternative therapy. Two patients were lost to follow-up. At a median follow up of 59 months (range: 2-248 months), the overall survival was 96% at 1 year and 81% at 5 years, much greater than predicted by the Rotterdam score. No patients required liver transplantation. CONCLUSION There is a high incidence of MPN in patients with primary BCS, including patients with normal peripheral blood counts at the time of diagnosis. Our approach of anticoagulation, aggressive and early radiological intervention aimed at rapid decompression of the congested liver resulted in excellent medium-term outcomes.
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Affiliation(s)
- Allison Mo
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Janine French
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Marcus Robertson
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Peter Angus
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
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Brown A, Hézode C, Zuckerman E, Foster GR, Zekry A, Roberts SK, Lahser F, Durkan C, Badshah C, Zhang B, Robertson M, Wahl J, Barr E, Haber B. Efficacy and safety of 12 weeks of elbasvir ± grazoprevir ± ribavirin in participants with hepatitis C virus genotype 2, 4, 5 or 6 infection: The C-SCAPE study. J Viral Hepat 2018; 25:457-464. [PMID: 29152828 DOI: 10.1111/jvh.12801] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 04/26/2017] [Accepted: 09/02/2017] [Indexed: 02/06/2023]
Abstract
People with hepatitis C virus (HCV) infection other than genotype 1 represent a heterogeneous group. The aim of the phase 2 C-SCAPE study was to evaluate elbasvir/grazoprevir (EBR/GZR), with or without ribavirin (RBV), in participants with HCV genotype 2, 4, 5 or 6 infection. This was a part randomised, open-label, parallel-group study (NCT01932762; PN047-03) of treatment-naive, noncirrhotic participants. Participants with HCV genotype 2 infection received GZR 100 mg + RBV ± EBR 50 mg for 12 weeks and those with genotype 4, 5 or 6 infection were randomized to receive EBR/GZR ± RBV for 12 weeks. The primary endpoint was sustained virological response 12 weeks after completion of treatment (SVR12; HCV RNA <25 IU/mL). Among participants with genotype 2 infection, SVR12 was achieved by 80% (24/30) of those receiving EBR/GZR + RBV and 73% (19/26) of those receiving GZR + RBV. SVR rates were high in participants with HCV genotype 4 infection receiving EBR/GZR with and without RBV (100% [10/10] and 90% [9/10]; respectively). In contrast, the addition of RBV to EBR/GZR appeared to increase SVR12 in participants with genotype 5 infection (EBR/GZR, 25%; EBR/GZR + RBV 100% [4/4]). In participants with genotype 6 infection, SVR12 was 75% (3/4) in both those receiving EBR/GZR and those receiving EBR/GZR + RBV. The safety profile was similar across treatment arms, with adverse events tending to occur more frequently among participants receiving RBV. In conclusion, these data support the inclusion of participants with genotype 4 or 6 infection in the EBR/GZR phase 3 studies. EBR/GZR ± RBV was unsatisfactory for participants with genotype 2 or 5 infection.
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Affiliation(s)
- A Brown
- Imperial College Healthcare NHS Trust, London, UK
| | - C Hézode
- Henri Mondor Hospital, University of Paris-Est, Creteil, France
| | - E Zuckerman
- Liver Unit, Carmel Medical Center Technion Faculty of Medicine, Haifa, Israel
| | - G R Foster
- Liver Unit, Queen Mary University of London, London, UK
| | - A Zekry
- St George Hospital Clinical School, Inflammation and Infection Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - S K Roberts
- The Alfred Hospital, Melbourne, VIC, Australia
| | - F Lahser
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - C Durkan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - C Badshah
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Zhang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Haber
- Merck & Co., Inc., Kenilworth, NJ, USA
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Conway B, Dore GJ, Altice F, Litwin A, Grebely J, Dalgard O, Gane EJ, Shibolet O, Luetkemeyer A, Nahass R, Peng C, Gendrano I, Huang H, Chen E, Nguyen B, Wahl J, Barr E, Robertson M, Platt H. A172 C-EDGE CO-STAR: RISK OF REINFECTION FOLLOWING SUCCESSFUL THERAPY WITH ELBASVIR (EBR) AND GRAZOPREVIR (GZR) IN PERSONS WHO INJECT DRUGS (PWID) RECEIVING OPIOD AGONIST THERAPY (OAT). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - G J Dore
- Kirby Institute, Sydney, New South Wales, Australia
| | - F Altice
- Yale School of Medicine, New Haven, CT
| | - A Litwin
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - J Grebely
- Kirby Institute, Sydney, New South Wales, Australia
| | - O Dalgard
- Institute of Clinical Medicine, Oslo, Norway
| | - E J Gane
- Auckland Clinical Studies, Auckland, New Zealand
| | - O Shibolet
- Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - R Nahass
- ID Care, Hillsborough Township, NJ
| | - C Peng
- China Medical University Hospital, Taiwan, Taiwan
| | | | - H Huang
- Merck & Co., Inc., Kenilworth, NJ
| | - E Chen
- Merck & Co., Inc., Kenilworth, NJ
| | - B Nguyen
- Merck & Co., Inc., Kenilworth, NJ
| | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ
| | | | - H Platt
- Merck & Co., Inc., Kenilworth, NJ
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DeStephano C, Gajarawala S, Heckman M, Vargas E, Pettit P, Robertson M. 41: Factors associated with readiness for discharge from the hospital following robotic and laparoscopic hysterectomy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.060] [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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Killaspy H, Johnson S, Livingston G, Hassiotis A, Robertson M. Women in academic psychiatry in the United Kingdom. Psychiatr bull 2018. [DOI: 10.1192/pb.27.9.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although there seems to be a shared impression that the proportion of women in academic psychiatry is substantially lower than in National Health Service (NHS) posts, we are not aware of any empirical data on this. In the USA, women physicians have been shown to be more likely to pursue an academic career than men (Nonnemaker, 2000), but the number who advance to Professor appears significantly lower than expected (Reiser et al, 1993; Nonnemaker, 2000). Women in academic psychiatry in Canada also appear less likely to advance to senior positions than their male colleagues (Penfold, 1987). A recent survey of 44 academic institutions in the UK, carried out by the National Centre for Social Research (Blake & La Valle, 2000), found that women occupied lower grade academic posts than their male counterparts and therefore were less eligible to apply for project research grants. Those that were eligible were as successful in gaining funding as their male colleagues.
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Gane E, Nahass R, Luketic V, Asante-Appiah E, Hwang P, Robertson M, Wahl J, Barr E, Haber B. Efficacy of 12 or 18 weeks of elbasvir plus grazoprevir with ribavirin in treatment-naïve, noncirrhotic HCV genotype 3-infected patients. J Viral Hepat 2017; 24:895-899. [PMID: 28470815 DOI: 10.1111/jvh.12719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/05/2017] [Accepted: 04/03/2017] [Indexed: 12/13/2022]
Abstract
Elbasvir (EBR; HCV NS5A inhibitor) and grazoprevir (GZR; HCV NS3/4A protease inhibitor) are approved as a fixed-dose combination to treat patients chronically infected with HCV genotypes 1 and 4. During the development programme and supported by in vitro potency, the efficacy of EBR+GZR was assessed in HCV GT3-infected patients. This study's aim was to determine the efficacy and tolerability of 12 or 18 weeks of EBR+GZR with ribavirin (RBV) in treatment-naïve, noncirrhotic HCV GT3-infected patients. Randomized patients received open-label EBR (50 mg once daily) + GZR (100 mg once daily) + RBV. The primary efficacy objective was to evaluate the sustained virologic response rates 12 weeks after the end of all study therapy (SVR12). SVR12 rates (95% confidence interval) were 45.0% (23.1, 68.5) and 57.1% (34.0, 78.2) after treatment with EBR+GZR+RBV for 12 weeks or 18 weeks, respectively. On-treatment virologic failure was observed in 41% (17 of 41) of patients. At virologic failure, resistance-associated substitutions (RASs) with a >five-fold shift in potency occurred in the NS3 region in six (35%) patients and in the NS5A region in 16 (94%) patients. The most common RAS at virologic failure was Y93H in NS5A which was identified in 13 of 17 (76%) patients. The efficacy of EBR+GZR+RBV was suboptimal in HCV GT3-infected patients due to a high rate of on-treatment virologic failure and treatment-emergent RASs which demonstrates an inadequate barrier to the development of GT3 resistance. However, rapid viral clearance demonstrated the antiviral activity of EBR+GZR+RBV in GT3-infected patients.clinicaltrials.gov: NCT01717326.
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Affiliation(s)
- E Gane
- Auckland Clinical Studies, Grafton, Auckland, New Zealand
| | | | - V Luketic
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA, USA
| | | | - P Hwang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Haber
- Merck & Co., Inc., Kenilworth, NJ, USA
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Cleland J, Robertson M, Ford I, Mareev Y, Borer J, Komajda M, Tavazzi L, Swedberg K, Bohm M. 246Effect of Ivabradine on Mortality in Patients with heart failure and a reduced left ventricular ejection fraction not receiving a beta-blocker: an analysis from SHIFT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J.G. Cleland
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - M. Robertson
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - I. Ford
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - Y. Mareev
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - J. Borer
- State University of New York Downstate Medical Center, New York, United States of America
| | - M. Komajda
- University Pierre & Marie Curie Paris VI, Department of Cardiology, Paris, France
| | - L. Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | - K. Swedberg
- Sahlgrenska Academy - University of Gothenburg, Department of Emergency and Cardiovascular Medicine, Goteborg, Sweden
| | - M. Bohm
- Saarland University Hospital, Homburg, Germany
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Reau N, Robertson M, Feng H, Caro L, Yeh W, Nguyen B, Wahl J, Barr E, Hwang P, Klopfer S. P64 Concomitant proton pump inhibitor use does not reduce the efficacy of elbasvir/grazoprevir. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sinha R, Lockman KA, Mallawaarachchi N, Robertson M, Plevris JN, Hayes PC. Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites. J Hepatol 2017; 67:40-46. [PMID: 28213164 DOI: 10.1016/j.jhep.2017.02.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 09/21/2016] [Revised: 01/20/2017] [Accepted: 02/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Carvedilol, a non-selective beta-blocker (NSBB) with additional anti-alpha 1 receptor activity, is a potent portal hypotensive agent and has been used as prophylaxis against variceal bleeding. However, its safety in patients with decompensated liver cirrhosis and ascites is still disputed. In this study, we examined whether long-term use of carvedilol in patients with ascites is a risk factor for mortality. METHODS A single-centre retrospective analysis of 325 consecutive patients with liver cirrhosis and ascites presenting to our Liver Unit between 1st of January 2009 to 31st August 2012 was carried out. The primary outcome was all-cause and liver-specific mortality in patients receiving or not receiving carvedilol as prophylaxis against variceal bleeding. RESULTS The final cohort after propensity score matching comprised 264 patients. Baseline ascites severity and UK end-stage liver disease (UKELD) score between carvedilol (n=132) and non-carvedilol (n=132) treated patient groups were comparable. Median follow-up time was 2.3years. Survival at the end of the follow-up was 24% and 2% for the carvedilol and the non-carvedilol groups respectively (log-rank p<0.0001). The long-term survival was significantly better in carvedilol than non-carvedilol group (log-rank p<0.001). The survival difference remained significant after adjusting for age, gender, ascites severity, aetiology of cirrhosis, previous variceal bleed, spontaneous bacterial peritonitis prophylaxis, serum albumin and UKELD with hazard ratio of 0.59 (95% confidence interval [CI]: 0.44, 0.80; p=0.001), suggesting a 41% reduction in mortality risk. When stratified by the severity of ascites, carvedilol therapy resulted in hazard ratio of 0.47 (95% CI: 0.29, 0.77; p=0.003) in those with mild ascites. Even with moderate or severe ascites, carvedilol use was not associated with increased mortality risk. CONCLUSION Long-term carvedilol therapy is not harmful in patients with decompensated cirrhosis and ascites. LAY SUMMARY The safety of carvedilol and other non-selective beta-blocker drugs in patients with liver cirrhosis and ascites is still debated. In this study, we have shown that carvedilol therapy in these patients was associated with reduced risk of mortality, particularly in those with mild ascites. We concluded that low dose, chronic treatment with carvedilol in patients with liver cirrhosis and ascites is not detrimental.
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Affiliation(s)
- Rohit Sinha
- Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom; Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom.
| | - Khalida A Lockman
- Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom
| | - Nethmee Mallawaarachchi
- Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom
| | - Marcus Robertson
- Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom
| | - John N Plevris
- Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom; Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom
| | - Peter C Hayes
- Liver Unit, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom; Hepatology Laboratory, The Royal Infirmary of Edinburgh and The University of Edinburgh, Edinburgh, United Kingdom
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Hyatt R, Taylor JK, Robertson M, Dean J, Finch J, Bedwell R, Youds J, Wood J. 30MEASURING THE PROCESS OF CARE OF FRAIL OLDER PATIENTS IN HOSPITAL: THE FRAIL OLDER PATIENT ADMISSION QUESTIONNAIRE (FOPAQ). Age Ageing 2017. [DOI: 10.1093/ageing/afx055.30] [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: 11/12/2022] Open
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Robertson M, Watanabe M. JGH OPEN: A new open access journal for gastroenterology and hepatology. J Gastroenterol Hepatol 2017; 32:289. [PMID: 28221689 DOI: 10.1111/jgh.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Raeside MC, Robertson M, Nie ZN, Partington DL, Jacobs JL, Behrendt R. Dietary choice and grazing behaviour of sheep on spatially arranged pasture systems. 1. Herbage mass, nutritive characteristics and diet selection. Anim Prod Sci 2017. [DOI: 10.1071/an15539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Offering livestock dietary choice through access to different pasture species enables livestock to regulate their own feed intake, select for nutrients and minerals, balance rumen health and display natural grazing and foraging behaviours, which could in turn result in increased livestock productivity. An experiment was conducted at Hamilton, Victoria, Australia, to test the hypothesis that offering lambs dietary choice through spatially separated combinations of pasture species would improve lamb performance, relative to lambs with no dietary choice. The experiment tested seven treatments, replicated four times in a randomised complete block design with plot sizes of 1 ± 0.1 ha. The treatments were: 100% perennial ryegrass (Lolium perenne L.) (PR), 100% plantain (Plantago lanceolata L.) (PL), 100% lucerne (Medicago sativa L.) (LU), 50 : 50 perennial ryegrass/plantain (PR + PL), 50 : 50 perennial ryegrass/lucerne (PR + LU), 50 : 50 plantain/lucerne (PL + LU) and 33 : 33 : 33 perennial ryegrass/plantain/lucerne (PR + PL + LU). In the multiple species swards, the pasture species were separated spatially (by area). Plots were grazed by weaned lambs between March and June 2011. Pre-grazing herbage mass during March and April were highest (P < 0.05) from the lucerne and lowest (P < 0.05) from the plantain, with lucerne producing 4.5–5.5 t DM/ha during this time, whereas the perennial ryegrass and plantain produced 3.5–3.9 t DM/ha and 2.3–3.0 t DM/ha, respectively. Herbage disappearance (calculated estimate of feed intake) was highest (P < 0.05) from the lucerne and lowest (P < 0.05) from the plantain during March and April. Leaf crude protein between the perennial ryegrass and plantain did not differ (P > 0.05) and were lower (P < 0.05) than the lucerne, but the perennial ryegrass and plantain had higher (P < 0.05) leaf on offer (kg DM/ha). Plantain leaf had higher (P < 0.05) Fe, Zn, Co, Ca and S than the perennial ryegrass leaf and higher (P < 0.05) Se, Cu, Mg, Na and Cl than the perennial ryegrass and lucerne leaf and a more negative (P < 0.05) dietary cation : anion difference. The agronomic data presented in this paper provides support for the hypothesis, with lambs showing dietary preferences between pasture species and morphological components, and forms to basis for why these preferences exist. The two subsequent papers show how offering lambs dietary choice affected the performance of male lambs to slaughter and female lambs to first joining.
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Raeside MC, Robertson M, Nie ZN, Partington DL, Jacobs JL, Behrendt R. Dietary choice and grazing behaviour of sheep on spatially arranged pasture systems. 2. Wether lamb growth and carcass weight at slaughter. Anim Prod Sci 2017. [DOI: 10.1071/an15540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dry matter production and nutritive characteristics of the pasture feedbase during autumn are key drivers of profitability in Australia’s prime lamb systems. An experiment was conducted to test the hypothesis that offering lambs dietary choice through spatially separated combinations of perennial ryegrass (Lolium perenne L.), plantain (Plantago lanceolata L.) and/or lucerne (Medicago sativa L.) improves the post-weaning liveweight gain, condition score (CS), pre- and post-slaughter carcass characteristics and reduces the internal parasite burdens of wether lambs finished to a slaughter weight over autumn, relative to lambs offered no dietary choice. The experiment tested seven treatments, replicated four times in a randomised complete block design with plot sizes of 1 ± 0.1 ha. The treatments were: 100% perennial ryegrass (PR), 100% plantain (PL), 100% lucerne (LU), 50 : 50 perennial ryegrass/plantain (PR + PL), 50 : 50 perennial ryegrass/lucerne (PR + LU), 50 : 50 plantain/lucerne (PL + LU) and 33 : 33 : 33 perennial ryegrass/plantain/lucerne (PR + PL + LU). Plots were grazed by weaned lambs between March and June 2011. The lambs had been born between 3 August and 7 September 2010 and were derived from either Coopworth composite dams joined to Coopworth maternal sires or from Merino dams (Toland or Centreplus bloodlines) joined to Border Leicester sires. Backgrounding the lambs on a pasture system that contained lucerne during the lactation to weaning period increased (P < 0.05) liveweight at slaughter by 8% and hot carcass weight by 10%, relative to lambs backgrounded on perennial ryegrass. Finishing lambs on the LU treatment between weaning and slaughter increased (P < 0.05) liveweight at slaughter by 11%, CS at slaughter by 0.3 units, hot carcass weight by 16%, carcass CFAT (measured over the loin) by 2.5 mm, carcass eye muscle depth by 1.1 mm and carcass GRFAT (total tissue depth at 11/12th rib, 11 cm from mid line) by 3.8 mm, relative to lambs finished on the PR treatment. Finishing lambs on LU + PR, LU + PL or LU + PR + PL did not (P > 0.05) improve any of the measured parameters, relative to finishing lambs on the LU treatment. The PL and PR treatments did not differ (P > 0.05) in liveweight at slaughter, CS at slaughter or carcass characteristics, but the PL treatment had lower (P < 0.05) liveweight gain than the PR treatment during the first 2 weeks of the experiment (39 g/day vs 330 g/day), which was later partially compensated for. Our hypothesis has not been supported given that the use of spatially arranged mixes resulted in no improvement in liveweight gain, CS, carcass characteristics or internal parasite burdens relative to the comparable single species sward.
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Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, Wei J, Lontos S, Angus P, Vaughan R. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016; 83:1151-60. [PMID: 26515955 DOI: 10.1016/j.gie.2015.10.021] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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] [Received: 04/28/2015] [Accepted: 10/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores. METHODS ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score. RESULTS Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P < .027) and the pre-endoscopy Rockall score (0.74, P = .001) and equivalent to the full Rockall score (0.78, P = .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion. CONCLUSION The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission.
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Affiliation(s)
- Marcus Robertson
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ray Boyapati
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - William Chung
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tom Worland
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ryma Terbah
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - James Wei
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Steve Lontos
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Peter Angus
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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Zeng G, Robertson M, Murphy J, Lamey M, Wang Y. SU-D-201-02: A Systematic Planning Quality Monitoring Program for VMAT Treatment. Med Phys 2016. [DOI: 10.1118/1.4955614] [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: 11/07/2022] Open
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Lagging M, Brown A, Mantry PS, Ramji A, Weilert F, Vierling JM, Howe A, Gendrano IN, Hwang P, Zhang B, Wahl J, Robertson M, Mobashery N. Grazoprevir plus peginterferon and ribavirin in treatment-naive patients with hepatitis C virus genotype 1 infection: a randomized trial. J Viral Hepat 2016; 23:80-8. [PMID: 26353843 DOI: 10.1111/jvh.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/29/2015] [Accepted: 08/12/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Grazoprevir (MK-5172, Merck & Co., Inc.) is a selective inhibitor of the hepatitis C virus (HCV) NS3/4a protease. The aim of this study was to evaluate the safety and efficacy of grazoprevir at doses of 25-100 mg/day in combination with peginterferon and ribavirin (PEG-IFN/RBV). In this randomized, dose-ranging, multicentre trial, treatment-naive adults with chronic HCV genotype 1 infection received once-daily grazoprevir 25 mg, 50 mg or 100 mg plus PEG-IFN/RBV for 12 weeks. Patients with quantifiable HCV RNA (≥25 IU/mL) at week 4 received an additional 12 weeks of PEG-IFN/RBV. The primary endpoint was sustained virologic response (HCV RNA <25 IU/mL 12 weeks after completing therapy [SVR12]). Eighty-seven patients were randomly assigned and received ≥1 dose of therapy. Median time to undetectable HCV RNA was 16 days in the 100-mg arm and 22 days in the 25- and 50-mg arms. All patients except one had HCV RNA undetectable or unquantifiable at week 4 and received 12 weeks of therapy. SVR12 was achieved by 13 of 24 (54.2%), 21 of 25 (84.0%) and 23 of 26 (88.5%) patients in the 25-, 50- and 100-mg arms, respectively (per-protocol analysis). Three patients discontinued as a result of nonserious adverse events (AEs) and three patients experienced serious AEs. Transaminase elevations occurred in two patients (one each in the 25- and 100-mg arms). CONCLUSION These data support further study of the grazoprevir 100-mg dose. Phase 3 studies of grazoprevir 100 mg in combination with elbasvir are currently ongoing (NCT01710501; protocol P038).
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Affiliation(s)
- M Lagging
- Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Brown
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P S Mantry
- The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA
| | - A Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - F Weilert
- Waikato District Health Board, Hamilton, New Zealand
| | | | - A Howe
- Merck & Co. Inc., Kenilworth, NJ, USA
| | | | - P Hwang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - B Zhang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - J Wahl
- Merck & Co. Inc., Kenilworth, NJ, USA
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Omar AY, Stern JS, Simmons H, Robertson M. MOTOR VERSUS VOCAL TICS. J Neurol Psychiatry 2015. [DOI: 10.1136/jnnp-2015-311750.42] [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: 11/03/2022]
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Poordad F, Lawitz E, Gutierrez J, Evans B, Howe A, Feng HP, Li J, Hwang P, Robertson M, Wahl J, Barr E, Haber B. O006 : C-swift: grazoprevir/elbasvir + sofosbuvir in cirrhotic and noncirrhotic, treatment-naive patients with hepatitis C virus genotype 1 infection, for durations of 4, 6 or 8 weeks and genotype 3 infection for durations of 8 or 12 weeks. J Hepatol 2015. [DOI: 10.1016/s0168-8278(15)30013-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
Public health and therapeutic measures to reduce cardiac and stroke risk may already be reducing risks of dementia in populations. In routine clinical care, dementia risk could be further reduced by optimized management of delirium, depressive disorders, traumatic brain injury and stroke. These are opportunities to minimize risk of progression to dementia during acute care and subsequent rehabilitation. Although interventions to protect against progress to dementia may be of small effect in each clinical situation, awareness of dementia risk and appropriate steps to reduce that risk should contribute to an overall reduction in the incidence of dementia.
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Affiliation(s)
- M Robertson
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
| | - A Seaton
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
| | - L J Whalley
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
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Robertson M, Majumdar A, Garrett K, Rumler G, Gow P, Testro A. Continuous outpatient terlipressin infusion for hepatorenal syndrome as a bridge to successful liver transplantation. Hepatology 2014; 60:2125-6. [PMID: 24687396 DOI: 10.1002/hep.27154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/28/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Marcus Robertson
- Liver Transplant Unit Victoria, Austin Health, Melbourne, Australia
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