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Swaminathan M, Angelakas A, Baxter M, Cotton J, Dobeson C, Feeney L, Gault A, Hughes D, Jones C, Lee R, Mughal S, Parikh S, Pritchard M, Rodgers L, Rowe M, Salawu A, Shotton R, Tinsley N, Tivey A, Olsson-Brown A. 241P Treatment and outcomes of patients with gastrointestinal toxicity following immunotherapy: A large multi-center retrospective study in the United Kingdom by the National Oncology Trainees Collaborative for Healthcare Research (NOTCH). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gonçalves BP, Hall M, Jassat W, Balan V, Murthy S, Kartsonaki C, Semple MG, Rojek A, Baruch J, Reyes LF, Dasgupta A, Dunning J, Citarella BW, Pritchard M, Martín-Quiros A, Sili U, Baillie JK, Aryal D, Arabi Y, Rashan A, Angheben A, Caoili J, Carrier FM, Harrison EM, Gómez-Junyent J, Figueiredo-Mello C, Douglas JJ, Mat Nor MB, Chow YP, Wong XC, Bertagnolio S, Thwin SS, Streinu-Cercel A, Salazar L, Rishu A, Rangappa R, Ong DSY, Hashmi M, Carson G, Diaz J, Fowler R, Kraemer MUG, Wils EJ, Horby P, Merson L, Olliaro PL. An international observational study to assess the impact of the Omicron variant emergence on the clinical epidemiology of COVID-19 in hospitalised patients. eLife 2022; 11:e80556. [PMID: 36197074 PMCID: PMC9534549 DOI: 10.7554/elife.80556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods Here, we propose an innovative approach to study changes in COVID-19 hospital presentation and outcomes after the Omicron variant emergence using publicly available population-level data on variant relative frequency to infer SARS-CoV-2 variants likely responsible for clinical cases. We apply this method to data collected by a large international clinical consortium before and after the emergence of the Omicron variant in different countries. Results Our analysis, that includes more than 100,000 patients from 28 countries, suggests that in many settings patients hospitalised with Omicron variant infection less often presented with commonly reported symptoms compared to patients infected with pre-Omicron variants. Patients with COVID-19 admitted to hospital after Omicron variant emergence had lower mortality compared to patients admitted during the period when Omicron variant was responsible for only a minority of infections (odds ratio in a mixed-effects logistic regression adjusted for likely confounders, 0.67 [95% confidence interval 0.61-0.75]). Qualitatively similar findings were observed in sensitivity analyses with different assumptions on population-level Omicron variant relative frequencies, and in analyses using available individual-level data on infecting variant for a subset of the study population. Conclusions Although clinical studies with matching viral genomic information should remain a priority, our approach combining publicly available data on variant frequency and a multi-country clinical characterisation dataset with more than 100,000 records allowed analysis of data from a wide range of settings and novel insights on real-world heterogeneity of COVID-19 presentation and clinical outcome. Funding Bronner P. Gonçalves, Peter Horby, Gail Carson, Piero L. Olliaro, Valeria Balan, Barbara Wanjiru Citarella, and research costs were supported by the UK Foreign, Commonwealth and Development Office (FCDO) and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z]; and Janice Caoili and Madiha Hashmi were supported by the UK FCDO and Wellcome [222048/Z/20/Z]. Peter Horby, Gail Carson, Piero L. Olliaro, Kalynn Kennon and Joaquin Baruch were supported by the Bill & Melinda Gates Foundation [OPP1209135]; Laura Merson was supported by University of Oxford's COVID-19 Research Response Fund - with thanks to its donors for their philanthropic support. Matthew Hall was supported by a Li Ka Shing Foundation award to Christophe Fraser. Moritz U.G. Kraemer was supported by the Branco Weiss Fellowship, Google.org, the Oxford Martin School, the Rockefeller Foundation, and the European Union Horizon 2020 project MOOD (#874850). The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission. Contributions from Srinivas Murthy, Asgar Rishu, Rob Fowler, James Joshua Douglas, François Martin Carrier were supported by CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and coordinated out of Sunnybrook Research Institute. Contributions from Evert-Jan Wils and David S.Y. Ong were supported by a grant from foundation Bevordering Onderzoek Franciscus; and Andrea Angheben by the Italian Ministry of Health "Fondi Ricerca corrente-L1P6" to IRCCS Ospedale Sacro Cuore-Don Calabria. The data contributions of J.Kenneth Baillie, Malcolm G. Semple, and Ewen M. Harrison were supported by grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE) (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. All funders of the ISARIC Clinical Characterisation Group are listed in the appendix.
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Affiliation(s)
- Bronner P Gonçalves
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Matthew Hall
- Big Data Institute, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Waasila Jassat
- National Institute for Communicable Diseases, South Africa; Right to CareJohannesburgSouth Africa
| | - Valeria Balan
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Srinivas Murthy
- Faculty of Medicine, University of British ColumbiaVancouverCanada
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of LiverpoolLiverpoolUnited Kingdom
- Respiratory Medicine, Alder Hey Children's Hospital, University of LiverpoolLiverpoolUnited Kingdom
| | - Amanda Rojek
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
- Royal Melbourne HospitalMelbourneAustralia
- Centre for Integrated Critical Care, University of MelbourneMelbourneAustralia
| | - Joaquín Baruch
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Luis Felipe Reyes
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
- Universidad de La SabanaChiaColombia
- Clinica Universidad de La SabanaChiaColombia
| | - Abhishek Dasgupta
- Department of Computer Science, University of OxfordOxfordUnited Kingdom
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Jake Dunning
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | | | - Mark Pritchard
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | | | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara UniversityIstanbulTurkey
| | - J Kenneth Baillie
- Roslin Institute, University of EdinburghEdinburghUnited Kingdom
- Intensive Care Unit, Royal Infirmary of EdinburghEdinburghUnited Kingdom
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti HospitalLalitpurNepal
| | - Yaseen Arabi
- King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
| | - Aasiyah Rashan
- Network for Improving Critical care Systems and TrainingColomboSri Lanka
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di ValpolicellaVeronaItaly
| | | | - François Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de MontréalMontréalCanada
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de MontréalMontréalCanada
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)MontréalCanada
- Department of Anesthesiology and Pain Medicine, Université de MontréalMontréalCanada
| | - Ewen M Harrison
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and InformaticsEdinburghUnited Kingdom
| | - Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu FabraBarcelonaSpain
| | | | | | | | - Yock Ping Chow
- Clinical Research Centre, Sunway Medical Centre, Selangor Darul EhsanSelangorMalaysia
| | - Xin Ci Wong
- Digital Health Research and Innovation Unit, Institute for Clinical Research, National Institutes of Health (NIH)SelangorMalaysia
| | | | | | - Anca Streinu-Cercel
- Carol Davila University of Medicine and PharmacyBucharestRomania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals"BucharestRomania
| | | | - Asgar Rishu
- Department of Critical Care Medicine, Sunnybrook Health Sciences CentreTorontoCanada
| | | | - David SY Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & VlietlandRotterdamNetherlands
| | - Madiha Hashmi
- Critical Care Asia and Ziauddin UniversityKarachiPakistan
| | - Gail Carson
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Janet Diaz
- World Health OrganizationGenèveSwitzerland
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences CentreTorontoCanada
| | - Moritz UG Kraemer
- Department of Biology, University of OxfordOxfordUnited Kingdom
- Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & VlietlandRotterdamNetherlands
| | - Peter Horby
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
| | - Laura Merson
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
| | - Piero L Olliaro
- ISARIC, Pandemic Sciences Institute, University of OxfordOxfordUnited Kingdom
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Fonseca De Freitas D, Patel I, Kadra-Scalzo G, Pritchard M, Shetty H, Broadbent M, Patel R, Downs J, Segev A, Khondoker M, Maccabe J, Bhui K, Hayes R. Ethnic inequalities in treatment with clozapine. Eur Psychiatry 2022. [PMCID: PMC9567955 DOI: 10.1192/j.eurpsy.2022.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Ethnic disparities in treatment with clozapine, the antipsychotic recommended for treatment-resistant schizophrenia (TRS), have been reported. However, these investigations frequently suffer from potential residual confounding. For example, few studies have restricted the analyses to TRS samples and none has controlled for benign ethnic neutropenia. Objectives This study investigated if service-users’ ethnicity influenced clozapine prescription in a cohort of people with TRS. Methods Information from the clinical records of South London and Maudsley NHS Trust was used to identify a cohort of service-users with TRS between 2007 and 2017. In this cohort, we used logistic regression to investigate any association between ethnicity and clozapine prescription while adjusting for potential confounding variables, including sociodemographic factors, psychiatric multimorbidity, substance use, benign ethnic neutropenia, and inpatient and outpatient care received. Results
We identified 2239 cases that met the criteria for TRS. Results show that after adjusting for confounding variables, people with Black African ethnicity had half the odds of being treated with clozapine and people with Black Caribbean or Other Black background had about two-thirds the odds of being treated with clozapine compared White British service-users. No disparities were observed regarding other ethnic groups, namely Other White background, South Asian, Other Asian, or any other ethnicity. Conclusions There was evidence of inequities in care among Black ethnic groups with TRS. Interventions targeting barriers in access to healthcare are recommended. Disclosure During the conduction of the study, DFdF, GKS, and RH received funds from the NIHR Maudsley Biomedical Research Centre. For other activities outside the submitted work, DFdF received research funding from the UK Department of Health and Social Care, Janss
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Fonseca De Freitas D, Agbedjro D, Kadra-Scalzo G, Francis E, Ridler I, Pritchard M, Shetty H, Segev A, Casetta C, Smart S, Morris A, Downs J, Christensen S, Bak N, Kinon B, Stahl D, Hayes R, Maccabe J. Correlates of late-onset antipsychotic treatment resistance. Eur Psychiatry 2022. [PMCID: PMC9567017 DOI: 10.1192/j.eurpsy.2022.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS. Objectives This study aims to investigate socio-demographic and clinical correlates of late-onset of TRS. Methods Using data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics. Results We observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS. Conclusions Our findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance. Disclosure DFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp
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Sun Myint A, Rao C, Dhadda AS, Wong H, Hershman M, Sripadam R, Pritchard M. Improved organ preservation with dose escalation using contact X-ray brachytherapy for good responders following external beam chemoradiotherapy: Long-term outcomes from a single institution. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
131 Background: We previously reported the benefit of Contact X-ray Brachytherapy boost (CXB) in achieving a higher clinical complete response (cCR) following partial response to external beam chemoradiotherapy (EBCRT). We now update our report on the organ preservation rate and long-term durability of the cCR in this cohort. Methods: Outcome data for rectal cancer patients referred to our institution from 2003 to 2012 were retrieved from an institutional database after an audit approval. These patients were referred after initial local multidisciplinary team discussion. All patients had EBCRT 45Gy/25/5 weeks with capecitabine 825mg/m2 (Mon-Fri). Those who respond well but has a small residual tumour were offered CXB boost of 90Gy in 3 fractions over 4-6 weeks as they were not suitable or unwilling to undergo completion surgery. Following treatment, patients had close 3 monthly follow-ups with DRE, endoscopy, and MRI in the first 2 years, then 6 monthly up to 5 years. Results: Of 345 consecutive patients with rectal cancer referred to us, 83 patients who responded well to EBCRT but with small suspicious residual disease (≤3 cm) were offered CXB boost. Median age was 72 years (range 36–87) and 58 (69.9%) were males. Initial MRI tumor stages were cT2 (n = 28), cT3 (n = 55) and 54.2% were node positive. The median follow up of surviving patients was 6.4 years (range 2-11 years). cCR was achieved after CXB boost in 53/83 (64%). After achieving cCR, 8/53 (15%) developed local regrowth. However, all patients successfully underwent curative surgery with R(0) resection rate of 24/30 (80%) and only 21/83 (25%) had stoma. Organ preservation was achieved in 62/83 (75%). 12/53 (14%) patients developed metastatic disease. At the end of the study period, 64/83(77%) were cancer free. Conclusions: Our long-term data suggests dose escalation with CXB boost following EBCRT can achieved high organ preservation rate with excellent long-term durable cCR. This approach can provide an alternative treatment option for elderly or comorbid patient patients who are not suitable for surgery. This can also be an option for some patients who wish to avoid surgery upfront after initial diagnosis. Those who needed surgery later for treatment failure can be salvage successfully. A phase 3 European randomised trial OPERA (Organ Preservation in Early Rectal Adenocarcinoma) was set up to evaluate this concept further.
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Affiliation(s)
| | - Christopher Rao
- North Cumbria University Hospitals NHS Trust, Carlisle, United Kingdom
| | | | - Helen Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Hall MD, Baruch J, Carson G, Citarella BW, Dagens A, Dankwa EA, Donnelly CA, Dunning J, Escher M, Kartsonaki C, Merson L, Pritchard M, Wei J, Horby PW, Rojek A, Olliaro PL. Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: An observational cohort. eLife 2021; 10:e70970. [PMID: 34812731 PMCID: PMC8791638 DOI: 10.7554/elife.70970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high dependency unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics. Methods We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay. Results Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors. Conclusions Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly evolving situation. Funding This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Affiliation(s)
- Matthew D Hall
- Big Data Institute, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Joaquín Baruch
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Barbara Wanjiru Citarella
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Andrew Dagens
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | | | - Christl A Donnelly
- Department of Statistics, University of OxfordOxfordUnited Kingdom
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics and Department of Infectious Disease Epidemiology, Imperial College LondonLondonUnited Kingdom
| | - Jake Dunning
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Martina Escher
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Laura Merson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
| | - Mark Pritchard
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Jia Wei
- Big Data Institute, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Peter W Horby
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Amanda Rojek
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Royal Melbourne Hospital, Melbourne, Australia Centre for Integrated Critical Care, University of MelbourneMelbourneAustralia
| | - Piero L Olliaro
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
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Patel R, Irving J, Brinn A, Broadbent M, Shetty H, Pritchard M, Downs J, Stewart R, Harland R. Insights from electronic health record data to improve mental health service delivery during the COVID-19 pandemic. Eur Psychiatry 2021. [PMCID: PMC9471467 DOI: 10.1192/j.eurpsy.2021.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BackgroundRemote consultation technology has been rapidly adopted due to the COVID-19 pandemic. However, some healthcare settings have faced barriers in implementation. We present a study to investigate changes in rates of remote consultation during the pandemic using a large electronic health record (EHR) dataset.MethodsThe Clinical Record Interactive Search tool (CRIS) was used to examine de-identified EHR data of people receiving mental healthcare in South London, UK. Data from around 37,500 patients were analysed for each week from 7th January 2019 and 20th September 2020 using linear regression and locally estimated scatterplot smoothing (LOESS) to investigate changes in the number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals and prescribing of antipsychotics and mood stabilisers. The data are presented in an interactive dashboard: http://rpatel.co.uk/TelepsychiatryDashboard.ResultsThe frequency of in-person contacts was substantially reduced following the onset of the pandemic (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts increased significantly (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite the increase in remote contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in prescribing. Further work is needed to support older patients in accessing remote mental healthcare.DisclosureAll authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and H
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Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, Seth S, Egan C, Hardwick HE, Halpin S, Girvan M, Donohue C, Pritchard M, Patel LB, Ladhani S, Sigfrid L, Sinha IP, Olliaro PL, Nguyen-Van-Tam JS, Horby PW, Merson L, Carson G, Dunning J, Openshaw PJM, Baillie JK, Harrison EM, Docherty AB, Semple MG. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 2020; 370:m3249. [PMID: 32960186 PMCID: PMC7488201 DOI: 10.1136/bmj.m3249] [Citation(s) in RCA: 385] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). DESIGN Prospective observational cohort study with rapid data gathering and near real time analysis. SETTING 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). PARTICIPANTS 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. MAIN OUTCOME MEASURES Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. RESULTS Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. CONCLUSIONS Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). STUDY REGISTRATION ISRCTN66726260.
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Affiliation(s)
- Olivia V Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK
| | - Karl A Holden
- Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Lance Turtle
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Infectious diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Louisa Pollock
- Paediatric Infectious Diseases, Royal Hospital for Children, Glasgow, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK
| | - Conor Egan
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK
| | - Hayley E Hardwick
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sophie Halpin
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Mark Pritchard
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Latifa B Patel
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, UK
- Paediatric Infectious Disease, St George's Hospital, London, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ian P Sinha
- Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Piero L Olliaro
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
- United Kingdom Department of Health and Social Care, London, UK
| | - Peter W Horby
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Merson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jake Dunning
- National Infection Service, Public Health England, [A: Where?]
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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9
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Morton S, Chan O, Price J, Pritchard M, Crisp T, Perry J, Morrissey D. High volume image-guided injections and structured rehabilitation improve greater trochanter pain syndrome in the short and medium term: a combined retrospective and prospective case series. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2015.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Morton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK
| | - O. Chan
- Department of Orthopedic Surgery, University of Basel, Switzerland
| | - J. Price
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK
| | | | - T. Crisp
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK
- BMI London Independent Hospital, UK
| | - J.D. Perry
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK
- BMI London Independent Hospital, UK
| | - D. Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK
- BMI London Independent Hospital, UK
- Physiotherapy Department, Bart’s Health NHS Trust, London, UK
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10
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Morton S, Chan O, Webborn N, Pritchard M, Morrissey D. Tears of the fascia cruris demonstrate characteristic sonographic features: a case series analysis. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2015.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Morton
- Centre for Sports and Exercise Medicine, Queen Mary University of London, UK
| | - O. Chan
- BMI London Independent Hospital, London, UK
| | - N. Webborn
- Centre for Sports and Exercise Science and Medicine, University of Brighton, Eastbourne, UK
| | | | - D. Morrissey
- Centre for Sports and Exercise Medicine William Harvey Research Institute Queen Mary University of London, UK; BMI London Independent Hospital, London, UK
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11
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Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, Padhiar N, Perry J, King J, Morrissey D. Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2017.11] [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: 11/05/2022]
Affiliation(s)
- O. Chan
- BMI London Independent Hospital, Stepney Green, London, UK
| | - B. Havard
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - S. Morton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - M. Pritchard
- BMI London Independent Hospital, Stepney Green, London, UK
| | - N. Maffulli
- BMI London Independent Hospital, Stepney Green, London, UK
| | - T. Crisp
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- BMI London Independent Hospital, Stepney Green, London, UK
| | - N. Padhiar
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- BMI London Independent Hospital, Stepney Green, London, UK
| | - J.D. Perry
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- BMI London Independent Hospital, Stepney Green, London, UK
| | - J. King
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- BMI London Independent Hospital, Stepney Green, London, UK
| | - D. Morrissey
- BMI London Independent Hospital, Stepney Green, London, UK
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- Bart’s Health NHS Trust, London, UK
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12
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Chan O, Morton S, Pritchard M, Parkes T, Malliaras P, Crisp T, Padhiar N, Maffulli N, King J, Morrissey D. Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2017.08] [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: 11/05/2022]
Affiliation(s)
- O. Chan
- BMI London Independent Hospital, London, UK
| | - S. Morton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | | | - T. Parkes
- BMI London Independent Hospital, London, UK
| | - P. Malliaras
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - T. Crisp
- BMI London Independent Hospital, London, UK>
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- Bart’s Health NHS Trust, London, UK
| | - N. Padhiar
- BMI London Independent Hospital, London, UK>
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - N. Maffulli
- BMI London Independent Hospital, London, UK>
| | - J. King
- BMI London Independent Hospital, London, UK>
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
- Bart’s Health NHS Trust, London, UK
| | - D. Morrissey
- BMI London Independent Hospital, London, UK>
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
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13
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Kravariti E, Reeve-Mates C, Da Gama Pires R, Tsakanikos E, Hayes D, Renshaw S, McAllister S, Bhavsar V, Patterson P, Daley E, Stewart J, Pritchard M, Shetty H, Ramsay R, Perez-Iglesias R, McGuire P. Effectiveness of automated appointment reminders in Psychosis Community Services: A randomised controlled trial - CORRIGENDUM. BJPsych Open 2018; 4:419. [PMID: 30295223 PMCID: PMC6235977 DOI: 10.1192/bjo.2018.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Main C, Dandapani M, Pritchard M, Dodds R, Stevens SP, Thorp N, Taylor RE, Wheatley K, Pizer B, Morrall M, Phillips R, English M, Kearns PR, Wilne S, Wilson JS. The effectiveness and safety of proton beam radiation therapy in children with malignant central nervous system (CNS) tumours: protocol for a systematic review. Syst Rev 2016; 5:124. [PMID: 27460473 PMCID: PMC4962509 DOI: 10.1186/s13643-016-0285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to use a systematic review framework to identify and synthesise the evidence on the use of proton beam therapy (PBT) for the treatment of children with CNS tumours and where possible compare this to the use of photon radiotherapy (RT). METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Twelve electronic databases have been searched, and further citation, hand searching and reference checking will be employed. Studies assessing the effects of PBT used either alone or as part of a multimodality treatment regimen in children with CNS tumours will be included. Relevant economic evaluations will also be identified. The outcomes are survival (overall, progression-free, event-free, disease-free), local and regional control rates, short- and long-term adverse events, functional status measures and quality of survival. Two reviewers will independently screen and select studies for inclusion in the review. All interventional study designs will be eligible for inclusion in the review. However, initial scoping searches indicate the evidence base is likely to be limited to case series studies, with no studies of a higher quality being identified. Quality assessment will be undertaken using pre-specified criteria and tailored to study design if applicable. Studies will be combined using a narrative synthesis, with differences in results between studies highlighted and discussed in relation to the patient population, intervention and study quality. Where appropriate, if no studies of a comparative design are identified, outcomes will be compared against a range of estimates from the literature for similar populations and treatment regimens from the best available evidence from studies that include the use of advanced conventional photon therapy. DISCUSSION The evidence base for the use of PBT in children with CNS tumours is likely to be relatively sparse, highly heterogeneous and potentially of a low quality with small sample sizes. Furthermore, selection and publication biases may limit the internal and external validity of studies. However, any tentative results from the review on potential treatment effects can be used to plan better quality research studies that are of a design appropriate for outcome comparison with conventional therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029583.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | | | | | | | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Robert Phillips
- Leeds General Infirmary, Leeds, UK
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
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15
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Finnamore H, Pritchard M, Abdul Kadhir O, Mayer J, Bannon J, Burhan H. M27 Should there be a Respiratory-specific Modified Early Warning Score?: Abstract M27 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.437] [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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16
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Kemp J, Schache A, Makdissi M, Sims K, Pritchard M, Crossley K. Physical impairments are greater following hip arthroscopy in people with chondropathy compared to people without chondropathy or controls. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.332] [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: 10/27/2022]
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17
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Kemp J, Schache A, Makdissi M, Sims K, Pritchard M, Crossley K. DJO Global Sponsored Session. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.587] [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: 10/27/2022]
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18
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Powell L, Pritchard M, Doull I, Hill K, Onsøyen E, Myrvold R, Wright C, Thomas D. 54 Effects of the alginate oligosaccharide OligoG on the surface properties of Gram-negative bacterial biofilms using atomic force microscopy. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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20
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Krouse RZ, Ransdell LB, Lucas S, Pritchard M. Examining Motivation, Goal Orientation, Coaching, and Training Habits of Female Ultrarunners. J Strength Cond Res 2011. [DOI: 10.1097/01.jsc.0000395661.67282.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Velayudhan L, Pritchard M, Lovestone S. Smell identification test as a progression marker in Alzheimer's disease. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionFactors influencing or predicting progression in Alzheimer's disease (AD) is not well understood. Olfactory dysfunction, impaired smell identification in particular, is known to occur in AD. Mesial temporal lobe, important for memory function is also critical for the processing of olfactory information. In view of the common anatomical substrate, we hypothesized that olfaction dysfunction worsens faster in people with AD with rapid cognitive decline compared to those with slower cognitive decline.AimsTo test whether smell identification test can be used as a predictor for illness progression in AD patients.MethodsForty one participants with late onset mild to moderate AD were recruited from mental health services for older adults. Subjects were classified as ‘Rapid Progressors’ defined on ‘a-priori’ with a loss of 2 or more points in Mini-Mental State Examination (MMSE) within six months. Assessments included MMSE, Neuropsychiatric Inventory, Bristol Activities of Daily Living, and the University of Pennsylvania Smell Identification Test (UPSIT), at baseline and after 3 months.ResultsTwenty subjects were ‘Rapid Progressors’, and had lower UPSIT scores compared to ‘Non-Rapid Progressors’ both at the baseline (p = 0.02) and at follow up after 3 months (p = 0.05). Baseline UPSIT correlated with follow up UPSIT (r = 0.5, p < 0.01) and MMSE (r = 0.4, p = 0.04). Also it was the baseline UPSIT score that best predicted (p < 0.05) the follow up smell and cognitive function on linear regression analysis.ConclusionsSmell identification function could be useful as a clinical measure to assess and predict progression in AD.
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22
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Shimizu C, Tamura K, Koizumi F, Komori O, Pritchard M, Mollah MH, Eguchi S, Fujiwara Y. Prediction of the benefit of trastuzumab (T)-based therapy by the change of gene expression of peripheral blood mononuclear cells (PBMC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14578 Background: Identification of molecular predictors of response is important in the aspect of personalization of treatment, especially in the era of molecular targeted drugs. Antibody-dependent cell-mediated cytotoxicity (ADCC) is suggested as one of the main mechanism of action of T. Moreover, PBMC specimens can securely be obtained with minimal invasion. We therefore hypothesized that gene expression changes induced by T of PBMC may be useful for prediction of response of T. Methods: 36 HER2-positive metastatic breast cancer (BC) patients were enrolled in this prospective biomarker study. The patients were treated with single-agent T (q1w) for chemotherapy-naïve, hormone refractory metastatic disease. The clinical response was measured after 8 cycles of single-agent T. PBMC were collected prior to and 1-week after the first administration of T. Gene expressions of PBMC were measured using Affimetrix GeneChip Human Genome U133 Plus 2.0 array. Change of gene expressions before and after T was correlated with clinical response using Wilcoxon rank sum test. A multi-gene predictor of response to T was generated using the highly ranked genes. The performance of the predictor was then assessed in patients prospectively treated with neoadjuvant chemotherapy (NAC): HER2- positive BC patients recieved NAC containing T. PBMC were collected prior to NAC and 1-week after the first administration of T. Results: 34 patients were evaluable for clinical outcome. 15 and 19 patients were classified as responders and non- responders, respectively. The top 4 genes differentially regulated by T between responders and non-responders were selected for development of a predictor by leave-one-out cross validation. The 4-gene predictor correctly predicted the pathological complete response (pCR) in 5 out of 5 patients who achieved pCR and residual disease (RD) in 10 out of 12 patients with RD (error rate 12 %) in HER2-positive breast BC patients treated with NAC containing T. However, it was not associated with pathological response in 19 HER2- negative patients treated with NAC without T (error rate 39 %). Conclusions: Change in PBMC gene expression after single dosage of T may be useful as a predictor of response to T-based therapy. No significant financial relationships to disclose.
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Affiliation(s)
- C. Shimizu
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - K. Tamura
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - F. Koizumi
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - O. Komori
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - M. Pritchard
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - M. H. Mollah
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - S. Eguchi
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
| | - Y. Fujiwara
- National Cancer Center, Chuo-ku Tokyo, Japan; Institute of Statistical Mathematics, Minato-ku, Tokyo, Japan
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Latham SE, Cramer R, Grant M, Kershaw P, Lawrence BN, Lowry R, Lowe D, O'Neill K, Miller P, Pascoe S, Pritchard M, Snaith H, Woolf A. The NERC DataGrid services. Philos Trans A Math Phys Eng Sci 2009; 367:1015-1019. [PMID: 19087931 DOI: 10.1098/rsta.2008.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This short paper outlines the key components of the NERC DataGrid: a discovery service, a vocabulary service and a software stack deployed both centrally to provide a data discovery portal, and at data providers to provide local portals and data and metadata services.
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Affiliation(s)
- S E Latham
- STFC Rutherford Appleton Laboratory, Didcot OX11 0QX, UK
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Abstract
Although religion is thought to be a positive aspect of life, sometimes that is not always the case. One potentially negative effect of religion is the way people learn to perceive their bodies. Although many studies have examined factors that influence disordered eating (e.g., gender, self-esteem), few studies have examined the relationships among disordered eating and religious affiliation and religious angst. In the present study of 330 undergraduates, we found that Catholics and Christians displayed significantly more disordered eating than did other students. In addition, individuals scoring high on religious angst also reported more disordered eating behaviors than did other students. Implications for counseling will be discussed.
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Affiliation(s)
- K Gates
- Department of Psychology, Boise State University, Boise, Idaho 83725-1715, USA
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25
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Abstract
Although once considered a 'female' disorder, eating disorders are becoming more prevalent in males. As such, researchers are beginning to focus on factors that predict eating disturbances in males. Previous research has established a relation between eating disorders and stress and exercise dependence. However, few studies have examined the relation between the more common diagnosis of disordered eating and stress and exercise dependence, particularly in men. The purpose of the present study was to investigate the relation between disordered eating, stress, and exercise dependence in undergraduate male students. Implications for counseling men suffering from disordered eating will be discussed.
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Affiliation(s)
- N Spann
- Department of Psychology, Boise State University, Boise, Idaho 83725-1715, USA.
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26
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Pritchard M, Reeves RH, Dierssen M, Patterson D, Gardiner KJ. Down syndrome and the genes of human chromosome 21: current knowledge and future potentials. Report on the Expert workshop on the biology of chromosome 21 genes: towards gene-phenotype correlations in Down syndrome. Washington D.C., September 28-October 1, 2007. Cytogenet Genome Res 2008; 121:67-77. [PMID: 18544929 DOI: 10.1159/000124384] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2007] [Indexed: 11/19/2022] Open
Abstract
Down syndrome (DS), trisomy of human chromosome 21, is the most common genetic cause of intellectual disability. With an incidence in some countries as high as one in approximately 700 live births, and a complex, extensive and variably severe phenotype, Down syndrome is a significant medical and social challenge. In recent years, there has been a rapid increase in information on the functions of the genes of human chromosome 21, as well as in techniques and resources for their analysis. A recent workshop brought together experts on the molecular biology of Down syndrome and chromosome 21 with interested researchers in other fields to discuss advances and potentials for generating gene-phenotype correlations. An additional goal of the workshop was to work towards identification of targets for therapeutics that will correct features of DS. A knowledge-based approach to therapeutics also requires the correlation of chromosome 21 gene function with phenotypic features.
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27
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Sullivan SD, Wenzel SE, Bresnahan BW, Zheng B, Lee JH, Pritchard M, Kamath TV, Weiss ST. Association of control and risk of severe asthma-related events in severe or difficult-to-treat asthma patients. Allergy 2007; 62:655-60. [PMID: 17508970 DOI: 10.1111/j.1398-9995.2007.01383.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical tools for predicting poor outcomes in asthma patients are lacking. This study investigated the association of asthma control and subsequent severe asthma-related healthcare events in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. METHODS The extent of asthma control problems was determined from baseline values of the Asthma Therapy Assessment Questionnaire (ATAQ). Patients self-reported the presence of severe asthma-related events at 6- and 12-month follow up. Poisson regression models determined the adjusted association between baseline control and the likelihood of severe asthma-related events. RESULTS At baseline, 2942 patients (mean age, 49.6 years; female, 71.9%) had an ATAQ score (no control problems, 17.0%; 1 control problem, 20.0%; 2 control problems, 30.8%; 3 or 4 control problems, 32.2%) and at least one severe asthma-related event. After adjustment, subjects with three or four control problems were at greater risk for unscheduled office visits [relative risk (RR) = 2.8; 95% confidence interval (CI): 2.4-3.2], course of oral steroids (RR = 2.9; 95% CI: 2.5-3.3), emergency room visits (RR = 4.1; 95% CI: 2.7-6.2) or hospitalization (RR = 13.6; 95% CI: 7.4-24.9), vs no control problems. Progressively poorer levels of asthma control are associated with increasing risk of severe asthma-related events. CONCLUSIONS This study provides evidence of an association between poor asthma control and future severe asthma-related healthcare events. A validated questionnaire may help clinicians identify patients requiring intervention to prevent future severe asthma-related events.
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Affiliation(s)
- S D Sullivan
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Abstract
The goal of this study was to examine gender differences in the prevalence of disordered eating and body dissatisfaction as well as examine gender differences in several risk factors: mass media, self-esteem and perfectionism. Three hundred fifty-three undergraduates completed surveys about their body dissatisfaction, disordered eating habits, exposure to and influence of mass media, self-esteem and perfectionistic tendencies. As expected, women experienced more symptoms of disordered eating as well as body dissatisfaction than did their male counterparts. There were also gender differences in the risk factors. For women, mass media, self-esteem, and perfectionism related to disordered eating behaviors, whereas for men, only perfectionism and mass media related to disordered eating behaviors. For women, mass media and self-esteem related to body image dissatisfaction, whereas for men, mass media and perfectionism related to body image dissatisfaction. The results of the present study indicate that risk factors for disordered eating and body dissatisfaction for men and women may be different, which has implications for understanding the etiology of body dissatisfaction and disordered eating and for possible treatment interventions.
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Affiliation(s)
- J Elgin
- Boise State University, Boise, ID, USA
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De Villiers RV, Pritchard M, De Beer J, Koenig J. Scapular stress fracture in a professional cricketer and a review of the literature. S Afr Med J 2005; 95:312-7. [PMID: 15931442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- R V De Villiers
- Van Wageningen and Partners in Somerset West and Stellenbosch Mediclinics, South Africa.
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Brown HM, Pritchard M, Russell DL. 225. Early ovarian follicle dysgenesis in a disintegrin and metalloproteinase with thrombospondin motifs type 1 (ADAMTS-1) null mice. Reprod Fertil Dev 2005. [DOI: 10.1071/srb05abs225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ADAMTS-1 is a multi-domain, multi-functional matrix metalloproteinase expressed in the mouse ovary during folliculogenesis and ovulation. Adult ADAMTS-1 null female mice are infertile; however, the exact mechanism responsible for their reproductive failure is yet to be explained.
ADAMTS-1 null ovaries prior to and following ovulation were examined and a defect in ovarian follicle development was identified. A classification system was devised and used to identify morphological differences between normal and ADAMTS-1 null ovaries. The phenotype indicated a progressive loss of follicle structural integrity ranging from a slight loss of shape, to full structural dysgenesis. As a result, large numbers of oocytes with healthy appearance were found with no surrounding follicle structure. The numbers of preantral follicles was not altered, but type 6 (early antral) follicles in the ADAMTS-1 null ovaries were significantly reduced (P < 0.05) when compared to wild-type ovaries suggesting initiation of follicular degeneration coincident with antrum formation. There was also a significant decrease (P < 0.05) in the number of periovulatory follicles (type 7 and 8) in the ADAMTS-1 null ovaries. This suggests that late folliculogenesis, in the period of rapid growth and expansion is disrupted when ADAMTS-1 is not present and results in fewer follicles available for ovulation. Further, we have demonstrated that the active form of ADAMTS-1 is present in the thecal-granulosa boundary of the ovarian follicle suggesting a role in extracellular matrix remodeling at this boundary during follicle growth. Analyses of the basement membrane at this boundary both in growing and ovulating follicles indicate that ECM remodeling in this region is indeed disrupted.
These data demonstrate that remodeling of surrounding structural matrix is crucial to follicle growth and structural integrity. Functional ADAMTS-1 is important for matrix remodeling during the growth of the follicle, particularly during antrum formation.
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Gardiner K, Davisson MT, Pritchard M, Patterson D, Groner Y, Crnic LS, Antonarakis S, Mobley W. Report on the ‘Expert Workshop on the Biology of Chromosome 21: towards gene-phenotype correlations in Down syndrome’, held June 11–14, 2004, Washington D.C. Cytogenet Genome Res 2004; 108:269-77. [PMID: 15627744 DOI: 10.1159/000081518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- K Gardiner
- Eleanor Roosevelt Institute at the University of Denver, Denver, CO 80206, USA.
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33
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Cochlin DL, Evans C, Gadahadh R, Pritchard M. Imaging in prostate cancer--a reply. Clin Radiol 2003; 59:111. [PMID: 14697386 DOI: 10.1016/s0009-9260(03)00333-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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de Haan JB, Susil B, Pritchard M, Kola I. An altered antioxidant balance occurs in Down syndrome fetal organs: Implications for the “gene dosage effect” hypothesis. ACTA ACUST UNITED AC 2003:67-83. [PMID: 15068240 DOI: 10.1007/978-3-7091-6721-2_6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Down syndrome (DS) is the congenital birth defect responsible for the greatest number of individuals with mental retardation. It arises due to trisomy of human chromosome 21 (HSA21) or part thereof. To date there have been limited studies of HSA21 gene expression in trisomy 21 conceptuses. In this study we investigate the expression of the HSA21 antioxidant gene, Cu/Zn-superoxide dismutase-1 (SOD1) in various organs of control and DS aborted conceptuses. We show that SOD1 mRNA levels are elevated in DS brain, lung, heart and thymus. DS livers show decreased SOD1 mRNA expression compared with controls. Since non-HSA21 antioxidant genes are reported to be concomitantly upregulated in certain DS tissues, we examined the expression of glutathione peroxidase-1 (GPX1) in control and DS fetal organs. Interestingly, GPX1 expression was unchanged in the majority of DS organs and decreased in DS livers. We examined the SOD1 to GPX1 mRNA ratio in individual organs, as both enzymes form part of the body's defense against oxidative stress, and because a disproportionate increase of SOD1 to GPX1 results in noxious hydroxyl radical damage. All organs investigated show an approximately 2-fold increase in the SOD1 to GPX1 mRNA ratio. We propose that it is the altered antioxidant ratio that contributes to certain aspects of the DS phenotype.
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Affiliation(s)
- J B de Haan
- Monash Institute of Reproduction and Development, Centre for Functional Genomics and Human Disease, Monash University, Clayton, Victoria, Australia.
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35
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36
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Webster J, Pritchard M. Postnatal depression and health care use. Aust Fam Physician 2001; 30:1024. [PMID: 11759449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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37
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Razzouk BI, Raimondi SC, Srivastava DK, Pritchard M, Behm FG, Tong X, Sandlund JT, Rubnitz JE, Pui CH, Ribeiro RC. Impact of treatment on the outcome of acute myeloid leukemia with inversion 16: a single institution's experience. Leukemia 2001; 15:1326-30. [PMID: 11516092 DOI: 10.1038/sj.leu.2402215] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To identify treatment factors that may affect the survival of children with inv(16)(p13.1q22), we compared the outcomes of 19 patients with this genetic feature treated at our institution during two treatment eras. Nine patients were treated during era 1 (1980 to 1987), and 10 were treated during era 2 (1988 to 1996). All entered complete remission (CR) with induction therapy. Eight of the nine children treated in era 1 died, seven of relapsed leukemia. In contrast, three of 10 patients treated during era 2 have died, all of non-disease-related causes. Event-free survival (EFS) estimates were significantly higher for patients treated during era 2 than for those treated during era 1 (P = 0.03); the 6-year estimates were 70 +/- 15% (s.e.) and 11 +/- 7%, respectively. Era 2 treatment protocols differed from those of era 1 in their use of higher doses of cytarabine and etoposide during induction and consolidation chemotherapy and in their use of 2-chlorodeoxyadenosine (2-CDA). These results suggest that dose intensification of cytarabine benefits children with AML and inv(16), as is the case in adults. They also suggest that dose intensification of etoposide and addition of 2-CDA may also offer an advantage. This study underscores the dependence of the prognostic impact of cytogenetic features on the efficacy of treatment.
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MESH Headings
- Acute Disease
- Adolescent
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Child
- Child, Preschool
- Chromosome Inversion
- Chromosomes, Human, Pair 16
- Cladribine/therapeutic use
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Cytarabine/therapeutic use
- Drug Therapy, Combination
- Etoposide/administration & dosage
- Etoposide/therapeutic use
- Female
- Humans
- Infant
- Leukemia, Megakaryoblastic, Acute/genetics
- Leukemia, Megakaryoblastic, Acute/therapy
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/therapy
- Male
- Prognosis
- Treatment Outcome
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Affiliation(s)
- B I Razzouk
- Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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Abstract
This review describes the evolution of pediatric oncology nursing research over the past 25 years. It highlights practice-changing contributions from single-site studies and from multisite trials and discusses strategies for interdisciplinary collaboration. Technological advances that will alter the way in which studies are conducted and findings are disseminated will influence the future of nursing research. Studies implemented by pediatric nurse researchers will continue to influence practice and change how we, and others, view the experience of childhood cancer.
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Affiliation(s)
- S M Schneider
- Graduate Oncology Nursing Program, Duke University School of Nursing, Durham, NC 27710, USA
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39
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Hickman J, Potten C, Pritchard M, Jackman A, Meyer-Losic F. Apoptosis in the normal and malignant colon. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Endotracheal suctioning for mechanically ventilated infants is routine practice in neonatal intensive care. However, this practice is associated with serious complications including lobar collapse, pneumothorax, bradycardia and hypoxemia. Increasing the inspired oxygen immediately prior to suction (preoxygenation) has been proposed as an intervention to minimise the risk of complications. OBJECTIVES To compare the effects of preoxygenation with no preoxygenation for endotracheal suctioning on ventilated newborn infants. To conduct sub group analyses by i) different populations of newborn infants; by gestational age <30 weeks, <34 weeks and <37 weeks and by disease; infants with chronic lung disease compared to those without and; ii) by different techniques of endotracheal suctioning; with or without disconnection from the ventilator, increased mechanical ventilation, use of manual ventilation and chest wall vibrations or percussion. SEARCH STRATEGY The standard search strategy of the Neonatal Review Group was used. This included searches of electronic databases; Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (Cochrane Library Issue 1 2001); MEDLINE (1966 - April 2001); and CINAHL (1982-2001) using MeSH term infant-newborn and text terms oxygen* and suction*, preoxygenation, pre-oxygenation and premature and also previous reviews including cross references, abstracts in conferences and symposia proceedings, expert informants, journal hand searching in the English language. SELECTION CRITERIA Random or quasi random controlled trials of mechanically ventilated neonates in which endotracheal suctioning with preoxygenation was compared to suctioning without preoxygenation. DATA COLLECTION AND ANALYSIS Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by the authors. Data were analysed using relative risk (RR) for dichotomous outcomes and mean difference (MD) for data measured on a continuous scale with the use of 95% confidence intervals. Meta-analysis was conducted using a fixed effects model. MAIN RESULTS One cross-over trial involving outcomes for 16 preterm neonates was included in this review. Preoxygenation, prior to an endotracheal suctioning procedure involving two suctions, resulted in a statistically significant reduction in infants with hypoxemia (TcPO2 <40 mmHg) at the end of the first suction (RR 0.18, 95% CI 0.05, 0.69), at the end of the second suction (RR 0.23, 95% CI 0.08, 0.66) and also at 120 seconds after the second suction (RR 0.10, 95% CI 0.01, 0.69). Mean TcPO2 was statistically significantly higher in the preoxygenation group at the end of the first suction (MD 25.00 mmHg, 95%CI 14.20, 35.80), second suction (MD 24.80, 95% CI 14.80, 34.80) and also at 120 seconds after the second suction (MD 29.10, 95% CI 14.96, 43.24). The time taken to return to baseline oxygenation status was shorter than the group not receiving preoxygenation (MD -2.12 minutes, 95% CI -3.82, -0.42). REVIEWER'S CONCLUSIONS No recommendations for practice can be confidently made from the results of this review. Although preoxygenation was shown to decrease hypoxemia at the time of suctioning, other clinically important short and longer-term outcomes including adverse effects were unable to be assessed. Further studies are needed to adequately assess the effects of this widely practiced procedure.
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Affiliation(s)
- M Pritchard
- Perinatal Research Centre, Royal Women's Hospital, Bowen Bridge road, Herston, Brisbane, Australia, 4029.
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41
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Nadal M, Vigo CG, Melaragno MI, Andrade JA, Alonso LG, Brunoni D, Pritchard M, Estivill X. Clinical and cytogenetic characterisation of a patient with Down syndrome resulting from a 21q22.1-->qter duplication. J Med Genet 2001; 38:73-6. [PMID: 11334012 PMCID: PMC1734728 DOI: 10.1136/jmg.38.1.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Chrast R, Scott HS, Papasavvas MP, Rossier C, Antonarakis ES, Barras C, Davisson MT, Schmidt C, Estivill X, Dierssen M, Pritchard M, Antonarakis SE. The mouse brain transcriptome by SAGE: differences in gene expression between P30 brains of the partial trisomy 16 mouse model of Down syndrome (Ts65Dn) and normals. Genome Res 2000; 10:2006-21. [PMID: 11116095 PMCID: PMC313062 DOI: 10.1101/gr.10.12.2006] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2000] [Accepted: 10/03/2000] [Indexed: 11/24/2022]
Abstract
Trisomy 21, or Down syndrome (DS), is the most common genetic cause of mental retardation. Changes in the neuropathology, neurochemistry, neurophysiology, and neuropharmacology of DS patients' brains indicate that there is probably abnormal development and maintenance of central nervous system structure and function. The segmental trisomy mouse (Ts65Dn) is a model of DS that shows analogous neurobehavioral defects. We have studied the global gene expression profiles of normal and Ts65Dn male and normal female mice brains (P30) using the serial analysis of gene expression (SAGE) technique. From the combined sample we collected a total of 152,791 RNA tags and observed 45,856 unique tags in the mouse brain transcriptome. There are 14 ribosomal protein genes (nine under expressed) among the 330 statistically significant differences between normal male and Ts65Dn male brains, which possibly implies abnormal ribosomal biogenesis in the development and maintenance of DS phenotypes. This study contributes to the establishment of a mouse brain transcriptome and provides the first overall analysis of the differences in gene expression in aneuploid versus normal mammalian brain cells.
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Affiliation(s)
- R Chrast
- Division of Medical Genetics, Geneva University Medical School and University Hospital, Geneva, Switzerland
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43
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Abstract
The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%) scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p < or = 0.001). Low social support (p < or = 0.001), a personal history of mood disorder (p < or = 0.001) and a past history of postnatal depression ( p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.
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Affiliation(s)
- J Webster
- Women's Health Research Centre, Royal Women's Hospital, Queensland, Australia
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Abstract
BACKGROUND/PURPOSE To better characterize childhood carcinoid tumors, the authors reviewed the clinical presentation, treatment, and outcomes of pediatric patients with these rare tumors. METHODS A retrospective review was conducted of medical records and pathologic materials of all children with carcinoid tumors treated at St Jude Children's Research Hospital between December 1977 and March 1999. RESULTS Eight patients (median age, 12.7 years) were identified; 2 were boys, and 7 were white. Primary tumor sites were the appendix (n = 5), small intestine (n = 1), bronchus (n = 1), and 1 unknown site. In 7 cases, carcinoid tumor was not suspected at the time the tumor was identified. Seven patients had localized disease; 5 remain disease-free after complete resection, and 2, whose carcinoid tumors were identified incidentally, died of metastatic mucinous adenocarcinoma of the colon. One patient who presented with symptoms of carcinoid syndrome had metastatic disease that responded poorly to cytotoxic chemotherapy and remains alive with active disease. CONCLUSIONS Although most pediatric carcinoid tumors arise in the appendix, these tumors also occur in other primary sites. Clinical awareness and early diagnosis are important factors in preventing morbidity and mortality. Outcomes are excellent for patients with localized disease that is completely resected, but those with metastatic disease fare poorly. New therapeutic strategies are needed for these patients.
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Affiliation(s)
- S L Spunt
- Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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45
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Elgar DF, Norris CS, Ayers JS, Pritchard M, Otter DE, Palmano KP. Simultaneous separation and quantitation of the major bovine whey proteins including proteose peptone and caseinomacropeptide by reversed-phase high-performance liquid chromatography on polystyrene-divinylbenzene. J Chromatogr A 2000; 878:183-96. [PMID: 10866065 DOI: 10.1016/s0021-9673(00)00288-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A precise, sensitive and reliable RP-HPLC method was developed to enable not only unequivocal determination of alpha-lactalbumin and beta-lactoglobulin in bovine whey samples, but also simultaneous measurement of proteose peptone, caseinomacropeptide, bovine serum albumin and immunoglobulin G. The optimised method on the Resource RPC column allowed separation of the proteins in 30 min and could be applied to the analysis of soluble proteins in a variety of commercial and laboratory whey products. Furthermore, some qualitative information on protein heterogeneity and quality could be derived from the RP-HPLC analyses with additional data available from on-line electrospray mass spectrometry. Within- and between-day repeatability over a wide range of concentrations was excellent (RSD< or =5%) for all proteins except immunoglobulin G and bovine serum albumin where RSD was 7-10%. Analysis of grouped data from whey protein concentrate and whey protein isolate samples gave a limit of detection of < or =0.3% powder mass and a limit of quantitation of < or =1.0% powder mass for all proteins except immunoglobulin G. Limits of detection and quantitation were 0.6% and 2.0%, respectively, for this protein. Quantitative data obtained by the RP-HPLC method compared very favourably with data obtained by alternative methods of whey protein analysis.
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Affiliation(s)
- D F Elgar
- Institute of Fundamental Sciences, Massey University, Palmerston North, New Zealand
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46
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Nadal M, Valiente A, Domènech A, Pritchard M, Estivill X, Ramos-Arroyo MA. Hereditary neuropathy with liability to pressure palsies: two cases with a reciprocal translocation t(16;17)(q12;11.2) interrupting the PMP22 gene. J Med Genet 2000; 37:396-8. [PMID: 10905899 PMCID: PMC1734578 DOI: 10.1136/jmg.37.5.396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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47
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Fuentes JJ, Dierssen M, Pucharcós C, Fillat C, Casas C, Estivill X, Pritchard M. Application of Alu-splice PCR on chromosome 21: DSCR1 and Intersectin. J Neural Transm Suppl 2000; 57:337-52. [PMID: 10666688 DOI: 10.1007/978-3-7091-6380-1_24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Down syndrome (DS) is a major cause of mental retardation and congenital heart defects, with an overall incidence of one in 700 live births. DS is caused by increases in the amounts of a number of normal gene products, the exact number and identity of which are presently unknown. Elucidating the molecular basis of DS relies on the identification of the gene products whose augmentation by 50% or more causes symptoms of the disease. With the aim of contributing to the transcriptional map of human chromosome 21 and to identify new genes with potential involvement in DS, we developed a technique to isolate expressed sequences called Alu-splice PCR, which is very simple to perform and is independent of gene expression patterns. Putative exons are PCR amplified in genomic DNA by virtue of their proximity to Alu repeats using primers designed from splice-site consensus sequences in combination with specific Alu repeat primers. The Alu repeats, which are repetitive DNA elements found exclusively and at high frequency in the genomes of primates, impart the human specificity to the method. The splice-site consensus sequences were used to direct primers to exon boundaries. Using the Alu-splice technique, we have identified at least three new genes. We trapped an exon of DSCR1 (Down Syndrome Candidate Region 1) and two different exons of a gene called human Intersectin (ITSN). Presently, we are working with another novel trapped exon to identify the corresponding gene. The major advantage of Alu-splice PCR is that the technique can be readily established in any laboratory which has the basic facilities for molecular biology because no specialised materials or expertise is required.
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Affiliation(s)
- J J Fuentes
- Medical and Molecular Genetics Center-IRO, L'Hospitalet de Llobregat, Barcelona, Spain
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Pucharcós C, Fuentes JJ, Casas C, de la Luna S, Alcántara S, Arbonés ML, Soriano E, Estivill X, Pritchard M. Alu-splice cloning of human Intersectin (ITSN), a putative multivalent binding protein expressed in proliferating and differentiating neurons and overexpressed in Down syndrome. Eur J Hum Genet 1999; 7:704-12. [PMID: 10482960 DOI: 10.1038/sj.ejhg.5200356] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
By Alu-splice PCR we have trapped two exons and subsequently identified the full length cDNA of a human gene, Intersectin (ITSN), which maps to chromosome 21q22.1 between markers D21S320 and D21S325. The gene has the potential to code for at least two different protein isoforms by alternative splicing (ITSN-L and ITSN-S). Intersectin exists with a high degree of similarity in flies, frogs and mammals, suggesting a conserved role in higher eukaryotes. Analysis of the expression pattern of human and mouse Intersectin detected mRNAs in all adult and foetal tissues tested, with the longer isoform present in brain. In situ hybridisation studies in the developing mouse brain showed ITSN expression in both proliferating and differentiating neurons. The genomic structure of ITSN was determined using the chromosome 21 sequences deposited in the public databases. The protein contains several known motifs which implicate ITSN in clathrin mediated endocytosis and synaptic vesicle recycling. The expression pattern of Intersectin in mouse brain, its presumed function and its overexpression in brains from Down syndrome patients, suggest that Intersectin may contribute in a gene dosage-dependent manner to some of the abnormalities of Down syndrome.
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Affiliation(s)
- C Pucharcós
- Down Syndrome Research Group, Medical and Molecular Genetics Center, IRO, Hospital Duran i Reynals, Barcelona, Spain
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Affiliation(s)
- I Kola
- Centre for Functional Genomics and Human Disease, Institute of Reproduction and Development, Monash Medical Centre, Clayton, Victoria, Australia.
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Horvath JC, Horak A, Sinkovics JG, Pritchard M, Pendleton S, Horvath E. Cancer vaccines with emphasis on a viral oncolysate melanoma vaccine. Acta Microbiol Immunol Hung 1999; 46:1-20. [PMID: 10331063 DOI: 10.1556/amicr.46.1999.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Biotherapy of malignant diseases has become the fourth treatment modality besides surgery, chemo- and radiotherapy. Whole cell melanoma vaccines with or without BCG and other adjuvants, purified ganglioside and shed antigens, recombinant viruses carrying tumor antigens, dendritic cells pulsed with antigenic peptides etc. are in clinical trials. Efficacious viral oncolysate vaccines induce the host to mount tumor-specific cytotoxic T-cell response and prevention of relapses is supported by clinical trials. The use of "polyvalent" whole cell vaccines vs. purified or genetically engineered single antigen vaccines is justified as i. only very few single tumor antigens are present in all tumors of a given histological type; and ii. antigen modulation occurs in tumors rendering them resistant to immune attack generated by vaccine against a single antigen. Thus polyvalent vaccines immunize against several antigens vs. against a selected antigen.
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Affiliation(s)
- J C Horvath
- St. Joseph's Hospital Cancer Institute, Department of Medical Microbiology and Immunology, Tampa, FL 33607, USA
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