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White EG, Hayes HA, Clark P, Cloran FJ. Subclinical to catastrophic: a range of outcomes in cerebral air embolism. Emerg Radiol 2023; 30:823-827. [PMID: 37953444 DOI: 10.1007/s10140-023-02181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
Cerebral air embolism (CAE) is a rare, yet potentially devastating condition characterized by entrance of air into cerebral vasculature, that is nearly always iatrogenic. While many findings of CAE are subclinical and incidental at computed tomography (CT), there remain cases of catastrophic and fatal embolisms. Increasing physician awareness of prevention, presentation, and treatment for CAE is crucial for reducing morbidity and mortality. In this case series, we highlight this preventable entity by comparing three cases of CAE that showcase a diverse array of presentations, radiologic findings, and clinical outcomes. We will also explore predisposing factors, prognostic predictors, diagnostic considerations, and available treatments.
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Affiliation(s)
- E G White
- Uniformed Services University of Health Sciences, Bethesda, USA.
| | - H A Hayes
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - P Clark
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - F J Cloran
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
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Jagodinsky J, Jin W, Bates A, Clark P, Sriramaneni R, Havighurst T, Chakravarthy I, Nystuen E, Kim K, Sondel P, Morris Z. Intratumoral MPL Induces Th1 Polarization and Augments In Situ Vaccination Generated by Radiation and Checkpoint Blockade. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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Lewiecki EM, Binkley N, Clark P, Kim S, Leslie WD, Morin SN. Core principles for fracture prevention: North American Consensus from the National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico. Osteoporos Int 2020; 31:2073-2076. [PMID: 32676822 DOI: 10.1007/s00198-020-05541-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/07/2020] [Indexed: 01/12/2023]
Abstract
UNLABELLED Core principles for fracture prevention address fundamental concepts for the evaluation and management of patients at risk for fracture. These are intended to form the foundation of clinical practice guidelines and represent a first step toward guideline harmonization. INTRODUCTION The large number of clinical practice guidelines for osteoporosis and discordance of recommendations has led to confusion among clinicians and patients, and likely contributes to the large osteoporosis treatment gap. We propose that stakeholder organizations reach agreement on fundamental principles in the management of osteoporosis and prevention of fracture as a first step toward a goal of guideline harmonization. METHODS The best available evidence, as interpreted by an ad hoc working group of expert representatives from major osteoporosis societies in North America, was considered in the development of core principles for skeletal healthcare. These principles were subsequently endorsed by the USA National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico (National Academy of Medicine of Mexico). RESULTS Core principles are summarized here in bullet format. Categories include evaluation, lifestyle and nutrition, pharmacological therapy, and monitoring. A pathway forward to achieve guideline harmonization, at least in part, is proposed. CONCLUSION Greater concordance of recommendations for the care of patients at risk for fracture are expected to lead to improved patient care across jurisdictions, with a narrowing of the osteoporosis treatment gap and reduced burden of fractures.
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Affiliation(s)
- E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - N Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, USA
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez, Mexico, D.F. Mexico, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico, D.F., Mexico
| | - S Kim
- Department of Medicine, Division of Endocrinology & Metabolism, Women's College Hospital, University of Toronto, Toronto, Canada
| | - W D Leslie
- Departments of Medicine and Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - S N Morin
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, Canada
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Harris M, El Hindy M, Usmari-Moraes M, Hudd F, Shafei M, Dong M, Hezwani M, Clark P, House M, Forshaw T, Kehoe P, Conway ME. BCAT-induced autophagy regulates Aβ load through an interdependence of redox state and PKC phosphorylation-implications in Alzheimer's disease. Free Radic Biol Med 2020; 152:755-766. [PMID: 31982508 DOI: 10.1016/j.freeradbiomed.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 01/09/2023]
Abstract
Leucine, nutrient signal and substrate for the branched chain aminotransferase (BCAT) activates the mechanistic target of rapamycin (mTORC1) and regulates autophagic flux, mechanisms implicated in the pathogenesis of neurodegenerative conditions such as Alzheimer's disease (AD). BCAT is upregulated in AD, where a moonlighting role, imparted through its redox-active CXXC motif, has been suggested. Here we demonstrate that the redox state of BCAT signals differential phosphorylation by protein kinase C (PKC) regulating the trafficking of cellular pools of BCAT. We show inter-dependence of BCAT expression and proteins associated with the P13K/Akt/mTORC1 and autophagy signalling pathways. In response to insulin or an increase in ROS, BCATc is trafficked to the membrane and docks via palmitoylation, which is associated with BCATc-induced autophagy through PKC phosphorylation. In response to increased levels of BCATc, as observed in AD, amyloid β (Aβ) levels accumulate due to a shift in autophagic flux. This effect was diminished when incubated with leucine, indicating that dietary levels of amino acids show promise in regulating Aβ load. Together these findings show that increased BCATc expression, reported in human AD brain, will affect autophagy and Aβ load through the interdependence of its redox-regulated phosphorylation offering a novel target to address AD pathology.
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Affiliation(s)
- M Harris
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M El Hindy
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Usmari-Moraes
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - F Hudd
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Shafei
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Dong
- Department of Chemistry, North Carolina Agricultural and Technical State University, Market Street, Greensboro, NC, 27411, USA
| | - M Hezwani
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - P Clark
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M House
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - T Forshaw
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - P Kehoe
- Institute of Clinical Neurosciences, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - M E Conway
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK.
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Abstract
Electronic nicotine delivery systems (ENDS) are devices that contain a power source, a heating element, and a tank or cartridge containing an “e-liquid,” which is a mixture of nicotine and flavoring in a glycerol–propylene glycol vehicle. Their increasing popularity among adolescents might be attributed to aggressive marketing in physical venues, social media outlets, as well as irreversible changes caused by nicotine in the developing brains of youth and young adults, predisposing them to addictive behaviors. Adolescent ENDS users were 4 times more likely to initiate cigarette smoking, and the odds of quitting smoking were lower and, in many instances, delayed for those using ENDS. ENDS also renormalize cigarette-like behaviors, such as inhaling/exhaling smoke. The oral cavity is the initial point of contact of ENDS and the first affected system in humans. Oral health depends on an intricate balance in the interactions between oral bacteria and the human immune system, and dysbiosis of oral microbial communities underlies the etiology of periodontitis, caries, and oral cancer. Emerging evidence from subjects with periodontitis as well as periodontally healthy subjects demonstrates that e-cigarette use is associated with a compositional and functional shift in the oral microbiome, with an increase in opportunistic pathogens and virulence traits.
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Affiliation(s)
- P.S. Kumar
- College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - P. Clark
- School of Public Health, University of Maryland, Baltimore, MD, USA
| | - M.C. Brinkman
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - D. Saxena
- College of Dentistry, New York University, New York, NY, USA
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Hyndman TH, Marschang RE, Bruce M, Clark P, Vitali SD. Reptarenaviruses in apparently healthy snakes in an Australian zoological collection. Aust Vet J 2019; 97:93-102. [PMID: 30919443 DOI: 10.1111/avj.12792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 12/02/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inclusion body disease (IBD) is a disease of snakes with a global distribution and has recently been shown to be caused by reptarenaviruses. Testing for this group of viruses in asymptomatic snakes allows the association between infection and disease to be further elucidated. METHODS A reptarenavirus was detected by RT-PCR in a reticulated python (Malayopython reticulatus) from an Australian zoological collection that was open-mouth breathing and had erythematous oral mucosa. Another 27 pythons, 4 elapids, 2 colubrids and 2 boas from this collection were then screened. From these animals, swabs, whole blood and/or tissue were tested for reptarenaviruses by RT-PCR. Additionally, blood films from 10 snakes were examined by light microscopy for the presence of inclusion bodies. The majority of samples were collected over a 484-day period. RESULTS A total of 8 animals were RT-PCR-positive (8/36 = 22.2%): 6 were pythons, 1 was a corn snake (Pantherophis guttatus) and 1 was a Madagascar tree boa (Sanzinia madagascariensis). From them, 57 samples were collected, but only one from each animal was RT-PCR-positive (8/57 = 14.0%). From all 36 animals in this study, 8/182 samples were RT-PCR-positive (4.4%). Inclusion bodies were not recognised in any of the blood films. Only the reticulated python showed signs of illness, which improved without any further intervention. All other RT-PCR-positive snakes were apparently healthy throughout the duration of the study. CONCLUSION This study showed a weak association between the presence of reptarenaviruses and disease. Testing serially collected swab and whole-blood samples increased the number of animals in which reptarenaviruses were detected.
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Affiliation(s)
- T H Hyndman
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | | | - M Bruce
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - P Clark
- School of Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - S D Vitali
- Perth Zoo, Department of Biodiversity, Conservation and Attractions, South Perth, WA, Australia
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Baschnagel A, Kaushik S, Abel L, Clark P, Buehler D, Kimple R. The development and characterization of patient derived xenografts from non-small cell lung cancer brain metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barton D, Brooks T, Cieslak A, Elkins G, Clark P, Baydoun M, Smith A, VanPoznak C. Abstract P1-12-04: Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The number of cancer survivors is growing and expected to be 18.9 million by 2024. Addressing survivorship issues, such as sexual health, are a critical part of health promotion. Women diagnosed with breast or gynecologic cancer can experience distressing changes in their self and/or body image, which affects their sexual health. This study evaluates hypnosis compared to progressive muscle relaxation (PMR) to improve self/body image in order to improve sexuality.
Methods: Women with a history of breast or gynecologic cancer, who also report negative body image changes, were randomized in a 2:1 fashion to a 6-week intervention of hypnotic relaxation or PMR. Both intervention arms consisted of three 30-minute sessions delivered face-to-face by a trained therapist, one every two weeks, along with home practice using a CD. The primary outcome was impact of treatment on body image using the Impact of Treatment Scale (ITS). Secondary outcomes included mood (Positive/Negative Affect Scale-PANAS), sexual satisfaction (PROMIS satisfaction), and perceived change (Global Impression of Change Scale -GCIS). Outcomes were measured at baseline and 6 weeks except for the GCIS measured only at 6 weeks. A series of independent samples t-tests were used to compare changes in outcome measures between arms. The intention-to-treat principle was applied.
Results: The final randomized sample consisted of 87 women. There was no statistically significant difference (p=.15) in the change in ITS between groups at 6 weeks, with both groups significantly improving (within group effect size Cohen's d .49 - .75). There were non-significant differences between groups on secondary outcomes. Change from baseline for positive affect (PANAS) was 1.7 in the hypnosis group and 3.8 in the PMR group while negative affect change was very similar being about 2.8 in both groups. Change from baseline for the PROMIS general sexual satisfaction scale was 1.5 in the hypnosis group and 1.3 in the PMR group. On the GCIS at 6 weeks, 42% of the hypnosis group reported moderate to very much improvement on self/body image (GCIS) while only 32% of the PMR group reported this level of improvement; and 36% of the hypnosis group versus 11% of the PMR group reported moderate to very much improvement in their sexuality.
Implications: The stress relieving strategies applied in this study may contribute substantially to decreasing the distress of the cancer experience related to altered self/body image and sexuality. The variable improvement across domains suggests that hypnosis and PMR may work in different ways, mechanistically. Further mechanistic studies of interventions to optimally promote survivorship health are warranted.
Citation Format: Barton D, Brooks T, Cieslak A, Elkins G, Clark P, Baydoun M, Smith A, VanPoznak C. Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-04.
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Affiliation(s)
- D Barton
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - T Brooks
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - A Cieslak
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - G Elkins
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - P Clark
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - M Baydoun
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - A Smith
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - C VanPoznak
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Abstract P5-09-06: Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-06] [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: 11/16/2022]
Abstract
Abstract
Background: Pathogenic genetic variants are estimated to occur in 10-15% of all breast cancer patients, with BRCA 1/2 accounting for 40-50% of pathogenic/likely pathogenic (P/LP) variants. However, it is estimated that <30% of breast cancer patients harboring a BRCA 1/2 variant have been identified, with the percentage being much less for ˜20 other breast cancer associated genes. Reasons for this are multifactorial and include complicated and restrictive testing guidelines developed at a time when the cost of testing was high and guidelines for management were limited. Today, cost has plummeted and there are definitive management guidelines for a broader range of genes. We created a community based Registry to determine the incidence of P/LP variants in breast cancer patients who meet and who do not meet the NCCN 2017 genetic testing criteria.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community and academic sites experienced incancer genetic testing and counseling.
Eligibility criteria included patients with a breast cancer diagnosis who had not been previously tested. Consecutive patients aged 18-90 were consented and underwent an 80 gene panel test (Invitae –Multi-Cancer Panel). The non-inferiority study was powered to detect a difference in P/LP variant rate of 4 percentage points with statistical significance (p<0.05, Fisher's exact test).
HIPAA compliant electronic case report forms collected information on patient diagnosis, test results, and physician recommendations made after test results were received.
Results: Over 1000 patients were enrolled and data from 910 subjects analyzed to date. 50.4% met NCCN criteria and 49.5% did not. Median age for the enrolled patients is 60.5 and ranged from 22-93. 56.0% of patients were recently diagnosed with breast cancer. 10.9% of patients had a history of a prior non breast cancer. Overall, 8.9% of patients had a pathogenicvariant. 9.6% of patients who met NCCN criteria with test results had a P/LP variant. 8.2% of patients who did not meet criteria had a P/LP variant. The difference of positive cases among the two groups is not statistically significant (P = 0.49)
4.9% of patients had pathogenic variants if only an 11 gene standard breast cancer panel was considered.
The spectrum of mutated genes varied between the two groups, with some overlap.
Conclusions:
There was no statistically significant difference in the number of pathogenic/likely pathogenic variants between those patients who met and those who did not meet NCCN guidelines. Expanded panel testing yields more medically actionable P/LP variants than testing BRCA 1/2 alone or breast cancer panels with 11 genes. This study demonstrates that there will be a significant number of patients with P/LP variants are missed if NCCN guidelines are required for genetic testing. Current NCCN guidelines for the genetic testing of breast cancer patients are an obstacle to identifying patients with P/LP variants and should be removed.
Universal BC Genetic Testing RegistryNCCN Criteria (910 patients analyzed)#/% who have P/LP variants#/% who do not have P/LP variantsPatients who meet guidelines44/459 (9.6%)415/459 (90.4%)Patients who do not meet guidelines37/451 (8.2%)414/451 (91.8%)
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-06.
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Affiliation(s)
- P Beitsch
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Abstract P5-09-03: Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-03] [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: 11/16/2022]
Abstract
Abstract
Background: The testing of hereditary breast and ovarian cancer (HBOC) patients for BRCA1/2 only was established years ago to identify patients with clinically actionable variants and limit the economic burden. However, the cost of genetic testing has plummeted, and the number of breast cancer-risk genes with management guidelines has expanded. We created a community-based registry to test all breast cancer patients. A primary objective of this registry included accruing and comparing patients who did and did not meet NCCN guidelines and determining if providing all breast cancer patients with comprehensive multi-gene panel testing yields additional clinical value than testing BRCA1/2 alone.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community-based and academic breast sites, selected to insure geographic and ethnic diversity. Consecutive patients ages 18-90 with current or prior breast cancer were offered testing with an 80-gene panel (Invitae, San Francisco, CA). HIPAA-compliant case report forms collected patient diagnosis, test results, and physician recommendations made after test results.
Results: Over 1,000 patients were enrolled and data on 911 have been analyzed to date. Median age of patients is 60.5 (range 22 to 93). 56.0% were recently diagnosed with breast cancer. Of these patients, 50.54% met NCCN criteria, and 49.5% did not. 10.9% had history of a prior non-breast cancer. The pathogenic/likely pathogenic (P/LP) variant rate for patients on a comprehensive 80-gene panel was 8.9%. When restricted to a guidelines-based 11-gene breast cancer panel (BRCA1/2, ATM, CDH1, CHEK2, NBN, NF1, PTEN, STK11, TP53, PALB2), 4.9% had P/LP variants; when limited to BRCA1/2, 1.6% had P/LP variants. Of all patients with P/LP findings, 93% had variants in cancer-risk genes with established management recommendations (Table 1) and 80% had germline variants conferring eligibility for precision medicine-based cancer treatments, such as PARP inhibitors, through actively enrolling clinical trials.
Conclusions: This study demonstrates that comprehensive panel testing of breast cancer patients provides a higher yield of clinically actionable P/LP variants than BRCA1/2 testing alone. Limited panels may miss clinically relevant P/LP variants, leaving risk for preventable cancers undiscovered and unnecessarily restricting patients' treatment options. These results also suggest that variants in tumor suppressor genes, not previously thought related to breast cancer, may contribute to its etiology. A comprehensive panel strategy reveals untapped clinical utility and can impact breast cancer patient care by informing implementation of precision medicine treatment interventions and guiding long-term medical management and surveillance for patients and their family members.
PatientsVariantsWith breast cancer management guidelines (including variants ATM*, BRCA1*, BRCA2*, CHEK2*, NBN*, NF1, PALB2*, TP53*)45 (56%)46 (55%)With cancer guidelines and clinical management implications (including variants BARD1*, FH, MITF, MSH6*, MUTYH*, PTCH1, RAD50*, RAD51C*, RAD51D*, RB1, RET, VHL)31 (38%)33 (39%)Evidence of actionability accruing (including variants BLM, DIS3L2, RECQL4)5 (6%)5 (6%)Totals8184*P/LP variants in these genes confer potential clinical trial eligibility, e.g. NCT02401347.
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-03.
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Affiliation(s)
- P Beitsch
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Michalski
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
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Abstract
A number of European studies have documented the ability of procalcitonin (PCT), a novel inflammatory marker, to discriminate patients with sepsis from those with other causes of systemic inflammatory response syndrome (SIRS). The aim of this study was to assess procalcitonin's performance in an Australian intensive care unit (ICU) setting to examine whether it could discriminate between these two conditions. One hundred and twenty-three consecutive adult ICU patients fulfilling criteria for SIRS were enlisted in the study. Over a period of five days, daily serum PCT and C-reactive protein (CRP) levels were measured. At least two sets of cultures were taken of blood, sputum/broncho-alveolar lavage (BAL) and urine. Other cultures were taken as clinically indicated. Questionnaires to ascertain clinical suspicion of sepsis were prospectively answered by the ICU senior registrars. PCT values were ten times higher in patients with positive blood cultures; CRP values were also significantly higher in the bacteraemic patients. Both PCT and CRP had a good ability to discriminate bacteraemia from non-infectious SIRS, with the area under receiver operating characteristics (ROC) curves for PCT being 0.8 and for CRP being 0.82. However neither PCT or CRP was able to discriminate patients with localized sepsis from those without. Utilizing both tests resulted in a more sensitive screen than either one alone, while PCT was a more accurate diagnostic test for bacteraemia than CRP. The PCT value also differed between those who died in hospital and those who survived. Measurement of PCT alone or in combination with CRP can aid discrimination of septicaemia/bacteraemia with associated SIRS from non-infectious SIRS in an Australian ICU setting.
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Affiliation(s)
- K Bell
- Departments of Intensive Care and Immunopathology, Westmead Hospital, New South Wales
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13
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Maguire R, Arber A, Klepacz N, Connaghan J, Mcphelim J, Blythe K, Murray P, Rupani H, Mcnaughton L, Moylan A, Clark P. Determining the feasibility and acceptability of a mobile health application to remotely monitor the symptoms of people with mesothelioma at home. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Clark P, Denova-Gutiérrez E, Razo C, Rios-Blancas MJ, Lozano R. The burden of musculoskeletal disorders in Mexico at national and state level, 1990-2016: estimates from the global burden of disease study 2016. Osteoporos Int 2018; 29:2745-2760. [PMID: 30242448 DOI: 10.1007/s00198-018-4698-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Worldwide, musculoskeletal (MSK) disorders are the second cause of living with disability. According to our data, in Mexico, MSK conditions are an important cause of disability, at national and state level. Preventive actions promoted by health systems to reduce the burden of MSK disorders are essential. INTRODUCTION We describe premature mortality and disability due to musculoskeletal (MSK) disorders in Mexico at national and state level from 1990 to 2016. METHODS Using data from the global burden of disease study 2016 (GBD 2016), we present rates and trends in years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) caused by MSK disorders in Mexico by state from 1990 to 2016. The burden of MSK disorders was computed using standard GBD methodology. To compare the burden of MSK disorders across the country, states were grouped by sociodemographic index (SDI). RESULTS In Mexico, MSK disorders were the 3rd and 17th greatest cause of YLDs and YLLs in 2016, respectively, accounting for 1.95 million (95% UI 1.4-2.5) DALYs. Among all MSK disorders, low back and neck pain had the highest all-ages DALYs rate and represented 3.6% of total DALYs. All-ages YLLs and YLDs rates of MSK disorders were 234 and 37% higher in females (YLLs 102.2, 95% UI 79.9-110.7; YLDs 1677.9, 95% UI 1213.5-2209.4) than in males (YLLs 30.6, 95% UI 28.3-34.0; YLDs 1224.7, 95% UI 887.2-1608.3), respectively. Northern and high SDI states had higher rates of MSK disorders in comparison with southern and low SDI states. Only 16% of YLDs caused by all MSK disorders could be attributed to risk factors currently assessed in GBD. CONCLUSION MSK conditions are an important cause of premature mortality and disability. Researcher engagement and cross-sectorial actions to address the burden of MSK disorders are essential.
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Affiliation(s)
- P Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - E Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, 655 Colonia Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Mexico.
| | - C Razo
- National Institute of Public Health, Cuernavaca, Mexico
| | | | - R Lozano
- National Institute of Public Health, Cuernavaca, Mexico
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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15
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, 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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Guirant L, Carlos F, Curiel D, Kanis JA, Borgström F, Svedbom A, Clark P. Health-related quality of life during the first year after a hip fracture: results of the Mexican arm of the International Cost and Utility Related to Osteoporotic Fractures Study (MexICUROS). Osteoporos Int 2018; 29:1147-1154. [PMID: 29464277 DOI: 10.1007/s00198-018-4389-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED We investigated changes in health-related quality of life (HRQoL) due to hip fracture in Mexican adults aged ≥ 50 years during the first year post-fracture. Mean accumulated loss was 0.27 quality-adjusted life years (QALYs). HRQoL before fracture was the main contributor to explain the loss of QALYs. INTRODUCTION We aimed to estimate the health-related quality of life (HRQoL) loss over 1 year in patients sustaining a hip fracture in Mexico. METHODS Individuals aged ≥ 50 years old with diagnosis of a low-energy-induced hip fracture enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) composed the study population. After a recall of their own pre-fracture status, HRQoL was prospectively collected in three phases over 12 months of follow-up using EQ-5D-3L. The UK preference weight set was applied to calculate the utility values. The accumulated quality-adjusted life years (QALYs) loss in the first year post-fracture was estimated using the trapezoid method. Multivariate regression analysis allowed identifying determinants of QALYs loss. RESULTS One hundred ninety-three patients (mean ± SD age 77.2 ± 9.9 years; 80% women; 15.5% with prior fracture in the last 5 years; 78% in low-income category) were evaluated. Mean (95% CI) utility value before fracture was 0.64 (0.59-0.68). It dropped to 0.01 (0.01-0.02) immediately after fracture and then improved to 0.46 (0.42-0.51) and 0.60 (0.55-0.64) at 4 and 12 months post-fracture, respectively. Disregarding fracture-related mortality, accumulated QALYs loss over the first year was 0.27 (0.24-0.30) QALYs. Mobility, self-care, and usual activities were the most affected domains throughout the whole year. HRQoL before fracture was the main contributor to explain the loss of QALYs. CONCLUSIONS Hip fractures reduce dramatically the HRQoL, with the loss sustained at least over the first year post-fracture in Mexico. The utility values derived from this study can be used in future economic evaluations.
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Affiliation(s)
- L Guirant
- Instituto Tecnológico Autónomo de México, Mexico City, Mexico
| | - F Carlos
- R A C Salud Consultores, S.A. de C.V., Mexico City, Mexico
| | - D Curiel
- Faculty of Medicine UNAM, Mexico City, Mexico
- SSPDF C.S. TII Hortencia, Mexico City, Mexico
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, 3000, Australia
| | - F Borgström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - P Clark
- Faculty of Medicine UNAM, Mexico City, Mexico.
- Clinical Epidemiology Unit, Facultad de Medicina UNAM, Hospital Infantil Federico Gómez, Mexico City, Mexico.
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Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, Mithal A, Rizzoli R, Zerbini CAF, Pierroz DD, Dawson-Hughes B. Correction to: Global dietary calcium intake among adults: a systematic review. Osteoporos Int 2018; 29:1223. [PMID: 29480343 PMCID: PMC6828480 DOI: 10.1007/s00198-018-4447-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The original Electronic Supplementary Material file 3 contained an erroneous reference for Mali. A link to the corrected file is provided here.
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Affiliation(s)
- E M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA.
| | - G P Adam
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - V N Langberg
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - A Earley
- Evidera, 500 Totten Pond Rd, Waltham, MA, USA
| | - P Clark
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - P R Ebeling
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - A Mithal
- Medanta Medicity, Sector 38, Gurgaon, India
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C A F Zerbini
- Centro Paulista de Investigação Clínica, Sao Paulo, Brazil
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Svedbom A, Borgstöm F, Hernlund E, Ström O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uusküla A, Tosteson ANA, Jönsson B, Kanis JA. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 2018; 29:557-566. [PMID: 29230511 DOI: 10.1007/s00198-017-4317-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. INTRODUCTION The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. METHODS Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. RESULTS Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. CONCLUSIONS Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
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Affiliation(s)
| | - F Borgstöm
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - O Ström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - V Alekna
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - M L Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez and Faculty of Medicine UNAM, Mexico City, Mexico
| | - M D Curiel
- Servicio de Medicina Interna/Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz, Madrid, Spain
- Catedra de Enfermedades Metabolicas Óseas, Universidad Autonoma, Madrid, Spain
| | - H P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - M Jürisson
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Kallikorm
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Lember
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - O Lesnyak
- Ural State Medical University, Yekaterinburg, Russia
- North West Mechnikov State Medical University, St. Petersburg, Russia
| | - E McCloskey
- Academic Unit of Bone Metabolism, Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - K M Sanders
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - M Tamulaitiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - T Thomas
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Service de Rhumatologie, CHU de Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - N Toroptsova
- FSBSI "Scientific Research Institute of Rheumatology named after V.A.Nasonova, Moscow, Russia
| | - A Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, PA, USA
| | - B Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J A Kanis
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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Clark P, Denova-Gutiérrez E, Zerbini C, Sanchez A, Messina O, Jaller JJ, Campusano C, Orces CH, Riera G, Johansson H, Kanis JA. FRAX-based intervention and assessment thresholds in seven Latin American countries. Osteoporos Int 2018; 29:707-715. [PMID: 29273826 DOI: 10.1007/s00198-017-4341-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk. INTRODUCTION Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years. METHODS The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT. RESULTS For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively. CONCLUSIONS In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model.
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Affiliation(s)
- P Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gomez, Dr. Márquez #164, Col. Doctores, Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - E Denova-Gutiérrez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gomez, Dr. Márquez #164, Col. Doctores, Mexico City, Mexico.
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
| | - C Zerbini
- Centro Paulista de Investigação Clinica, São Paulo, Brazil
| | - A Sanchez
- Centro de Endocrinología, Rosario, Argentina
| | - O Messina
- Servicio de Reumatología, Hospital Argerich, Buenos Aires, Argentina
- Unidad de Postgrado en Reumatología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J J Jaller
- Centro de Reumatología y Ortopedia, Barranquilla, Colombia
| | - C Campusano
- Clínica de la Universidad de los Andes, Santiago, Chile
| | - C H Orces
- Department of Medicine, Laredo Medical Center, Laredo, TX, USA
| | - G Riera
- Unidad Metabolica, Universidad de Carabobo, Valencia, Venezuela
| | - H Johansson
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | - J A Kanis
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
- Medical School, Sheffield, UK Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, England
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Brennand J, Conkie JA, McCall F, Greer IA, Walker I, Clark P. Activated Protein C Sensitivity, Protein C, Protein S and Coagulation in Normal Pregnancy. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615035] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryA prospective study of activated protein C sensitivity, protein C, protein S, and other coagulation factors in 239 women during normal pregnancy was carried out. Protein C activity appeared unaffected by gestation, although an elevation of protein C activity was observed in the early puerperium. A fall in total and free protein S with increasing gestation was observed. Activated protein C sensitivity ratio (APC:SR) showed a progressive fall through pregnancy. This fall correlated with changes in factor VIIIc, factor Vc and protein S. 38% of subjects, with no evidence of Factor V Leiden or anticardiolipin antibodies, showed a low APC:SR (APC:SR <2.6) in the third trimester of pregnancy. Aside from a significant reduction in birth weight, no difference in pregnancy outcome was observed between these subjects and those with a normal APC:SR. Activated protein C sensitivity ratio, modified by pre-dilution of patient samples with factor V depleted plasma, showed no consistent trend with gestation.
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Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, Mithal A, Rizzoli R, Zerbini CAF, Pierroz DD, Dawson-Hughes B. Global dietary calcium intake among adults: a systematic review. Osteoporos Int 2017; 28:3315-3324. [PMID: 29026938 PMCID: PMC5684325 DOI: 10.1007/s00198-017-4230-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/17/2017] [Indexed: 11/06/2022]
Abstract
Low calcium intake may adversely affect bone health in adults. Recognizing the presence of low calcium intake is necessary to develop national strategies to optimize intake. To highlight regions where calcium intake should be improved, we systematically searched for the most representative national dietary calcium intake data in adults from the general population in all countries. We searched 13 electronic databases and requested data from domain experts. Studies were double-screened for eligibility. Data were extracted into a standard form. We developed an interactive global map, categorizing countries based on average calcium intake and summarized differences in intake based on sex, age, and socioeconomic status. Searches yielded 9780 abstracts. Across the 74 countries with data, average national dietary calcium intake ranges from 175 to 1233 mg/day. Many countries in Asia have average dietary calcium intake less than 500 mg/day. Countries in Africa and South America mostly have low calcium intake between about 400 and 700 mg/day. Only Northern European countries have national calcium intake greater than 1000 mg/day. Survey data for three quarters of available countries were not nationally representative. Average calcium intake is generally lower in women than men, but there are no clear patterns across countries regarding relative calcium intake by age, sex, or socioeconomic status. The global calcium map reveals that many countries have low average calcium intake. But recent, nationally representative data are mostly lacking. This review draws attention to regions where measures to increase calcium intake are likely to have skeletal benefits.
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Affiliation(s)
- E M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA.
| | - G P Adam
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - V N Langberg
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - A Earley
- Evidera, 500 Totten Pond Rd, Waltham, MA, USA
| | - P Clark
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - P R Ebeling
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - A Mithal
- Medanta Medicity, Sector 38, Gurgaon, India
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C A F Zerbini
- Centro Paulista de Investigação Clínica, Sao Paulo, Brazil
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Clark P, Chitnis N, Kamoun M, Johnson B, Margolis D, Monos D. 492 SNPs within the MHC associated with atopic dermatitis are located within miRNA sequences. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zerbini CAF, Clark P, Mendez-Sanchez L, Pereira RMR, Messina OD, Uña CR, Adachi JD, Lems WF, Cooper C, Lane NE. Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int 2017; 28:429-446. [PMID: 27796445 DOI: 10.1007/s00198-016-3769-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis. One of the most deleterious effects induced by the chronic inflammation of RA is bone loss. During the last 15 years, the better knowledge of the cytokine network involved in RA allowed the development of potent inhibitors of the inflammatory process classified as biological DMARDs. These new drugs are very effective in the inhibition of inflammation, but there are only few studies regarding their role in bone protection. The principal aim of this review was to show the evidence of the principal biologic therapies and bone loss in RA, focusing on their effects on bone mineral density, bone turnover markers, and fragility fractures. METHODS Using the PICOST methodology, two coauthors (PC, LM-S) conducted the search using the following MESH terms: rheumatoid arthritis, osteoporosis, clinical trials, TNF- antagonists, infliximab, adalimumab, etanercept, certolizumab, golimumab, IL-6 antagonists, IL-1 antagonists, abatacept, tocilizumab, rituximab, bone mineral density, bone markers, and fractures. The search was conducted electronically and manually from the following databases: Medline and Science Direct. The search period included articles from 2003 to 2015. The selection included only original adult human research written in English. Titles were retrieved and the same two authors independently selected the relevant studies for a full text. The retrieved selected studies were also reviewed completing the search for relevant articles. The first search included 904 titles from which 253 titles were selected. The agreement on the selection among researchers resulted in a Kappa statistic of 0.95 (p < 0.000). Only 248 abstracts evaluated were included in the acronym PICOST. The final selection included only 28 studies, derived from the systematic search. Additionally, a manual search in the bibliography of the selected articles was made and included into the text and into the section of "small molecules of new agents." CONCLUSION Treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD and also a better profile of bone markers. Most of these studies were performed with infliximab. Only three epidemiological studies analyzed the effect on fractures after anti-TNF blocking agent's treatment. IL-6 blocking agents also showed improvement in localized bone loss not seen with anti-TNF agents. There are a few studies with rituximab and abatacept. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.
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Affiliation(s)
- C A F Zerbini
- Centro Paulista de Investigação Clínica, Rua Moreira e Costa, 342-Ipiranga, São Paulo, SP, 04266-010, Brazil.
| | - P Clark
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - L Mendez-Sanchez
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - R M R Pereira
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - O D Messina
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - C R Uña
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - J D Adachi
- Actavis Chair for Better Bone Health in Rheumatology, Hamilton, ON, Canada
| | - W F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- University of Oxford, Oxford, UK
| | - N E Lane
- Center for Musculoskeletal Health, Sacramento, CA, USA
- UC Davis Health System, University of California, Sacramento, CA, USA
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Denova-Gutiérrez E, Clark P, Tucker KL, Muñoz-Aguirre P, Salmerón J. Dietary patterns are associated with bone mineral density in an urban Mexican adult population. Osteoporos Int 2016; 27:3033-40. [PMID: 27198234 DOI: 10.1007/s00198-016-3633-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Several types of nutrients and foods affect bone mineral density (BMD). However, these nutrients occur together in food groups and dietary patterns, and the overall effects of dietary patterns are not yet well known. INTRODUCTION We evaluated the associations between dietary patterns and BMD among adults participating in the Health Workers Cohort Study. METHODS In a cross-sectional analysis, we examined 6915 Mexican adults aged 20-80 years. All participants completed a validated self-administered food frequency questionnaire (FFQ) and had total, hip, and spine BMD measurements assessed by dual-energy X-ray absorptiometry (DXA). The FFQ included 116 foods, which were grouped into 22 categories and entered into a factor analysis to derive dietary patterns. RESULTS Three dietary patterns emerged-a Prudent, a Refined foods, and a Dairy and fish pattern. After adjustment for potential confounders, those in the highest quintile of the Prudent pattern had lower odds (OR) of low spine BMD (OR = 0.80; 95 % CI 0.68, 0.94; P for trend = 0.031) compared to those in the lowest quintile. In contrast, participants in the highest quintile of the Refined foods pattern had greater odds of low total BMD (OR = 1.74; 95 % CI 1.10, 2.76; P for trend = 0.016) than those in the lowest quintile. Finally, participants in the highest quintile of the Dairy and fish dietary pattern had significantly lower likelihood of having low BMD. CONCLUSION This study identified specific dietary patterns associated with BMD among a Mexican adult population and highlights the importance of promoting food-based prevention strategies for maintaining bone health.
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Affiliation(s)
| | - P Clark
- Hospital Infantil de Mexico Federico Gomez, Ciudad de México, Mexico.
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - K L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - P Muñoz-Aguirre
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
| | - J Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Hughes J, Jagoe R, Clark P, Klenerman L. Pattern Recognition of Images of the Pressure Distribution under the Foot from the Pedobarograph. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/00223638.1989.11737030] [Citation(s) in RCA: 7] [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: 10/21/2022]
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Rivas-Ruiz R, Méndez-Sánchez L, Castelán-Martínez OD, Clark P, Tamayo J, Talavera JO, Huitrón G, Salmerón-Castro J. Comparison of International Reference Values for Bone Speed of Sound in Pediatric Populations: Meta-analysis. J Clin Densitom 2016; 19:316-25. [PMID: 26088387 DOI: 10.1016/j.jocd.2015.04.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare international reference values (RV) for tibial and radial speed of sound (SoS) assessed by quantitative ultrasound (QUS) in pediatric populations. These values were compared by age and country of origin in a systematic review with meta-analysis from studies published on QUS (Sunlight Omnisense). A search was carried out in electronic databases. Nine studies with 6963 patients were included in the meta-analysis. For the newborn populations, 3 studies (from Italy, Portugal, and Israel) were used. These studies included subjects with 27-42 wk gestational age. The mean difference (Portugal-Israel) was found to be 23.62 m/s [95% confidence interval [CI] 6.29, 40.95]. Additionally, no difference was found between Italy-Portugal (p = 0.69), or Italy-Israel (p = 0.28). In pediatric populations, we compared 8 studies from Canada, Mexico, Israel, Greece, Portugal, and Turkey. No significant differences found for SoS RV between Israel-Turkey, Israel-Greece, or Israel-Canada (p > 0.05). Significant differences were found in Mexico-Israel -105.29 m/s (95% CI -140.05, -70.54) (p < 0.001); Mexico-Portugal -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Greece: -239.14 m/s (95% CI -267.67, -210.62) (p < 0.001); Mexico-Turkey: -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Canada: -113.51 m/s (95% CI -140.25, -86.77) (p < 0.001).This study demonstrates that there are differences in SoS-RV obtained by tibial and radial QUS in pediatric populations between Mexico and other countries (Israel, Portugal, Greece, Turkey, and Canada).
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Affiliation(s)
- R Rivas-Ruiz
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - L Méndez-Sánchez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F..
| | - O D Castelán-Martínez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F
| | - P Clark
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - J Tamayo
- Comité Mexicano para la Prevención de la Osteoporosis, México, D.F
| | - J O Talavera
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - G Huitrón
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - J Salmerón-Castro
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México; Centro de Investigación de Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
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Jones M, Welch J, Turvey J, Cannon J, Clark P, Szram J, Cullinan P. Prevalence of sensitization to 'improver' enzymes in UK supermarket bakers. Allergy 2016; 71:997-1000. [PMID: 26836630 DOI: 10.1111/all.12854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supermarket bakers are exposed not only to flour and alpha-amylase but also to other 'improver' enzymes, the nature of which is usually shrouded by commercial sensitivity. We aimed to determine the prevalence of sensitization to 'improver' enzymes in UK supermarket bakers. METHODS We examined the prevalence of sensitization to enzymes in 300 bakers, employed by one of two large supermarket bakeries, who had declared work-related respiratory symptoms during routine health surveillance. Sensitization was determined using radioallergosorbent assay to eight individual enzymes contained in the specific 'improver' mix used by each supermarket. RESULTS The prevalence of sensitization to 'improver' enzymes ranged from 5% to 15%. Sensitization was far more likely if the baker was sensitized also to either flour or alpha-amylase. The prevalence of sensitization to an 'improver' enzyme did not appear to be related to the concentration of that enzyme in the mix. CONCLUSIONS We report substantial rates of sensitization to enzymes other than alpha-amylase in UK supermarket bakers; in only a small proportion of bakers was there evidence of sensitization to 'improver mix' enzymes without sensitization to either alpha-amylase or flour. The clinical significance of these findings needs further investigation, but our findings indicate that specific sensitization in symptomatic bakers may not be identified without consideration of a wide range of workplace antigens.
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Affiliation(s)
- M. Jones
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Welch
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J Turvey
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Cannon
- Department of Occupational and Environmental Medicine; Harefield NHS Trust; London UK
| | - P. Clark
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Szram
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
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Butterworth DM, Rose SS, Clark P, Rowland P, Knight S, Haboubi NY. Light Microscopy, Immunohistochemistry and Electron Microscopy of the Valves of the Lower Limb Veins and Jugular Veins. Phlebology 2016. [DOI: 10.1177/026835559200700107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To demonstrate the light, electron microscopy and immunohistochemistry appearances of the valves of lower limb veins and jugular veins of subject with evidence of venous disease. Design: A prospective study of saphenous veins obtained at post mortem examination and jugular vein obtained at time of surgery. Setting: Health Service district general hospital. Patients: Patients with no evidence of venous disease being treated in the hospital for unrelated conditions, or examined at autopsy in the Department of Pathology. Interventions: Sections of saphenous vein from the lower limb and jugular vein were examined using conventional histology, immunohistochemical staining and electron microscopy. Main outcome measures: Microscopic and electron microscopic appearances of histological sections of venous valves. Results: The valve agger contains an increased amount of fibrous tissue compared with the vein wall and saphenous and jugular veins. However, in saphenous veins the muscle layer of the wall could be traced across the base of the agger, but this was deficient in jugular valves. Electron microscopic examination showed that most of the valve cusp was composed of collagen fibrils, aggregated in irregularly arranged bundles. Elastic fibre material was present in the subendothelial zones. Nerve and muscle fibres were not present in the cusp. Conclusions: Valve cusps in both high and low pressure systems are similar, and the authors suggest that cusp/agger/vein wall complex is important for valve function.
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Affiliation(s)
- D. M. Butterworth
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - S. S. Rose
- Department of Vascular Surgery, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - P. Clark
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - P. Rowland
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - S. Knight
- Department of Plastic, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - N. Y. Haboubi
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
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Kay AB, Clark P, Maurer M, Ying S. Elevations in T-helper-2-initiating cytokines (interleukin-33, interleukin-25 and thymic stromal lymphopoietin) in lesional skin from chronic spontaneous ('idiopathic') urticaria. Br J Dermatol 2015; 172:1294-302. [PMID: 25523947 DOI: 10.1111/bjd.13621] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mechanism of wealing in chronic spontaneous urticaria (CSU) is largely unknown. We previously demonstrated increased expression of T-helper 2 [interleukin (IL)-4 and IL-5] cytokines in skin biopsies from CSU. This suggested that Th2-initiating cytokines [IL-33, IL-25 and thymic stromal lymphopoietin (TSLP)], released through innate immune mechanisms, may play a role in pathogenesis. OBJECTIVES To identify Th2-initiating cytokines in lesional and nonlesional skin from patients with CSU and to compare the results with a control group. METHODS Paired biopsies (one from a 4-8 h spontaneous weal and one from uninvolved skin) were taken from eight patients with CSU and nine control subjects, and studied by immunohistochemistry and confocal microscopy. RESULTS There were increases in IL-4(+) and IL-5(+) cells in lesional skin vs. controls (P = 0·03 and P < 0·001, respectively) and marked elevations in the numbers of IL-33(+), IL-25(+) and TSLP(+) cells in the dermis of lesional skin vs. both nonlesional skin (P = 0·002, P = 0·01 and P = 0·04, respectively) and controls (P = 0·001, P < 0·001 and P = 0·005, respectively). There was also a correlation between the numbers of IL-33(+) and IL-25(+) cells (r = 0·808, P = 0·015). IL-33 localized to CD31(+) endothelial cells, CD90(+) fibroblasts, CD68(+) macrophages and tryptase(+) mast cells, whereas IL-25 was expressed by epithelial cells, mast cells and major basic protein-positive eosinophils. IL-33 and IL-25 were constitutively expressed in the epidermis of both controls and patients with CSU. CONCLUSIONS Increased expression of Th2-initiating cytokines in lesional skin in CSU suggests that innate pathways might play a role in the mechanism of wealing. As Th2-initiating cytokines play a role in mast cell activation, inflammation and vascular leakage in CSU, these findings may also have therapeutic implications.
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Affiliation(s)
- A B Kay
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - P Clark
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin, Berlin, Germany
| | - S Ying
- Asthma, Allergy and Lung Biology, Guy's Hospital, London, U.K
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Kay AB, Ying S, Ardelean E, Mlynek A, Kita H, Clark P, Maurer M. Calcitonin gene-related peptide and vascular endothelial growth factor are expressed in lesional but not uninvolved skin in chronic spontaneous urticaria. Clin Exp Allergy 2015; 44:1053-60. [PMID: 24902612 DOI: 10.1111/cea.12348] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/21/2014] [Accepted: 05/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanisms for producing weals in chronic spontaneous (idiopathic) urticaria (CSU) are incompletely understood. Leucocyte infiltration with vascular leakage and expression of the potent vasoactive agents' calcitonin gene-related peptide (CGRP) and vascular endothelial growth factor (VEGF) are features of late-phase allergic skin reactions, previously proposed as a model of CSU. OBJECTIVE To measure CGRP and VEGF expression in lesional and non-lesional skin from CSU patients and to compare results with a control group. METHODS Eight paired biopsies (one from 4-8 h spontaneous weals and one from uninvolved skin) were taken from eight patients with CSU and nine control subjects and studied by immunohistochemistry and confocal microscopy. RESULTS Lesional skin in CSU contained significantly more CGRP+ and VEGF+ cells than non-lesional skin. No significant differences were observed in CGRP and VEGF expression between non-lesional skin and controls. In lesional skin, VEGF and CGRP co-localised to UEA-1+ blood vessels. CGRP was also expressed by neutrophils and eosinophils and to a lesser extent by CD90(+) fibroblasts, mast cells, CD3(+) and CD68(+) cells. CGRP and VEGF expression was not related to the duration of disease. CONCLUSION AND CLINICAL RELEVANCE Increased expression of CGRP and VEGF in lesional, but not uninvolved, skin indicates that these potent vasoactive agents may play a role in wealing and tissue oedema in CSU so representing novel targets in therapy.
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Affiliation(s)
- A B Kay
- Leukocyte Biology Section, National Heart & Lung Institute, Imperial College London, London, UK
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Clark P, Bhattacharya S, van Ginkel P, Darjatmoko S, Elmayam A, Polans A, Kuo J. ET-11 * RESVERATROL REGULATES GLIOBLASTOMA AND GLIOBLASTOMA STEM-LIKE CELLS VIA ANTI-TUMORIGENIC AKT DEPHOSPHORYLATION AND p53 ACTIVATION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou255.11] [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: 11/14/2022] Open
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Clark P, Spencer P. Description of Three New Species ofTheileriaBettencourt, Franca & Borges, 1907 From Macropodoidea in Western Australia. T ROY SOC SOUTH AUST 2014. [DOI: 10.1080/03721426.2007.10887071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kay AB, Ying S, Ardelean E, Mlynek A, Kita H, Clark P, Maurer M. Elevations in vascular markers and eosinophils in chronic spontaneous urticarial weals with low-level persistence in uninvolved skin. Br J Dermatol 2014; 171:505-11. [PMID: 24665899 PMCID: PMC4282040 DOI: 10.1111/bjd.12991] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 11/27/2022]
Abstract
Background In chronic spontaneous urticaria (CSU) mast cell activation together with inflammatory changes in the skin are well documented and may play an important role in mechanisms of tissue oedema. Objectives To confirm and extend these observations by measuring microvascular markers, leucocytes and mast cell numbers in lesional and uninvolved skin and to compare findings with a control group. Methods Paired biopsies (one from 4–8-h spontaneous weals and one from uninvolved skin) were taken from eight patients with CSU and nine control subjects and studied using immunohistochemistry and confocal microscopy using the lectin Ulex europaeus agglutinin 1 (UEA-1). Results Lesional skin in CSU contained significantly more CD31+ endothelial cells; CD31+ blood vessels, neutrophils, eosinophils, basophils and macrophages; and CD3+ T cells than nonlesional skin. Increased vascularity was confirmed by confocal imaging using the lectin UEA-1. Uninvolved skin from CSU contained significantly more CD31+ endothelial cells, CD31+ blood vessels and eosinophils compared with the control subjects. There was a threefold increase in mast cell numbers when CSU was compared with controls but no difference was observed between lesional and uninvolved skin. Conclusions Increased vascular markers together with eosinophil and neutrophil infiltration are features of lesional skin in CSU and might contribute to tissue oedema. Eosinophils and microvascular changes persist in uninvolved skin, which, together with increased mast cells, suggests that nonlesional skin is primed for further wealing.
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Affiliation(s)
- A B Kay
- Leukocyte Biology Section, National Heart and Lung Institute, Imperial College, London, SW7 2AZ, U.K
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Curiel D, Chico G, Clark P, Carlos F, Svedbom A, Borgström F. Sociodemographic Factors Associated to Health-Related Quality of Life Among Patients With Osteoporotic Fractures in Mexico. J Clin Densitom 2014. [DOI: 10.1016/j.jocd.2014.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D’Asta F, Homsi J, Clark P, Buffalo M, Melandri D, Carboni A, Pinzauti E, Graziano A, Masellis A, Bussolin L, Messineo A. Introducing the Advanced Burn Life Support (ABLS) course in Italy. Burns 2014; 40:475-9. [DOI: 10.1016/j.burns.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Kanis JA, Adachi JD, Cooper C, Clark P, Cummings SR, Diaz-Curiel M, Harvey N, Hiligsmann M, Papaioannou A, Pierroz DD, Silverman SL, Szulc P. Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 2013; 24:2763-4. [PMID: 23884436 PMCID: PMC5096926 DOI: 10.1007/s00198-013-2413-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Committee of Scientific Advisors of International Osteoporosis Foundation (IOF) recommends that papers describing the descriptive epidemiology of osteoporosis using bone mineral density (BMD) at the femoral neck include T-scores derived from an international reference standard. INTRODUCTION The prevalence of osteoporosis as defined by the T-score is inconsistently reported in the literature which makes comparisons between studies problematic. METHODS The Epidemiology and Quality of Life Working Group of IOF convened to make its recommendations and endorsement sought thereafter from the Committee of Scientific Advisors of IOF. RESULTS The Committee of Scientific Advisors of IOF recommends that papers describing the descriptive epidemiology of osteoporosis using BMD at the femoral neck include T-scores derived from the National Health and Nutrition Examination Survey III reference database for femoral neck measurements in Caucasian women aged 20-29 years. CONCLUSIONS It is expected that the use of the reference standard will help resolve difficulties in the comparison of results between studies and the comparative assessment of new technologies.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK,
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Cheng L, Huang Z, Zhou W, Wu Q, Rich J, Bao S, Baxter P, Mao H, Zhao X, Liu Z, Huang Y, Voicu H, Gurusiddappa S, Su JM, Perlaky L, Dauser R, Leung HCE, Muraszko KM, Heth JA, Fan X, Lau CC, Man TK, Chintagumpala M, Li XN, Clark P, Zorniak M, Cho Y, Zhang X, Walden D, Shusta E, Kuo J, Sengupta S, Goel-Bhattacharya S, Kulkarni S, Cochran B, Cusulin C, Luchman A, Weiss S, Wu M, Fernandez N, Agnihotri S, Diaz R, Rutka J, Bredel M, Karamchandani J, Das S, Day B, Stringer B, Al-Ejeh F, Ting M, Wilson J, Ensbey K, Jamieson P, Bruce Z, Lim YC, Offenhauser C, Charmsaz S, Cooper L, Ellacott J, Harding A, Lickliter J, Inglis P, Reynolds B, Walker D, Lackmann M, Boyd A, Berezovsky A, Poisson L, Hasselbach L, Irtenkauf S, Transou A, Mikkelsen T, deCarvalho AC, Emlet D, Del Vecchio C, Gupta P, Li G, Skirboll S, Wong A, Figueroa J, Shahar T, Hossain A, Lang F, Fouse S, Nakamura J, James CD, Chang S, Costello J, Frerich JM, Rahimpour S, Zhuang Z, Heiss JD, Golebiewska A, Stieber D, Evers L, Lenkiewicz E, Brons NHC, Nicot N, Oudin A, Bougnaud S, Hertel F, Bjerkvig R, Barrett M, Vallar L, Niclou SP, Hao X, Rahn J, Ujack E, Lun X, Cairncross G, Weiss S, Senger D, Robbins S, Harness J, Lerner R, Ihara Y, Santos R, Torre JDL, Lu A, Ozawa T, Nicolaides T, James D, Petritsch C, Higgins D, Schroeder M, Ball B, Milligan B, Meyer F, Sarkaria J, Henley J, Flavahan W, Wu Q, Hitomi M, Rahim N, Kim Y, Sloan A, Weil R, Nakano I, Sarkaria J, Stringer B, Li M, Lathia J, Rich J, Hjelmeland A, Kaluzova M, Platt S, Kent M, Bouras A, Machaidze R, Hadjipanayis C, Kang SG, Kim SH, Huh YM, Kim EH, Park EK, Chang JH, Kim SH, Hong YK, Kim DS, Lee SJ, Kim EH, Kang SG, Hitomi M, Deleyrolle L, Sinyuk M, Li M, Goan W, Otvos B, Rohaus M, Oli M, Vedam-Mai V, Schonberg D, Wu Q, Rich J, Reynolds B, Lathia J, Lee ST, Chu K, Kim SH, Lee SK, Kim M, Roh JK, Lerner R, Griveau A, Ihara Y, Reichholf B, McMahon M, Rowitch D, James D, Petritsch C, Nitta R, Mitra S, Agarwal M, Bui T, Li G, Lin J, Adamson C, Martinez-Quintanilla J, Choi SH, Bhere D, Heidari P, He D, Mahmood U, Shah K, Mitra S, Gholamin S, Feroze A, Achrol A, Kahn S, Weissman I, Cheshier S, Nakano I, Sulman EP, Wang Q, Mostovenko E, Liu H, Lichti CF, Shavkunov A, Kroes RA, Moskal JR, Conrad CA, Lang FF, Emmett MR, Nilsson CL, Osuka S, Sampetrean O, Shimizu T, Saga I, Onishi N, Sugihara E, Okubo J, Fujita S, Takano S, Matsumura A, Saya H, Saito N, Fu J, Wang S, Yung WKA, Koul D, Schmid RS, Irvin DM, Vitucci M, Bash RE, Werneke AM, Miller CR, Shinojima N, Hossain A, Takezaki T, Fueyo J, Gumin J, Gao F, Nwajei F, Marini FC, Andreeff M, Kuratsu JI, Lang FF, Singh S, Burrell K, Koch E, Agnihotri S, Jalali S, Vartanian A, Gumin J, Sulman E, Lang F, Wouters B, Zadeh G, Spelat R, Singer E, Matlaf L, McAllister S, Soroceanu L, Spiegl-Kreinecker S, Loetsch D, Laaber M, Schrangl C, Wohrer A, Hainfellner J, Marosi C, Pichler J, Weis S, Wurm G, Widhalm G, Knosp E, Berger W, Takezaki T, Shinojima N, Kuratsu JI, Lang F, Tam Q, Tanaka S, Nakada M, Yamada D, Nakano I, Todo T, Hayashi Y, Hamada JI, Hirao A, Tilghman J, Ying M, Laterra J, Venere M, Chang C, Wu Q, Summers M, Rosenfeld S, Rich J, Tanaka S, Luk S, Chang C, Iafrate J, Cahill D, Martuza R, Rabkin S, Chi A, Wakimoto H, Wirsching HG, Krishnan S, Frei K, Krayenbuhl N, Reifenberger G, Weller M, Tabatabai G, Man J, Shoemake J, Venere M, Rich J, Yu J. STEM CELLS. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not190] [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: 11/13/2022] Open
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Agarwal M, Nitta R, Dovat S, Li G, Arita H, Narita Y, Fukushima S, Tateishi K, Matsushita Y, Yoshida A, Miyakita Y, Ohno M, Collins VP, Kawahara N, Shibui S, Ichimura K, Kahn SA, Gholamin S, Junier MP, Chneiweiss H, Weissman I, Mitra S, Cheshier S, Avril T, Hamlat A, Le Reste PJ, Mosser J, Quillien V, Carrato C, Munoz-Marmol A, Serrano L, Pijuan L, Hostalot C, Villa SL, Ariza A, Etxaniz O, Balana C, Benveniste ET, Zheng Y, McFarland B, Drygin D, Bellis S, Bredel M, Lotsch D, Engelmaier C, Allerstorfer S, Grusch M, Pichler J, Weis S, Hainfellner J, Marosi C, Spiegl-Kreinecker S, Berger W, Bronisz A, Nowicki MO, Wang Y, Ansari K, Chiocca EA, Godlewski J, Brown K, Kwatra M, Brown K, Kwatra M, Bui T, Nitta R, Li G, Zhu S, Kozono D, Li J, Kushwaha D, Carter B, Chen C, Schulte J, Srikanth M, Das S, Zhang J, Lathia J, Yin L, Rich J, Olson E, Kessler J, Chenn A, Cherry A, Haas B, Lin YH, Ong SE, Stella N, Cifarelli CP, Griffin RJ, Cong D, Zhu W, Shi Y, Clark P, Kuo J, Hu S, Sun D, Bookland M, Darbinian N, Dey A, Robitaille M, Remke M, Faury D, Maier C, Malhotra A, Jabado N, Taylor M, Angers S, Kenney A, Ren X, Zhou H, Schur M, Baweja A, Singh M, Erdreich-Epstein A, Fu J, Koul D, Yao J, Saito N, Zheng S, Verhaak R, Lu Z, Yung WKA, Gomez G, Volinia S, Croce C, Brennan C, Cavenee W, Furnari F, Lopez SG, Qu D, Petritsch C, Gonzalez-Huarriz M, Aldave G, Ravi D, Rubio A, Diez-Valle R, Marigil M, Jauregi P, Vera B, Rocha AADL, Tejada-Solis S, Alonso MM, Gopal U, Isaacs J, Gruber-Olipitz M, Dabral S, Ramkissoon S, Kung A, Pak E, Chung J, Theisen M, Sun Y, Monrose V, Franchetti Y, Sun Y, Shulman D, Redjal N, Tabak B, Beroukhim R, Zhao J, Buonamici S, Ligon K, Kelleher J, Segal R, Haas B, Canton D, Diaz P, Scott J, Stella N, Hara K, Kageji T, Mizobuchi Y, Kitazato K, Okazaki T, Fujihara T, Nakajima K, Mure H, Kuwayama K, Hara T, Nagahiro S, Hill L, Botfield H, Hossain-Ibrahim K, Logan A, Cruickshank G, Liu Y, Gilbert M, Kyprianou N, Rangnekar V, Horbinski C, Hu Y, Vo C, Li Z, Ke C, Ru N, Hess KR, Linskey ME, Zhou YAH, Hu F, Vinnakota K, Wolf S, Kettenmann H, Jackson PJ, Larson JD, Beckmann DA, Moriarity BS, Largaespada DA, Jalali S, Agnihotri S, Singh S, Burrell K, Croul S, Zadeh G, Kang SH, Yu MO, Song NH, Park KJ, Chi SG, Chung YG, Kim SK, Kim JW, Kim JY, Kim JE, Choi SH, Kim TM, Lee SH, Kim SK, Park SH, Kim IH, Park CK, Jung HW, Koldobskiy M, Ahmed I, Ho G, Snowman A, Raabe E, Eberhart C, Snyder S, Agnihotri S, Gugel I, Remke M, Bornemann A, Pantazis G, Mack S, Shih D, Sabha N, Taylor M, Tatagiba M, Zadeh G, Krischek B, Schulte A, Liffers K, Kathagen A, Riethdorf S, Westphal M, Lamszus K, Lee JS, Xiao J, Patel P, Schade J, Wang J, Deneen B, Erdreich-Epstein A, Song HR, Leiss L, Gjerde C, Saed H, Rahman A, Lellahi M, Enger PO, Leung R, Gil O, Lei L, Canoll P, Sun S, Lee D, Ho ASW, Pu JKS, Zhang XQ, Lee NP, Dat PJR, Leung GKK, Loetsch D, Steiner E, Holzmann K, Spiegl-Kreinecker S, Pirker C, Hlavaty J, Petznek H, Hegedus B, Garay T, Mohr T, Sommergruber W, Grusch M, Berger W, Lukiw WJ, Jones BM, Zhao Y, Bhattacharjee S, Culicchia F, Magnus N, Garnier D, Meehan B, McGraw S, Hashemi M, Lee TH, Milsom C, Gerges N, Jabado N, Trasler J, Pawlinski R, Mackman N, Rak J, Maherally Z, Thorne A, An Q, Barbu E, Fillmore H, Pilkington G, Maherally Z, Tan SL, Tan S, An Q, Fillmore H, Pilkington G, Malhotra A, Choi S, Potts C, Ford DA, Nahle Z, Kenney AM, Matlaf L, Khan S, Zider A, Singer E, Cobbs C, Soroceanu L, McFarland BC, Hong SW, Rajbhandari R, Twitty GB, Gray GK, Yu H, Benveniste EN, Nozell SE, Minata M, Kim S, Mao P, Kaushal J, Nakano I, Mizowaki T, Sasayama T, Tanaka K, Mizukawa K, Nishihara M, Nakamizo S, Tanaka H, Kohta M, Hosoda K, Kohmura E, Moeckel S, Meyer K, Leukel P, Bogdahn U, Riehmenschneider MJ, Bosserhoff AK, Spang R, Hau P, Mukasa A, Watanabe A, Ogiwara H, Saito N, Aburatani H, Mukherjee J, Obha S, See W, Pieper R, Nakajima K, Hara K, Kageji T, Mizobuchi Y, Kitazato K, Fujihara T, Otsuka R, Kung D, Nagahiro S, Rajbhandari R, Sinha T, Meares G, Benveniste EN, Nozell S, Ott M, Litzenburger U, Rauschenbach K, Bunse L, Pusch S, Ochs K, Sahm F, Opitz C, von Deimling A, Wick W, Platten M, Peruzzi P, Chiocca EA, Godlewski J, Read R, Fenton T, Gomez G, Wykosky J, Vandenberg S, Babic I, Iwanami A, Yang H, Cavenee W, Mischel P, Furnari F, Thomas J, Ronellenfitsch MW, Thiepold AL, Harter PN, Mittelbronn M, Steinbach JP, Rybakova Y, Kalen A, Sarsour E, Goswami P, Silber J, Harinath G, Aldaz B, Fabius AWM, Turcan S, Chan TA, Huse JT, Sonabend AM, Bansal M, Guarnieri P, Lei L, Soderquist C, Leung R, Yun J, Kennedy B, Sisti J, Bruce S, Bruce R, Shakya R, Ludwig T, Rosenfeld S, Sims PA, Bruce JN, Califano A, Canoll P, Stockhausen MT, Kristoffersen K, Olsen LS, Poulsen HS, Stringer B, Day B, Barry G, Piper M, Jamieson P, Ensbey K, Bruce Z, Richards L, Boyd A, Sufit A, Burleson T, Le JP, Keating AK, Sundstrom T, Varughese JK, Harter P, Prestegarden L, Petersen K, Azuaje F, Tepper C, Ingham E, Even L, Johnson S, Skaftnesmo KO, Lund-Johansen M, Bjerkvig R, Ferrara K, Thorsen F, Takeshima H, Yamashita S, Yokogami K, Mizuguchi S, Nakamura H, Kuratsu J, Fukushima T, Morishita K, Tanaka H, Sasayama T, Tanaka K, Nakamizo S, Mizukawa K, Kohmura E, Tang Y, Vaka D, Chen S, Ponnuswami A, Cho YJ, Monje M, Tateishi K, Narita Y, Nakamura T, Cahill D, Kawahara N, Ichimura K, Tiemann K, Hedman H, Niclou SP, Timmer M, Tjiong R, Rohn G, Goldbrunner R, Timmer M, Tjiong R, Stavrinou P, Rohn G, Perrech M, Goldbrunner R, Tokita M, Mikheev S, Sellers D, Mikheev A, Kosai Y, Rostomily R, Tritschler I, Seystahl K, Schroeder JJ, Weller M, Wade A, Robinson AE, Phillips JJ, Gong Y, Ma Y, Cheng Z, Thompson R, Wang J, Fan QW, Cheng C, Gustafson W, Charron E, Zipper P, Wong R, Chen J, Lau J, Knobbe-Thosen C, Weller M, Jura N, Reifenberger G, Shokat K, Weiss W, Wu S, Fu J, Zheng S, Koul D, Yung WKA, Wykosky J, Hu J, Taylor T, Villa GR, Gomez G, Mischel PS, Gonias SL, Cavenee W, Furnari F, Yamashita D, Kondo T, Takahashi H, Inoue A, Kohno S, Harada H, Ohue S, Ohnishi T, Li P, Ng J, Yuelling L, Du F, Curran T, Yang ZJ, Zhu D, Castellino RC, Van Meir EG, Zhu W, Begum G, Wang Q, Clark P, Yang SS, Lin SH, Kahle K, Kuo J, Sun D. CELL BIOLOGY AND SIGNALING. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not174] [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: 11/14/2022] Open
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Torres X, Collado A, Gomez E, Arias A, Cabrera-Villalba S, Messina OD, Vidal LF, Clark P, Ríos C, Salomón PA. SAT0389 Validation of the Spanish Version of the Fibromyalgia Rapid Screening Tool (First). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Borgström F, Lekander I, Ivergård M, Ström O, Svedbom A, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lesnyak O, McCloskey E, Nassonov E, Sanders KM, Silverman S, Tamulaitiene M, Thomas T, Tosteson ANA, Jönsson B, Kanis JA. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture. Osteoporos Int 2013; 24:811-23. [PMID: 23306819 DOI: 10.1007/s00198-012-2240-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. INTRODUCTION The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. METHODS ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. RESULTS The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. CONCLUSIONS The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.
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Affiliation(s)
- F Borgström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
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Colling D, Britton D, Gordon J, Lloyd S, Doyle A, Gronbech P, Coles J, Sansum A, Patrick G, Jones R, Middleton R, Kelsey D, Cass A, Geddes N, Clark P, Barnby L. Processing LHC data in the UK. Philos Trans A Math Phys Eng Sci 2013; 371:20120094. [PMID: 23230163 PMCID: PMC3538294 DOI: 10.1098/rsta.2012.0094] [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] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Large Hadron Collider (LHC) is one of the greatest scientific endeavours to date. The construction of the collider itself and the experiments that collect data from it represent a huge investment, both financially and in terms of human effort, in our hope to understand the way the Universe works at a deeper level. Yet the volumes of data produced are so large that they cannot be analysed at any single computing centre. Instead, the experiments have all adopted distributed computing models based on the LHC Computing Grid. Without the correct functioning of this grid infrastructure the experiments would not be able to understand the data that they have collected. Within the UK, the Grid infrastructure needed by the experiments is provided by the GridPP project. We report on the operations, performance and contributions made to the experiments by the GridPP project during the years of 2010 and 2011--the first two significant years of the running of the LHC.
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Affiliation(s)
- D Colling
- Department of Physics, Imperial College London, Blackett Laboratory, Prince Consort Road, London SW7 2BW, UK.
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Abstract
BACKGROUND Fetal growth restriction (FGR) is associated with thrombosis of the placenta and an increased risk of subsequent vascular disease in the mother and fetus. The products of interactions between ABO(H), Lewis and Secretor genes are also associated with thrombosis and vascular disease risk. OBJECTIVES/METHODS A prospective case-control study of mothers with a severe FGR pregnancy (cases, n = 128; controls, n = 288) was performed to determine whether FGR is associated with particular maternal blood groups. RESULTS No association with ABO(H) status was observed, but FGR was more common in maternal secretors (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.08-2.69) and consequently in those mothers expressing Le(b) on their red cells (OR 1.80, 95% CI 1.15-2.83), with a reduced risk in non-secretors and those expressing Le(a). Given the association between blood groups and both activated protein C resistance (APCR) and von Willebrand factor (VWF) levels, post hoc pilot studies on first-trimester APCR and VWF antigen levels and blood group genotypes were performed. No relationship with Lewis or Secretor was observed. Despite this, lower first-trimester VWF levels were observed in pregnancies subsequently complicated by FGR. CONCLUSIONS This is the first study reporting a relationship between maternal Secretor/Lewis status and FGR. A link between blood groups and FGR is plausible, as both are associated with cardiovascular disease. We observed no relationship between Lewis/Secretor status and VWF or APCR, but this should be confirmed in a larger study. Thus, the mechanism whereby Secretor and/or Lewis influences FGR is unknown.
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Affiliation(s)
- P Clark
- Department of Transfusion Medicine, Ninewells Hospital and Medical School, Dundee University of Liverpool, Liverpool, UK.
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Furnari F, Fenton T, Nathanson D, de Alberquerque CP, Kuga D, Wanami A, Dang J, Yang H, Tanaka K, Gao L, Oba-Shinjo S, Uno M, Inda MDM, Bachoo R, James CD, DePinho R, Vandenberg S, Zhou H, Marie S, Mischel P, Cavenee W, Szerlip N, Pedraza A, Huse J, Mikkelsen T, Brennan C, Szerlip N, Castellani RJ, Ivanova S, Gerzanich VV, Simard JM, Ito M, See W, Mukherjee J, Ohba S, Tan IL, Pieper RO, Lukiw WJ, Culicchia F, Pogue A, Bhattacharjee S, Zhao Y, Proescholdt MA, Merrill M, Storr EM, Lohmeier A, Brawanski A, Abraham S, Jensen R, Khatua S, Gopal U, Du J, He F, Golub T, Isaacs JS, Dietrich J, Kalogirou-Valtis Y, Ly I, Scadden D, Proschel C, Mayer-Proschel M, Rempel SA, Schultz CR, Golembieski W, Brodie C, Mathew LK, Skuli N, Mucaj V, Imtiyaz HZ, Venneti S, Lal P, Zhang Z, Davuluri RV, Koch C, Evans S, Simon MC, Ranganathan P, Clark P, Salamat S, Kuo JS, Kalejta RF, Bhattacharjee B, Renzette N, Moser RP, Kowalik TF, McFarland BC, Ma JY, Langford CP, Gillespie GY, Yu H, Zheng Y, Nozell SE, Huszar D, Benveniste EN, Lawrence JE, Cook NJ, Rovin RA, Winn RJ, Godlewski JA, Ogawa D, Bronisz A, Lawler S, Chiocca EA, Lee SX, Wong ET, Swanson KD, Liu KW, Feng H, Bachoo R, Kazlauskas A, Smith EM, Symes K, Hamilton RL, Nagane M, Nishikawa R, Hu B, Cheng SY, Silber J, Jacobsen A, Ozawa T, Harinath G, Brennan CW, Holland EC, Sander C, Huse JT, Sengupta R, Dubuc A, Ward S, Yang L, Northcott P, Kroll K, Taylor M, Wechsler-Reya R, Rubin J, Chu WT, Lee HT, Huang FJ, Aldape K, Yao J, Steeg PS, Lu Z, Xie K, Huang S, Sim H, Agudelo-Garcia PA, Hu B, Viapiano MS, Hu B, Agudelo-Garcia PA, Saldivar J, Sim H, Dolan C, Mora M, Nuovo G, Cole S, Viapiano MS, Stegh AH, Ryu MJ, Liu Y, Du J, Zhong X, Marwaha S, Li H, Wang J, Salamat S, Chang Q, Zhang J, Ng HK, Yang L, Poon WS, Zhou L, Pang JC, Chan A, Didier S, Kwiatkowska A, Ennis M, Fortin S, Rushing E, Eschbacher J, Tran N, Symons M, Roldan G, McIntyre JB, Easaw J, Magliocco A, Wykosky J, Cavenee W, Furnari F, Lu D, Mreich E, Chung S, Teo C, Wheeler H, McDonald KL, Lawn S, Forsyth P, Sonabend AM, Lei L, Kennedy B, Soderquist C, Guarnieri P, Leung R, Yun J, Sisti J, Castelli M, Bruce S, Bruce R, Ludwig T, Rosenfeld S, Bruce JN, Canoll P, Lamszus K, Schulte A, Gunther HS, Riethdorf S, Phillips HS, Westphal M, Siegal T, Zrihan D, Granit A, Lavon I, Singh M, Chandra J, Ogawa D, Nakashima H, Godlewski J, Chiocca AE, Kapoor GS, Poptani H, Ittyerah R, O'Rourke DM, Sadraei NH, Burgett M, Ahluwalia M, Tipps R, Khosla D, Weil R, Nowacki A, Prayson R, Shi T, Gladson C, Moeckel S, Meyer K, Bosserhoff A, Spang R, Leukel P, Vollmann A, Jachnick B, Stangl C, Proescholdt M, Bogdahn U, Hau P, Kaur G, Sun M, Kaur R, Bloch O, Jian B, Parsa AT, Hossain A, Shinojima N, Gumin J, Feng G, Lang FF, Li L, Yang CR, Chakraborty S, Hatanpaa K, Chauncey S, Jiwani A, Habib A, Nguyen T, Nakashima H, Chiocca EA, Munson J, Machaidze R, Kaluzova M, Bellamkonda R, Hadjipanayis CG, Zhang Y, McFarland B, Bredel M, Benveniste EN, Lee SH, Zerrouqi A, Khwaja F, Devi NS, Van Meir EG, Haseley A, Boone S, Wojton J, Yu L, Kaur B, Wojton JA, Naduparambil J, Denton N, Chakravarti A, Kaur B, Conrad CA, Wang X, Sheng X, Nilsson C, Marshall AG, Emmett MR, Hu Y, Mark L, Zhou YHZ, Dhruv H, McDonough W, Tran N, Armstrong B, Tuncali S, Eschbacher J, Kislin K, Berens M, Plas D, Gallo C, Stringer K, Kendler A, McPherson C, Castelli MA, Ellis JA, Assanah M, Bruce JN, Canoll P, Ogden A, Liang J, Piao Y, deGroot JF, Gordon N, Patel D, Chakravarti A, Palanichamy K, Hervey-Jumper S, Wang A, He X, Zhu T, Heth J, Muraszko K, Fan X, Nakashima H, Nguyen T, Chiocca EA, Liu WM, Huang P, Rani S, Stettner MR, Jerry S, Dai Q, Kappes J, Tipps R, Gladson CL, Chakravarty D, Pedraza A, Koul D, Alfred Yung WK, Brennan CW, Jensen SA, Luciano J, Calvert A, Nagpal V, Stegh A, Kang SH, Yu MO, Lee MG, Chi SG, Chung YG, Cooper MK, Valadez JG, Grover VK, Kouri FM, Chin L, Stegh AH, Ahluwalia MS, Khosla D, Weil RJ, McGraw M, Huang P, Prayson R, Nowacki A, Barnett GH, Gladson C, Kang C, Zou J, Lan F, Yue X, Shi Z, Zhang K, Han L, Pu P, Seaman BF, Tran ND, McDonough W, Dhruv H, Kislin K, Berens M, Battiste JD, Sirasanagandla S, Maher EA, Bachoo R, Sugiarto S, Persson A, Munoz EG, Waldhuber M, Vandenberg S, Stallcup W, Philips J, Berger MS, Bergers G, Weiss WA, Petritsch C. CELL BIOLOGY AND SIGNALING. Neuro Oncol 2011; 13:iii10-iii25. [PMCID: PMC3199169 DOI: 10.1093/neuonc/nor148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
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Clark P. 69 INVITED Drug Availability in England – the Health Economics and Politics of Drugs for Advanced Renal Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thomas DR, Cann KF, Evans MR, Roderick J, Browning M, Birley HDL, Curley W, Clark P, Northey G, Caple S, Lyons M. The public health response to the re-emergence of syphilis in Wales, UK. Int J STD AIDS 2011; 22:488-92. [DOI: 10.1258/ijsa.2011.011048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During the 1990s, cases of infectious syphilis were uncommon in Wales. In 2002, an outbreak occurred in a sexual network of men who have sex with men (MSM) attending a sauna. A multidisciplinary outbreak control team was convened to raise awareness of the outbreak among MSM and health professionals, assess the extent of outbreak, and initiate surveillance measures. It is likely that early intensive control efforts dampened the epidemic curve. However, since 2006 the number of cases has increased steadily to a peak of four cases per 100,000 population in 2008. The majority of cases continue to occur in MSM (81% in 2009) and in those attending genitourinary (GU) medicine clinics in south east Wales (76%). Traditional sexual networks such as saunas, bars/clubs and cruising grounds remain frequently reported, but Internet-based networks are assuming increasing importance. Public health interventions have been sustained, using traditional partner notification, health promotion initiatives, and more innovative Internet network tracing methods.
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Affiliation(s)
- D Rh Thomas
- Public Health Wales Communicable Disease Surveillance Centre, Cardiff
| | - K F Cann
- Public Health Wales Communicable Disease Surveillance Centre, Cardiff
| | - M R Evans
- Public Health Wales Communicable Disease Surveillance Centre, Cardiff
| | - J Roderick
- Department of Genitourinary Medicine, Cardiff and Vale Local Health Board, Cardiff
| | - M Browning
- Department of Genitourinary Medicine, Cardiff and Vale Local Health Board, Cardiff
| | - H D L Birley
- Department of Genitourinary Medicine, Cardiff and Vale Local Health Board, Cardiff
| | - W Curley
- Terrence Higgins Trust Cymru, Cardiff
| | - P Clark
- Terrence Higgins Trust Cymru, Cardiff
| | - G Northey
- Public Health Wales Communicable Disease Surveillance Centre, Cardiff
| | - S Caple
- Public Health Wales Health Protection Services, Cardiff, UK
| | - M Lyons
- Public Health Wales Health Protection Services, Cardiff, UK
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Johansson H, Clark P, Carlos F, Oden A, McCloskey EV, Kanis JA. Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security. Osteoporos Int 2011; 22:2359-64. [PMID: 21174191 DOI: 10.1007/s00198-010-1475-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 10/12/2010] [Indexed: 01/28/2023]
Abstract
UNLABELLED This study, characterising the incidence of hip fracture in Mexico, showed that age- and sex-specific rates increased between 2000 and 2006. The demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 in 2050. If the age-specific incidence of hip fracture continues, the number of hip fractures would increase by a further 46%. INTRODUCTION The aim of the present study was to determine time trends, if any, in hip fracture rates for Mexico and to forecast the number of hip fractures expected in Mexico over the coming years up to 2050. METHODS All hip fracture cases registered during the years 2000-2006 were collected at all the second and tertiary-care hospitals across the country from one of the largest health systems in Mexico, The Instituto Mexicano del Seguro Social (IMSS). RESULTS Between the years 2000 and 2006, the age-specific incidence of hip fracture increased significantly both for men and women by 1% per year (p = 0.016 and p < 0.001, respectively). In 2005, there were there were 29,732 hip fractures estimated in Mexico, 68% of which were found in women. Assuming no change in the age- and sex-specific incidence of hip fracture, the number of hip fractures was expected to increase markedly with time to 155,874 in 2050. Assuming that the age-specific incidence continues, the number of hip fractures in men and women would increase by a further 46% to 226,886 in 2050. CONCLUSION Demographic changes estimated for Mexico indicate that the annual number of hip fractures will rise from 29,732 in 2005 to 155,874 expected in 2050. If the age-specific incidence of hip fracture continues to rise, the number of hip fractures would increase by a further 46%.
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Affiliation(s)
- H Johansson
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Anderson PJ, Watts H, Hille C, Philpott K, Clark P, Gentleman MCS, Jen LS. Glial and endothelial blood-retinal barrier responses to amyloid-beta in the neural retina of the rat. Clin Ophthalmol 2011; 2:801-16. [PMID: 19668434 PMCID: PMC2699783 DOI: 10.2147/opth.s3967] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The effects of an intravitreal or subretinal injection of soluble or aggregated forms of Abeta(1-42) on retinal nestin-immunoreactivity (-IR) and glial fibrillary acidic protein (GFAP)-IR in astrocytes and Müller glial cells and the integrity of the blood-retinal barrier (BRB) were tested in the in vivo rat vitreal-retinal model. Retinas were exposed for 1, 2, 3, 5 or 30 days. We present novel data demonstrating that aggregated Abeta(1-42) up-regulates nestin-IR in astrocytes and Müller cells, with a graded response directly related to the length of pre-injection aggregation time. Similar results were obtained with GFAP-IR, but the signal was weaker. An intravitreal injection of aggregated Abeta(1-42) led to VEGF-IR up-regulation, particularly in the GCL and to a lesser extent in the INL. VEGFR1-IR (Flt1) was also increased, particularly in Müller cells and this was accompanied by marked leakage of albumin into the retinal parenchyma of the injected eye, but not in the contralateral eye.
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Clark P, Gentile MJ, Helfenstein M, Jannaut MJ, Liendo V, Ríos C, Vidal Neira L, Messina OD. [Diagnosis and pharmacological and nonpharmacological treatment of fibromyalgia. Compendium of the best evidence]. Drugs Today (Barc) 2011; 47 Suppl A:1-28. [PMID: 21716964 DOI: 10.1358/dot.2011.47(suppl.a).1619953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic generalized musculoskeletal pain is one of the most common reasons for consultation in daily medical practice, and it poses a diagnostic and therapeutic challenge. Fibromyalgia is one of the so-called central sensitization syndromes, mainly characterized by generalized pain in the musculoskeletal system. Fibromyalgia diagnosis is basically clinical, and it should be considered whenever patients complain of generalized pain. Patients with chronic inflammatory diseases may also suffer from fibromyalgia, and this condition may be the reason for the pain they complain of in medical consultations. The aim of this review paper has been to provide our readers with a summary of the best available evidence about this disease based upon an updated review of scientific literature on fibromyalgia aspects, such as its diagnostic criteria, pathophysiology, clinical profile and differential diagnosis, followed by an ample systematic review of its pharmacological and non-pharmacological aspects. This systematic review analyses the multidisciplinary aspects in which sufficient evidence was found in the two strongest types of clinical research design, 1) controlled clinical trials and 2) systematic reviews or meta-analysis. This review was developed by a group of Latin American specialists from several countries, recognized as a group of experts in fibromyalgia study.
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Affiliation(s)
- P Clark
- Unidad de Epidemiología, Clínica HIMFG, Facultad de Medicina, UNAM, México DF, México
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Ngo S, Barber N, Jacklin A, Clark P. Time taken to produce dispensing labels in hospital pharmacies, and factors affecting it. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.1992.tb00567.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
The time taken in hospital pharmacies to produce labels for individual patients' medication was measured, and factors affecting the labelling process investigated. Labelling time was measured by direct observation using a stopclock at randomly chosen semi-stratified time periods. Four combinations of major London hospitals and computer systems were studied. The time to produce 2,167 labels was measured and 59 operators were observed. There were significant differences in average labelling time between the studied hospitals/systems (16.6 to 39.3 seconds per label). Operators' experience with their system and the occurrence of interruptions were found to affect labelling significantly (P<0.0001 in both cases). There was an overall trend for labelling time to decrease with increasing experience (P<0.0001), and interruptions added 11 to 12 seconds on average. Operator experience also affected the rate and duration of interruptions, which subsequently affected labelling time. Fewer interruptions occurred with more experienced staff (P=0.0015) and when interrupted, they took less time than inexperienced staff to complete the labelling process. A performance indicator of person-days per 100,000 labels varied from 62.3 to 147.6. Pharmacy managers should be aware that there are significant differences in performance using different labelling systems and that staff training and systems of work may have a marked effect on labelling time.
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Affiliation(s)
- S Ngo
- Pharmacy Department, Hammersmith Hospital, London
| | - N Barber
- School of Pharmacy, University of London
| | - A Jacklin
- Pharmacy Department, Hammersmith Hospital, London
| | - P Clark
- Department of Medical Physics, Royal Postgraduate Medical School, University of London statistician
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