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Lenthall R, Flynn P, White P. World federation for interventional stroke treatment (WIST) multispecialty training guidelines for endovascular stroke intervention: UK neurointerventional group (UKNG) commentary. Clin Radiol 2023; 78:848-850. [PMID: 37652794 DOI: 10.1016/j.crad.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Affiliation(s)
- R Lenthall
- NUH NHS Trust, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK.
| | - P Flynn
- Royal Victoria Hospital, Belfast, UK
| | - P White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Kumari S, Karikios D, Yeghiaian-Alvandi R, Flynn P, Morgan L, Kay L, Ding P. Treatment patterns and long-term survival outcomes for patients with stage III non-small cell lung cancer: A retrospective study. Asia Pac J Clin Oncol 2023. [PMID: 36722413 DOI: 10.1111/ajco.13937] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/26/2022] [Accepted: 01/07/2023] [Indexed: 02/02/2023]
Abstract
AIM Lung cancer is the leading cause of cancer-related deaths in Australia with poor long-term survival outcomes. Stage III non-small cell lung cancer (NSCLC) is a highly heterogenous group with diverse tumor characteristics and multiple, possible treatment options. We present retrospective data on patient characteristics, treatment patterns, and long-term outcomes in stage III NSCLC patients treated at a single cancer center in New South Wales, Australia. METHODS Stage III NSCLC patients were identified from the 'Nepean Cancer Research Biobank'. Patient demographics, cancer-related information, and long-term follow-up data were collected and analyzed. RESULTS A total of 88 patients were eligible for analysis with 61% of them diagnosed as stage IIIA, 35% IIIB, and 4% IIIC. Induction chemotherapy was administered in 20% of the patients. Overall, 48% of the study population underwent surgery, and 38% underwent concurrent chemoradiotherapy (CCRT). Both median progression-free survival and overall survival (OS) were superior in stage IIIA patients in comparison to stage IIIB (and IIIC) patients (22 vs. 11 months, p = .018; and 58 vs. 19 months, p = .048, respectively). Patients who were younger (<65 years old), good Eastern Cooperative Oncology Group performance status (ECOG PS <2), and females had better prognosis on univariate analysis. There was a nonstatistically significant trend toward better median OS with CCRT in comparison to surgery (58 vs. 37 months, p = .87). CONCLUSIONS Long-term outcomes remain poor, and hence better treatment strategies are urgently needed in stage III NSCLC. Equally, more robust, prospective studies would help delineate the optimal treatment modality in these patients.
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Affiliation(s)
- Seema Kumari
- Department of Medical Oncology, Nepean Hospital Cancer Care Centre, Kingswood, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Hospital Cancer Care Centre, Kingswood, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Roland Yeghiaian-Alvandi
- Department of Radiation Oncology, Nepean Hospital Cancer Care Centre, Kingswood, New South Wales, Australia
| | - Peter Flynn
- Surgical Department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Lucy Morgan
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Lisa Kay
- Nepean Cancer Research Biobank, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Pei Ding
- Department of Medical Oncology, Nepean Hospital Cancer Care Centre, Kingswood, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
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Gerak LR, Maguire DR, Cami-Kobeci G, Olson KM, Traynor JR, Husbands SM, France CP, Acevedo L, Belli B, Flynn P. OREX-1038: a potential new treatment for pain with low abuse liability and limited adverse effects. Behav Pharmacol 2022; 33:377-394. [PMID: 35947066 PMCID: PMC9371589 DOI: 10.1097/fbp.0000000000000684] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Drugs targeting mu opioid receptors are the mainstay of clinical practice for treating moderate-to-severe pain. While they can offer excellent analgesia, their use can be limited by adverse effects, including constipation, respiratory depression, tolerance, and abuse liability. Multifunctional ligands acting at mu opioid and nociceptin/orphanin FQ peptide receptors might provide antinociception with substantially improved adverse-effect profiles. This study explored one of these ligands, OREX-1038 (BU10038), in several assays in rodents and nonhuman primates. Binding and functional studies confirmed OREX-1038 to be a low-efficacy agonist at mu opioid and nociceptin/orphanin FQ peptide receptors and an antagonist at delta and kappa opioid receptors with selectivity for opioid receptors over other proteins. OREX-1038 had long-acting antinociceptive effects in postsurgical and complete Freund's adjuvant (CFA)-induced thermal hyperalgesia assays in rats and a warm water tail-withdrawal assay in monkeys. OREX-1038 was active for at least 24 h in each antinociception assay, and its effects in monkeys did not diminish over 22 days of daily administration. This activity was coupled with limited effects on physiological signs (arterial pressure, heart rate, and body temperature) and no evidence of withdrawal after administration of naltrexone or discontinuation of treatment in monkeys receiving OREX-1038 daily. Over a range of doses, OREX-1038 was only transiently self-administered, which diminished rapidly to nonsignificant levels; overall, both OREX-1038 and buprenorphine maintained less responding than remifentanil. These results support the concept of dual mu and nociceptin/orphanin FQ peptide receptor partial agonists having improved pharmacological profiles compared with opioids currently used to treat pain.
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Affiliation(s)
- Lisa R Gerak
- Department of Pharmacology, University of Texas Health Science Center at San Antonio
- Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David R Maguire
- Department of Pharmacology, University of Texas Health Science Center at San Antonio
- Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Gerta Cami-Kobeci
- Department of Pharmacy and Pharmacology, University of Bath, Bath
- Current address: School of Life Sciences, University of Bedfordshire, Luton, UK
| | - Keith M Olson
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John R Traynor
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Stephen M Husbands
- Department of Pharmacy and Pharmacology, University of Bath, Bath
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Charles P France
- Department of Pharmacology, University of Texas Health Science Center at San Antonio
- Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Barbara Belli
- Orexigen Therapeutics Inc., La Jolla, California, USA
| | - Peter Flynn
- Orexigen Therapeutics Inc., La Jolla, California, USA
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Ramsay S, Spence R, Robinson R, Bhattacharya D, Nelson A, Flynn P, Droogan A, Hughes S, Kennedy F, McDonnell G. 101 The importance of the multidisciplinary team (MDT) in the management of patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundClinical decision-making for patients with MS relies heavily on the expertise of radiologists. In June 2018 we developed a monthly MDT meeting with neuroradiology to review complex cases. In this study, we assess the rate and clinical significance of variance between original MRI reports and those following MDT review.MethodsA 6-month retrospective study was performed. Data focused on the frequency of scan report revisions and subsequent impact on clinical management.ResultsWe analysed 157 cases. Of these, 68% had confirmed MS whilst 32% were under investigation. Of the 157, 64% were originally reported by a general radiologist and 36% by neuroradiology. Following neuroradiology review, 63 cases (40%) had the original report amended; of these, 81% were originally authored by a non-neuroradiologist. MDT review amended 64% of original reports from general radiology. The most frequently occurring revision was identification of additional, originally unreported inflammatory lesions. Of the 63 report revisions, 29% resulted in a change in clinical management. Overall, 4% of patients with a diagnosis of MS had this diagnosis questioned or reversed following MDT review of their imaging.ConclusionsThis study demonstrates a high rate of variance in MRI reporting between general and neuroradiologists. This has clear implications for patient management, confirming the importance of dedicated MDTs involving specialist neuroradiology.sramsay03@qub.ac.uk|ABN Bursary
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Robinson R, Ramsay S, Burns P, Flynn P, Herron B, Poots J, Kennedy F, Hughes S. 104 A case of natalizumab-related progressive multifocal leukoencephalopathy treated with pembrolizumab. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionProgressive multifocal leukoencephalopathy (PML) is a rare, but potentially devastating viral infection of the brain and can occur as a complication of natalizumab, a treatment for highly-active relapsing remitting multiple sclerosis (RRMS).Case: Patient A is 52-years-old, diagnosed with RRMS in 2015. She commenced disease-modifying therapy with natalizumab following four clinical relapses in one year and had a stable clinical course for the subsequent 4 years. She was JCV antibody positive (titre 3.64) but had opted to continue natalizumab therapy, despite the risk of PML.Early 2020, an MRI abnormality raised suspicion for PML. In May, she developed left hand weakness, pro- gressing to left hemiparesis. Serial MRIs showed increasing signal change however, it was difficult to differ- entiate PML from new inflammatory activity. CSF JCV PCR was negative on two occasions. She proceeded to brain biopsy, confirming PML. She was treated with pembrolizumab and has remained stable.DiscussionThis case highlights the difficulty in distinguishing PML from an MS relapse, despite the use of MRI and CSF. We highlight the role of brain biopsy in making a definitive diagnosis. There is also lack of consensus on effective treatment for PML, but emerging evidence for use of pembrolizumab, a PD-1 inhibitor.rrobinson17@qub.ac.uk77
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Lenthall R, Crossley R, Clifton A, Flynn P, Goddard T, McConachie N, Mortimer A, Nejadhamzeeigilani H, Rennie A, Stockley H, White P. Current status of the credential “mechanical thrombectomy for acute ischaemic stroke” sponsored by the Royal College of Radiologists. What factors are preventing approval of training for non-radiologists to perform MT in the UK? Clin Radiol 2022; 77:561-566. [DOI: 10.1016/j.crad.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
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McCarron LV, Kelly P, McConville C, Flynn P, McCarron MO. Waxing and Waning Neuroimaging Abnormalities in Langerhans Cell Histiocytosis. Neurol Clin Pract 2022; 11:e968-e970. [PMID: 34992999 DOI: 10.1212/cpj.0000000000001120] [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] [Received: 12/29/2020] [Accepted: 06/16/2021] [Indexed: 11/15/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease in adults characterized by proliferation of CD1a+/CD207+ and S100 myeloid dendritic cells, forming granulomas.1 An inflammatory exudate is often found with “bean-shaped” nucleated histiocytes. We report a patient with multisystem (liver, lung and brain) LCH in whom neuroimaging abnormalities accumulated and partially regressed prior to definitive treatment.
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Affiliation(s)
- Luke V McCarron
- The Clinical School (LVM), University of Cambridge, UK; Department of Pathology (PK), Royal Victoria Hospital, Belfast; Department of Haematology (CM), Altnagelvin Hospital, Derry; Department of Neuroradiology (PF), Royal Victoria Hospital, Belfast; and Department of Neurology (MOM), Altnagelvin Hospital, Derry, N. Ireland
| | - Paul Kelly
- The Clinical School (LVM), University of Cambridge, UK; Department of Pathology (PK), Royal Victoria Hospital, Belfast; Department of Haematology (CM), Altnagelvin Hospital, Derry; Department of Neuroradiology (PF), Royal Victoria Hospital, Belfast; and Department of Neurology (MOM), Altnagelvin Hospital, Derry, N. Ireland
| | - Conal McConville
- The Clinical School (LVM), University of Cambridge, UK; Department of Pathology (PK), Royal Victoria Hospital, Belfast; Department of Haematology (CM), Altnagelvin Hospital, Derry; Department of Neuroradiology (PF), Royal Victoria Hospital, Belfast; and Department of Neurology (MOM), Altnagelvin Hospital, Derry, N. Ireland
| | - Peter Flynn
- The Clinical School (LVM), University of Cambridge, UK; Department of Pathology (PK), Royal Victoria Hospital, Belfast; Department of Haematology (CM), Altnagelvin Hospital, Derry; Department of Neuroradiology (PF), Royal Victoria Hospital, Belfast; and Department of Neurology (MOM), Altnagelvin Hospital, Derry, N. Ireland
| | - Mark O McCarron
- The Clinical School (LVM), University of Cambridge, UK; Department of Pathology (PK), Royal Victoria Hospital, Belfast; Department of Haematology (CM), Altnagelvin Hospital, Derry; Department of Neuroradiology (PF), Royal Victoria Hospital, Belfast; and Department of Neurology (MOM), Altnagelvin Hospital, Derry, N. Ireland
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Lim H, Medcalf A, Guerrettaz L, Choi EJ, Kim H, Yang B, Kim EJ, Lee ES, Kim JM, Kim Y, Min B, Paik SM, Nam HJ, Han S, Somanchi S, Helsel E, Litten J, Flynn P, Raymon H, Hwang YK. 129 Development of AB-201, a novel allogeneic anti-HER2-specific CAR-NK cell therapy for the treatment of HER2+ tumors. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundHuman Epidermal Growth Factor Receptor 2 (HER2), is a receptor tyrosine kinase that is highly expressed on the surface of many solid tumors. While many patients derive meaningful benefit from the approved HER2-directed therapies, most will eventually suffer relapse or progression of their disease highlighting the need for additional treatment options. Currently there are no FDA-approved cellular therapies targeting HER2. Over the past decade, however, cellular therapy has been shown to be a viable treatment option in different cancer types. Here we present AB-201, an off-the-shelf, cryopreserved cord blood (CB)-derived HER2 chimeric antigen receptor (CAR)-natural killer (NK) cell therapy as a safe, active, and readily available option for patients with HER2+ solid tumors.MethodsAB-201 is comprised of ex vivo expanded allogeneic CB-derived NK cells that have been genetically modified to express a HER2-directed CAR and presented as a cryopreserved infusion-ready product. The manufacturing process utilizes a feeder-cell line engineered to express factors specifically identified as supportive to NK cell expansion and a lentiviral transduction step to introduce the HER2 CAR construct. In vitro characterization of AB-201 included evaluation of the purity and expression of cell surface markers by flow cytometry and short- (4 hour) and long-term (over 5 days) cytotoxicity assays in the presence of HER2+ tumor cell lines at various effector to target ratios. In addition, AB-201 efficacy was assessed in vivo in established ovarian (intraperitoneal, SKOV-3), breast (intraperitoneal, HCC1954) and gastric (subcutaneous, N87) xenograft models in NSG mice.ResultsHER2 CAR expression was detected in 93.1% of AB-201 cells. AB-201 is 97.9% CD3-/CD56+ cells and 94.6% CD56+/CD16+. Further characterization of AB-201 demonstrated high expression of NK activating receptors such as NKG2D, NKp30, NKp46, and DNAM-1 and expression of the chemokine receptor, CXCR3. AB-201 demonstrated concentration-dependent and HER2 targeted short-term cytotoxic activity and sustained long-term cell killing against the tumor cell lines SKOV-3, HCC1954, and NCI-N87. Efficacy, as evidenced by a significant reduction in bioluminescent signal or tumor volume, was observed in all xenograft models. A significant survival benefit over non-transduced NK cells or trastuzumab controls was demonstrated in the HCC1954 model.ConclusionsData presented herein suggests that AB-201, a highly pure and readily expandable HER2-directed CAR NK cell product, has potential to be an effective therapy in the treatment of HER2+ tumors.Ethics ApprovalThe animal studies were conducted in accordance with an Institutional Animal Care and Use Committee-approved protocol and with the approval of an IACUC committee at each center where the studies took place
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Moseley G, Oborski Y, Mayorchak Y, Yau LA, Flynn P. Ink transfer in pre-operative marking: a patient safety issue? ANZ J Surg 2021; 90:187-188. [PMID: 32067311 DOI: 10.1111/ans.15412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Giles Moseley
- Department of Cardiothoracic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Yana Oborski
- Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Yaroslav Mayorchak
- Department of Cardiothoracic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Lee-Ann Yau
- Cardiac Services, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Peter Flynn
- Department of Cardiothoracic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
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Balami JS, Coughlan D, White PM, McMeekin P, Flynn D, Roffe C, Natarajan I, Chembala J, Nayak S, Wiggam I, Flynn P, Simister R, Sammaraiee Y, Sims D, Nader K, Dixit A, Craig D, Lumley H, Rice S, Burgess D, Foddy L, Hopkins E, Hudson B, Jones R, James MA, Buchan AM, Ford GA, Gray AM. The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study. Clin Med (Lond) 2020; 20:e40-e45. [PMID: 32414740 DOI: 10.7861/clinmed.2019-0413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK. METHOD This was a multicentre retrospective study using micro-costing methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018. RESULTS Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).The mean cost within 72 hours was £12,440 (95% CI 10,628-14,252). The total costs for the duration of inpatient care before discharge from a thrombectomy centre was £14,362 (95% CI 13,603-15,122). CONCLUSIONS Major factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.
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Affiliation(s)
- Joyce S Balami
- Centre for Evidence-Based Medicine, Oxford, UK and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Phil M White
- Newcastle University, Newcastle upon Tyne, UK and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Christine Roffe
- University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent, UK and Keele University, Keele, UK
| | - Indira Natarajan
- University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent, UK and Keele University, Keele, UK
| | - Jayan Chembala
- University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent, UK and Keele University, Keele, UK
| | - Sanjeev Nayak
- University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent, UK and Keele University, Keele, UK
| | | | | | | | | | - Don Sims
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kurdow Nader
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anand Dixit
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Newcastle University, Newcastle upon Tyne, UK
| | | | | | - David Burgess
- North East and North Cumbria Stroke Patient & Carer Panel, Newcastle upon Tyne, UK
| | - Lisa Foddy
- University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent, UK and Keele University, Keele, UK
| | | | - Beverley Hudson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachael Jones
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Alastair M Buchan
- University of Oxford, Oxford, UK and John Radcliffe Hospital, Oxford, UK
| | - Gary A Ford
- Oxford University, Oxford, UK, visiting professor, Newcastle University, Newcastle upon Tyne, UK and consultant stroke physician, John Radcliffe Hospital, Oxford, UK
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Maguire DR, Gerak LR, Cami-Kobeci G, Husbands SM, France CP, Belli B, Flynn P. OREX-1019: A Novel Treatment of Opioid Use Disorder and Relapse Prevention. J Pharmacol Exp Ther 2019; 372:205-215. [PMID: 31748404 DOI: 10.1124/jpet.119.261511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022] Open
Abstract
There is an urgent need for new pharmacological treatments for substance use disorders, including opioid use disorder, particularly for use in relapse prevention. A combination of buprenorphine with naltrexone has shown particular promise, with clinical studies indicating a substantial improvement over treatment with naltrexone alone. OREX-1019 (formerly BU10119) is a compound that mimics the pharmacology of the buprenorphine/naltrexone combination. This study evaluated, in rhesus monkeys, the therapeutic potential of OREX-1019 for treating opioid use disorder. Pretreatment with OREX-1019 (0.01-0.3 mg/kg s.c.) dose-dependently decreased responding for the μ opioid receptor agonist remifentanil in rhesus monkeys but did not maintain levels of responding above vehicle when it was available for self-administration. OREX-1019 (0.01-1.0 mg/kg s.c.) also decreased cue- plus heroin-primed reinstatement of extinguished responding in monkeys that self-administered remifentanil but did not alter cue- plus cocaine-primed reinstatement of responding in monkeys that self-administered cocaine. OREX-1019 (0.3 mg/kg s.c.), like naltrexone (0.1 mg/kg s.c.), increased heart rate and blood pressure, produced overt observable signs, and eliminated food-maintained responding in monkeys treated chronically with morphine. These results confirm that OREX-1019 has little or no efficacy at μ opioid receptorsand has low abuse potential, and, combined with promising safety (clean profile vs. other off-target proteins including the hERG (human ether-a-go-go-related gene) K+ channel) and pharmacokinetic data (supporting administration by subcutaneous or sublingual routes, but with low oral bioavailability), suggest it could be a safe and effective alternative to current treatments for opioid use disorders particularly as applied to relapse prevention. SIGNIFICANCE STATEMENT: The novel opioid OREX-1019 potentially provides an improved relapse prevention agent for use in opioid use disorder. The current study demonstrates that in monkeys OREX-1019 is able to inhibit the self-administration of, and cue- plus heroin-primed reinstatement of, responding previously maintained by remifentanil.
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Affiliation(s)
- David R Maguire
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Lisa R Gerak
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Gerta Cami-Kobeci
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Stephen M Husbands
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Charles P France
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Barbara Belli
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
| | - Peter Flynn
- Departments of Pharmacology (D.R.M., L.R.G., C.P.F.) and Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pharmacy and Pharmacology (G.C.-K., S.M.H.) and Centre for Therapeutic Innovation (S.M.H.), University of Bath, Bath, United Kingdom; and Orexigen Therapeutics, La Jolla, California (B.B., P.F.)
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Wenderoth J, McAuliffe W, Coulthard A, Mitchell P, Arthur A, Fraser JF, McConachie N, Clifton A, Flynn P, Crossley R, Brouwer P, Kulscar Z, Fiehler J. The Role of Interventional Radiologists in Acute Stroke Interventions: A Joint Statement from the Australia and New Zealand Society of Neuroradiology (ANZSNR), the Society of Neurointerventional Surgery (SNIS), the United Kingdom Neurointerventional Group (UKNG), the British Society of Neuroradiology (BSNR), and the European Society for Minimally Invasive, Neurological Therapy (ESMINT). J Vasc Interv Radiol 2019; 30:1400-1403. [DOI: 10.1016/j.jvir.2019.05.008] [Citation(s) in RCA: 4] [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: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
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Tran B, Sedrakyan A, Flynn P, Altorki N, Jorm L, Wright G. Reintervention and Survival After Limited Lung Resection for Lung Cancer Treatment in Australia. Ann Thorac Surg 2018; 107:1507-1514. [PMID: 30579847 DOI: 10.1016/j.athoracsur.2018.11.045] [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] [Received: 05/21/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To investigate the risk and predictors of reintervention (surgery or radiotherapy) after limited resection for lung cancer. METHODS A population-based, all-inclusive study using linked data from the New South Wales Admitted Patient Data Collection and Death Register included all patients undergoing limited resection for lung cancer between July 1, 2002, and March 31, 2014. Univariate and adjusted competing risk analyses were used to estimate the effect of potential factors for risk of reintervention within 6 months and 24 months of the initial surgery. RESULTS The overall 5-year survival for lung cancer patients undergoing limited lung resection was 52% (49% to 54%); for patients aged 70 years or more, the survival rate was 44% (40% to 47%). Reintervention occurred in 6.2% by 6 months and 11.3% by 24 months after the surgery. Younger age, surgery in private hospitals, and fewer comorbidities were independently associated with increased risk of reintervention. Patients who had the surgery performed in high surgical volume hospitals had 49% lower risk of reintervention within the first 6 months (95% confidence interval: 0.30 to 0.85). The effect of hospital surgical volume was attenuated by 24 months (hazard ratio 0.87, 95% confidence interval: 0.60 to 1.28). Patients undergoing reintervention within 6 months or 24 months had a twofold (1.52 to 2.57) and 2.3-fold (1.89 to 2.83) increased risk of death, respectively. CONCLUSIONS The reintervention rate within 6 or 24 months of initial limited lung cancer resection was modest, but there was considerable variation among hospitals. Reintervention was not a benign event and was associated with lower survival in an Australian population.
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Affiliation(s)
- Bich Tran
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
| | | | - Peter Flynn
- Nepean Hospital, Kingswood, New South Wales, Australia
| | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gavin Wright
- Victorian Comprehensive Cancer Center, Parkville, Victoria, Australia; St. Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, University of Melbourne, Victoria, Australia
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Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Tjahjono R, Chin RYK, Flynn P. Tracheobronchial stents in palliative care: a case series and literature review. BMJ Support Palliat Care 2018; 8:335-339. [DOI: 10.1136/bmjspcare-2018-001522] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
ObjectiveTo evaluate the outcomes of tracheobronchial stenting in patients with malignant central airway obstruction and assist practitioners in palliative settings in understanding the indications, contraindications and management of tracheobronchial stents.MethodsThis retrospective study involved a consecutive case series of palliative patients with central airway obstruction secondary to inoperable cancers who underwent tracheobronchial stenting at a single institution. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting.ResultsTwenty-three patients underwent tracheobronchial stenting for malignant central airway obstruction. The majority of patients presented with symptoms of worsening dyspnoea (21 of 23; 91%). Postoperatively, there was a significant improvement in mean ECOG performance status from 2.88±0.34 to 1.58±0.50 (p<0.01). There was no intraoperative mortality resulting from tracheobronchial stenting. Five patients (21.74%) re-presented to hospital due to worsening symptoms and required emergency bronchoscopy. Two patients had stent migration, requiring stent replacement. One patient restenosed from tumour granulation, requiring microdebrider to debulk the mass. Two patients had stent failure secondary to external tumour compression, leading to death.ConclusionTracheobronchial stenting is a safe and effective procedure that offers rapid palliation of symptoms and improvement in patient functional status.
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Abstract
Neuroradiologists provide quality-assured neuroimaging -reports. We developed the use of a neuroimaging team meeting to provide second-opinion reporting by neuroradiologists on neuroimaging that had previously been reported by general -radiologists. Neuroimaging from selected patients was reviewed at the meeting. Where there were discrepancies between an original report from a general radiologist and the report obtained from the meeting involving a neuroradiologist, we classified the discrepancies, recorded the scan modality -involved and used the data to assess temporal trends in discrepancy rates. Over 4 years, 562 patients (312 women, 250 men, mean age 50.6 [SD 17.3] years) were studied. Agreement occurred for 396 (70.5%) patients. Discrepancies that were not clinically important occurred for 60 (10.7%) patients. Clinically important discrepancies were found for 106 (18.9%) patients: missed lesions for 47 (8.3%) patients and misinterpretations for 59 (10.5%) patients. Cerebrovascular disease was the most common reason for a recommendation of neuroimaging review at a meeting. Scan modality did not influence the frequency of discrepancies. Discrepancy rates decreased with time (chi-squared test for linear trend p=0.015), while the frequency of neuroradiologists' recommendations for new investigations was stable at one in seven patients. Neuroimaging team meetings can facilitate improvements in neurology diagnoses.
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Stone E, Rankin N, Phillips J, Fong K, Currow DC, Miller A, Largey G, Zielinski R, Flynn P, Shaw T. Consensus minimum data set for lung cancer multidisciplinary teams: Results of a Delphi process. Respirology 2018; 23:927-934. [PMID: 29641841 DOI: 10.1111/resp.13307] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE While multidisciplinary team (MDT) care in lung cancer is widely practiced, there are few guidelines for MDT on best data collection strategies. MDT meetings need ready access to information for the provision of optimal treatment recommendations (the primary purpose of the meeting), audit of team performance and benchmarking. This study aimed to develop a practical data set designed for these goals through a recognized consensus process with health professionals who participate in formal MDT settings. METHODS A modified Delphi process with three iterations (two surveys and one consensus conference) was carried out involving over 100 Australian lung cancer MDT health professionals. RESULTS In total, 122 lung cancer MDT health professionals responded to the Round 1 survey from over 350 invitees. Of the 122, 98 were available for invitation to Round 2. Of 98, 52 (53%) invitees responded to the Round 2 survey. After two rounds, 51 data elements across 8 domains (patient demographics, risk factors, biopsy data, staging, timeliness, treatment, follow-up and patient selection) achieved consensus, defined as 80% agreement. For Round 3, 33 MDT lead clinicians were invited to participate in a consensus conference. Of 33, 14 (42%) invitees distilled the 47 data elements into 23 elements across 8 domains to address the study objectives. CONCLUSION A practical data set for lung cancer MDT to use for optimal treatment recommendations and to evaluate team performance was developed through recognized consensus methodology. Access to streamlined, relevant and feasible data collection strategies may improve MDT decision-making, audit of team performance and facilitate benchmarking.
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Affiliation(s)
- Emily Stone
- St Vincent's Hospital Thoracic Medicine and Cancer Services, Kinghorn Cancer Centre, University of Sydney, Sydney, NSW, Australia
| | - Nicole Rankin
- Cancer Council NSW, Cancer Research Division, University of Sydney, Sydney Catalyst Translational Cancer Research Centre, Sydney, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Kwun Fong
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Alistair Miller
- Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia
| | - Geraldine Largey
- Program Manager Research and Special Projects, Southern Melbourne Integrated Cancer Services, Melbourne, VIC, Australia
| | - Robert Zielinski
- Central West Cancer Care Centre, Orange NSW, University of Western Sydney, Sydney, NSW, Australia
| | - Peter Flynn
- Cardiothoracic Surgeon and Clinical Lead for Lung Cancer, Director Sydney West Translational Cancer Research Centre, Sydney, NSW, Australia
| | - Tim Shaw
- University of Sydney, Sydney Catalyst Translational Cancer Research Centre, Sydney, NSW, Australia
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K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño 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Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Mulder M, Deplanque D, Girot M, Henon H, Kalsoum E, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Saiedie N, Machi P, Mourand I, Riquelme C, Bounolleau P, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Heshmatollah A, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Schipperen S, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Vinken S, Freeman J, Ford I, Markus H, Wardlaw J, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, van Boxtel T, Perry R, Dixit A, Cloud G, Clifton A, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Koets J, Kandasamy N, Goddard T, Bamford J, Subramanian G, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Boers M, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Harrison L, Keshvara R, Cunningham J, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Abdul-Ghani M, Suen C, Jiang B, Deng Y, Weldrick JJ, Putinski C, Brunette S, Fernando P, Lee TT, Flynn P, Leenen FHH, Burgon PG, Stewart DJ, Megeney LA. Cardiotrophin 1 stimulates beneficial myogenic and vascular remodeling of the heart. Cell Res 2017; 27:1195-1215. [PMID: 28785017 PMCID: PMC5630684 DOI: 10.1038/cr.2017.87] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/06/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022] Open
Abstract
The post-natal heart adapts to stress and overload through hypertrophic growth, a process that may be pathologic or beneficial (physiologic hypertrophy). Physiologic hypertrophy improves cardiac performance in both healthy and diseased individuals, yet the mechanisms that propagate this favorable adaptation remain poorly defined. We identify the cytokine cardiotrophin 1 (CT1) as a factor capable of recapitulating the key features of physiologic growth of the heart including transient and reversible hypertrophy of the myocardium, and stimulation of cardiomyocyte-derived angiogenic signals leading to increased vascularity. The capacity of CT1 to induce physiologic hypertrophy originates from a CK2-mediated restraining of caspase activation, preventing the transition to unrestrained pathologic growth. Exogenous CT1 protein delivery attenuated pathology and restored contractile function in a severe model of right heart failure, suggesting a novel treatment option for this intractable cardiac disease.
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Affiliation(s)
- Mohammad Abdul-Ghani
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Colin Suen
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Baohua Jiang
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada
| | - Yupu Deng
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada
| | - Jonathan J Weldrick
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Charis Putinski
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Steve Brunette
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada
| | - Pasan Fernando
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Biology, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - Tom T Lee
- Fate Therapeutics Inc., 3535 General Atomics Court Suite 200, San Diego, CA 92121, USA
| | - Peter Flynn
- Fate Therapeutics Inc., 3535 General Atomics Court Suite 200, San Diego, CA 92121, USA
| | - Frans H H Leenen
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,Department of Medicine (Cardiology), Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Patrick G Burgon
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,Department of Medicine (Cardiology), Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Duncan J Stewart
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,Department of Medicine (Cardiology), Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Lynn A Megeney
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada.,Department of Medicine (Cardiology), Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
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Kearney S, Flynn P, Hughes S, Spence W, McCarron MO. Hypoactive-hypoalert behaviour and thalamic hypometabolism due to intracranial hypotension. Pract Neurol 2017; 17:289-292. [PMID: 28433974 DOI: 10.1136/practneurol-2016-001497] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/04/2022]
Abstract
A 47-year-old man presented with a 9-year history of a hypoalert hypoactive behaviour syndrome, caused by the deep brain swelling variant of spontaneous intracranial hypotension. Along with apathy with retained cognition, he had stable ataxia, impaired upgaze and episodes of central apnoea. MRI brain showed a sagging brainstem, pointed ventricles and reduced angle between the vein of Galen and the straight sinus, but no meningeal enhancement or subdural collections. A dopamine transporter scan showed preganglionic dopamine receptor deficiency; a fluorodeoxy glucose positron emission tomography scan showed bilateral hypothalamic hypometabolism. This variant of spontaneous intracranial hypotension may alter deep brain functioning within the basal ganglia and thalamus, causing the hypoactive-hypoalert behaviour phenotype.
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Affiliation(s)
- Seamus Kearney
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
| | - Peter Flynn
- Department of Neuroradiology, Royal Victoria Hospital, Belfast, UK
| | - Simon Hughes
- Department of Nuclear Medicine, Royal Victoria Hospital, Belfast, UK
| | - Wendy Spence
- Department of Neuropsychology, Belfast Health and Social Care Trust, Belfast, UK
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Stone E, Rankin N, Phillips J, Fong K, Miller A, Largey G, Zielinski R, Flynn P, Currow D, Shaw T. P3.07-019 AMDAT Lung, An Ideal Lung Cancer MDT Dataset. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McClure MC, Mullen M, Waters SM, Kearney F, McClure J, Flynn P, Weld R. P6001 Effectively managing bovine genetic disease risk via genotyping the Irish national herd. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4148x] [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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McKenna B, Flynn P, Kirkpatrick PJ, McVerry F, McCarron MO. Intracranial bleeding from collaterals following carotid artery occlusion. Pract Neurol 2016; 16:150-2. [PMID: 26740380 DOI: 10.1136/practneurol-2015-001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/04/2022]
Affiliation(s)
| | - Peter Flynn
- Department of Neuroradiology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Peter J Kirkpatrick
- University Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
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Blinman P, Hughes B, Crombie C, Christmas T, Hudson M, Veillard AS, Muljadi N, Millward M, Wright G, Flynn P, Windsor M, Stockler M, McLachlan SA. Patients' and doctors' preferences for adjuvant chemotherapy in resected non-small-cell lung cancer: What makes it worthwhile? Eur J Cancer 2015; 51:1529-37. [PMID: 26059196 DOI: 10.1016/j.ejca.2015.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjuvant chemotherapy (ACT) in non-small-cell lung cancer (NSCLC) improves overall survival, but the benefits must be weighed against its harms. We sought to determine the survival benefits that patients and their doctors judged sufficient to make ACT in NSCLC worthwhile. METHODS 122 patients completed a self-administered questionnaire at baseline and 6 months (before & after ACT, if they had it); 82 doctors completed the questionnaire once only. The time trade-off method was used to determine the minimum survival benefits judged sufficient in four hypothetical scenarios. Baseline survival times were 3 years & 5 years and baseline survival rates (at 5 years) were 50% & 65%. RESULTS At baseline, the median benefits judged sufficient by patients were an extra 9 months (Interquartile range (IQR) 1-12 months) beyond 3 years & 5 years and an extra 5% (IQR 0.1-10%) beyond 50% & 65%. At 6 months (n=91), patients' preferences had the same median benefit (9 months & 5%) but varied more (IQRs 0-18 months & 0-15%) than at baseline. Factors associated with judging smaller benefits sufficient were deciding to have ACT (P=0.01, 0.02) and better well-being (P=0.01, 0.006) during ACT. Doctors' preferences, compared with patients' preferences, had similar median benefits (9 months & 5%) but varied less (IQR 6-12 months versus 1-12 months, P<0.001; 5%-10% versus 0.1-10%, P<0.001). CONCLUSION Most patients and doctors judged moderate survival benefits sufficient to make ACT in NSCLC worthwhile, but the preferences of doctors varied less than those of patients. Doctors should endeavour to elicit patients' preferences during discussions about ACT in NSCLC.
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Affiliation(s)
| | - Brett Hughes
- The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | | | | - Malcolm Hudson
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | - Nick Muljadi
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | | | | | | | - Martin Stockler
- Concord Repatriation General Hospital, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Sue-Anne McLachlan
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
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Deplanque G, Demarchi M, Hebbar M, Flynn P, Melichar B, Atkins J, Nowara E, Moyé L, Piquemal D, Ritter D, Dubreuil P, Mansfield CD, Acin Y, Moussy A, Hermine O, Hammel P. A randomized, placebo-controlled phase III trial of masitinib plus gemcitabine in the treatment of advanced pancreatic cancer. Ann Oncol 2015; 26:1194-1200. [PMID: 25858497 PMCID: PMC4516046 DOI: 10.1093/annonc/mdv133] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/05/2015] [Accepted: 02/18/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Masitinib is a selective oral tyrosine-kinase inhibitor. The efficacy and safety of masitinib combined with gemcitabine was compared against single-agent gemcitabine in patients with advanced pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS Patients with inoperable, chemotherapy-naïve, PDAC were randomized (1 : 1) to receive gemcitabine (1000 mg/m(2)) in combination with either masitinib (9 mg/kg/day) or a placebo. The primary endpoint was overall survival (OS) in the modified intent-to-treat population. Secondary OS analyses aimed to characterize subgroups with poor survival while receiving single-agent gemcitabine with subsequent evaluation of masitinib therapeutic benefit. These prospectively declared subgroups were based on pharmacogenomic data or a baseline characteristic. RESULTS Three hundred and fifty-three patients were randomly assigned to receive either masitinib plus gemcitabine (N = 175) or placebo plus gemcitabine (N = 178). Median OS was similar between treatment-arms for the overall population, at respectively, 7.7 and 7.1 months, with a hazard ratio (HR) of 0.89 (95% CI [0.70; 1.13]. Secondary analyses identified two subgroups having a significantly poor survival rate when receiving single-agent gemcitabine; one defined by an overexpression of acyl-CoA oxidase-1 (ACOX1) in blood, and another via a baseline pain intensity threshold (VAS > 20 mm). These subgroups represent a critical unmet medical need as evidenced from median OS of 5.5 months in patients receiving single-agent gemcitabine, and comprise an estimated 63% of patients. A significant treatment effect was observed in these subgroups for masitinib with median OS of 11.7 months in the 'ACOX1' subgroup [HR = 0.23 (0.10; 0.51), P = 0.001], and 8.0 months in the 'pain' subgroup [HR = 0.62 (0.43; 0.89), P = 0.012]. Despite an increased toxicity of the combination as compared with single-agent gemcitabine, side-effects remained manageable. CONCLUSIONS The present data warrant initiation of a confirmatory study that may support the use of masitinib plus gemcitabine for treatment of PDAC patients with overexpression of ACOX1 or baseline pain (VAS > 20mm). Masitinib's effect in these subgroups is also supported by biological plausibility and evidence of internal clinical validation. TRIAL REGISTRATION ClinicalTrials.gov:NCT00789633.
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Affiliation(s)
- G Deplanque
- Department of Medical Oncology, Saint Joseph Hospital, Paris.
| | - M Demarchi
- Department of Medical Oncology, University Hospital of Besançon, Besançon
| | - M Hebbar
- Department of Medical Oncology, University Hospital, Lille, France
| | - P Flynn
- Metro-Minnesota Community Clinical Oncology Program, Park Nicollet Institute, Minneapolis, USA
| | - B Melichar
- Department of Oncology, Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic
| | - J Atkins
- Southeastern Medical Oncology Center, Goldsboro, USA
| | - E Nowara
- Department of Clinical and Experimental Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - L Moyé
- Department of Biostatistics, University of Texas School of Public Health, Houston, USA
| | - D Piquemal
- Clinical Development, Acobiom, Montpellier
| | - D Ritter
- Clinical Development, Acobiom, Montpellier
| | - P Dubreuil
- Signaling, Hematopoiesis and Mechanism of Oncogenesis, Inserm U1068, CRCM, Marseille; Institut Paoli-Calmettes, Marseille; Aix-Marseille University, UM 105, Marseille; CNRS, UMR7258, CRCM, Marseille; Clinical Development, AB Science, Paris
| | | | - Y Acin
- Clinical Development, AB Science, Paris
| | - A Moussy
- Clinical Development, AB Science, Paris
| | - O Hermine
- Clinical Development, AB Science, Paris; Department of Clinical Hematology, Necker Hospital, Paris; INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris; Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris; CNRS ERL 8254, Paris; Laboratory of Excellence GR-Ex, Paris; National Reference Center on Mastocytosis (CEREMAST), Paris
| | - P Hammel
- Department of Gastroenterology, Hôpital Beaujon, Clichy, France
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Valamehr B, Robinson M, Abujarour R, Rezner B, Vranceanu F, Le T, Medcalf A, Lee TT, Fitch M, Robbins D, Flynn P. Platform for induction and maintenance of transgene-free hiPSCs resembling ground state pluripotent stem cells. Stem Cell Reports 2014; 2:366-81. [PMID: 24672758 PMCID: PMC3964282 DOI: 10.1016/j.stemcr.2014.01.014] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 12/17/2022] Open
Abstract
Cell banking, disease modeling, and cell therapy applications have placed increasing demands on hiPSC technology. Specifically, the high-throughput derivation of footprint-free hiPSCs and their expansion in systems that allow scaled production remains technically challenging. Here, we describe a platform for the rapid, parallel generation, selection, and expansion of hiPSCs using small molecule pathway inhibitors in stage-specific media compositions. The platform supported efficient and expedited episomal reprogramming using just OCT4/SOX2/SV40LT combination (0.5%-4.0%, between days 12 and 16) in a completely feeder-free environment. The resulting hiPSCs are transgene-free, readily cultured, and expanded as single cells while maintaining a homogeneous and genomically stable pluripotent population. hiPSCs generated or maintained in the media compositions described exhibit properties associated with the ground state of pluripotency. The simplicity and robustness of the system allow for the high-throughput generation and rapid expansion of a uniform hiPSC product that is applicable to industrial and clinical-grade use.
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Affiliation(s)
- Bahram Valamehr
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Megan Robinson
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Ramzey Abujarour
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Betsy Rezner
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Florin Vranceanu
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Thuy Le
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Amanda Medcalf
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Tom Tong Lee
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Michael Fitch
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - David Robbins
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
| | - Peter Flynn
- Fate Therapeutics, Inc., 3535 General Atomics Court, Suite 200, San Diego, CA 92121, USA
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Abstract
A 70-year-old woman presented with a fracture and aspiration of her polyvinyl chloride tracheostomy tube. Her chest X-ray showed that a foreign body was lodged in the right main bronchus. She was otherwise asymptomatic. The foreign body was removed under general anaesthesia using a flexible bronchoscope. The patient developed pneumonia after the procedure and was admitted to the intensive care unit. She was discharged home 5 days after the event with no permanent complications.
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Affiliation(s)
- Tze Ling Loh
- Nepean Hospital, Kingswood, New South Wales, Australia
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Abujarour R, Bennett M, Valamehr B, Lee TT, Robinson M, Robbins D, Le T, Lai K, Flynn P. Myogenic differentiation of muscular dystrophy-specific induced pluripotent stem cells for use in drug discovery. Stem Cells Transl Med 2014; 3:149-60. [PMID: 24396035 DOI: 10.5966/sctm.2013-0095] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [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] [Indexed: 12/23/2022] Open
Abstract
Human induced pluripotent stem cells (iPSCs) represent a scalable source of potentially any cell type for disease modeling and therapeutic screening. We have a particular interest in modeling skeletal muscle from various genetic backgrounds; however, efficient and reproducible methods for the myogenic differentiation of iPSCs have not previously been demonstrated. Ectopic myogenic differentiation 1 (MyoD) expression has been shown to induce myogenesis in primary cell types, but the same effect has been unexpectedly challenging to reproduce in human iPSCs. In this study, we report that optimization of culture conditions enabled direct MyoD-mediated differentiation of iPSCs into myoblasts without the need for an intermediate step or cell sorting. MyoD induction mediated efficient cell fusion of mature myocytes yielding multinucleated myosin heavy chain-positive myotubes. We applied the same approach to dystrophic iPSCs, generating 16 iPSC lines from fibroblasts of four patients with Duchenne and Becker muscular dystrophies. As seen with iPSCs from healthy donors, within 36 hours from MyoD induction there was a clear commitment toward the myogenic identity by the majority of iPSCs in culture (50%-70%). The patient iPSC-derived myotubes successfully adopted the skeletal muscle program, as determined by global gene expression profiling, and were functionally responsive to treatment with hypertrophic proteins insulin-like growth factor 1 (IGF-1) and wingless-type MMTV integration site family, member 7A (Wnt7a), which are being investigated as potential treatments for muscular dystrophy in clinical and preclinical studies, respectively. Our results demonstrate that iPSCs have no intrinsic barriers preventing MyoD from inducing efficient and rapid myogenesis and thus providing a scalable source of normal and dystrophic myoblasts for use in disease modeling and drug discovery.
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Ramalingam S, Crawford J, Chang A, Manegold C, Perez-Soler R, Douillard JY, Thatcher N, Barlesi F, Owonikoko T, Wang Y, Pultar P, Zhu J, Malik R, Giaccone G, Della-Fiorentina S, Begbie S, Jennens R, Dass J, Pittman K, Ivanova N, Koynova T, Petrov P, Tomova A, Tzekova V, Couture F, Hirsh V, Burkes R, Sangha R, Ambrus M, Janaskova T, Musil J, Novotny J, Zatloukal P, Jakesova J, Klenha K, Roubec J, Vanasek J, Fayette J, Barlesi F, Bennouna-Louridi J, Chouaid C, Mazières J, Vallerand H, Robinet G, Souquet PJ, Spaeth D, Schott R, Lena H, Martinet Y, El Kouri C, Baize N, Scherpereel A, Molinier O, Fuchs F, Josten K, Manegold C, Marschner N, Schneller F, Overbeck T, Thomas M, von Pawel J, Reck M, Schuette W, Hagen V, Schneider CP, Georgoulias V, Varthalitis I, Zarogoulidis K, Syrigos K, Papandreou C, Bocskei C, Csanky E, Juhasz E, Losonczy G, Mark Z, Molnar I, Papai-Szekely Z, Tehenes S, Vinkler I, Almel S, Bakshi A, Bondarde S, Maru A, Pathak A, Pedapenki R, Prasad K, Prasad S, Kilara N, Gorijavolu D, Deshmukh C, John S, Sharma L, Amoroso D, Bajetta E, Bidoli P, Bonetti A, De Marinis F, Maio M, Passalacqua R, Cascinu S, Bearz A, Bitina M, Brize A, Purkalne G, Skrodele M, Baba A, Ratnavelu K, Saw M, Samson-Fernando M, Ladrera G, Jassem J, Koralewski P, Serwatowski P, Krzakowski M, Cebotaru C, Filip D, Ganea-Motan D, Ianuli C, Manolescu I, Udrea A, Burdaeva O, Byakhov M, Filippov A, Lazarev S, Mosin I, Orlov S, Udovitsa D, Khorinko A, Protsenko S, Chang A, Lim H, Tan Y, Tan E, Bastus Piulats R, Garcia-Foncillas J, Valdivia J, de Castro J, Domine Gomez M, Kim S, Lee JS, Kim H, Lee J, Shin S, Kim DW, Kim YC, Park K, Chang CS, Chang GC, Goan YG, Su WC, Tsai CM, Kuo HP, Benekli M, Demir G, Gokmen E, Sevinc A, Crawford J, Giaccone G, Haigentz M, Owonikoko T, Agarwal M, Pandit S, Araujo R, Vrindavanam N, Bonomi P, Berg A, Wade J, Bloom R, Amin B, Camidge R, Hill D, Rarick M, Flynn P, Klein L, Lo Russo K, Neubauer M, Richards P, Ruxer R, Savin M, Weckstein D, Rosenberg R, Whittaker T, Richards D, Berry W, Ottensmeier C, Dangoor A, Steele N, Summers Y, Rankin E, Rowley K, Giridharan S, Kristeleit H, Humber C, Taylor P. Talactoferrin alfa versus placebo in patients with refractory advanced non-small-cell lung cancer (FORTIS-M trial). Ann Oncol 2013; 24:2875-80. [DOI: 10.1093/annonc/mdt371] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parone P, Bennett M, Lee T, Lai K, Fitch M, Lynch C, Rudniki M, Flynn P. O.15 Engineering a Wnt7a-based protein therapeutic for the treatment of muscular dystrophy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tan WW, Dueck AC, Flynn P, Steen P, Anderson D, Rowland K, Northfelt D, Perez EA. N0539 phase II trial of fulvestrant and bevacizumab in patients with metastatic breast cancer previously treated with an aromatase inhibitor: a North Central Cancer Treatment Group (now Alliance) trial. Ann Oncol 2013; 24:2548-2554. [PMID: 23798616 PMCID: PMC3784332 DOI: 10.1093/annonc/mdt213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Based on preclinical studies, the vascular endothelial pathway is an important mechanism for estrogen receptor resistance. We conducted a phase II study of fulvestrant and bevacizumab in patients with aromatase inhibitor pretreated metastatic breast cancer. PATIENTS AND METHODS A single-stage phase II study was conducted with these objectives: 6-month progression-free survival (PFS), tumor response, toxic effect, and overall survival. Regimen: 250 mg fulvestrant days 1 and 15 (cycle 1) then day 1 (cycle 2 and beyond) and 10 mg/kg bevacizumab days 1 and 15 of each 4-week cycle. RESULTS At interim analysis, 20 eligible patients initiated treatment, 11 were progression free and on treatment at 3 months, not meeting the protocol-specified efficacy requirements (at least 12 of 20). Accrual remained open during interim analysis with 36 patients enrolling before final study closure. Among the 33 eligible patients, the median PFS was 6.2 months [95% confidence interval (CI) 3.6-10.1 months]. Of the 18 with measurable disease, 4 (22%) patients (95% CI 6% to 48%) had a confirmed tumor response (1 complete, 3 partial). The most common grade 3/4 adverse events were hypertension 3 (9%) and headache 3 (9%). CONCLUSIONS The fulvestrant/bevacizumab combination is safe and tolerable; however, it did not meet its statistical end point.
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Affiliation(s)
- W W Tan
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville
| | - A C Dueck
- Section of Biostatistics, Mayo Clinic, Scottsdale
| | - P Flynn
- Metro Minnesota CCOP, St Louis Park
| | - P Steen
- Sanford Medical Center, Fargo
| | | | | | - D Northfelt
- Divison of Hematology/Oncology, Mayo Clinic, Scottsdale, USA
| | - E A Perez
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville.
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Salter M, Nalos M, Shaffi M, Flynn P. Unilateral plication following phrenic nerve transection and failure to wean from mechanical ventilation. Anaesth Intensive Care 2013; 41:687-689. [PMID: 23977928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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McNamee J, Flynn P, O’Leary S, Love M, Kelly B. Imaging in cauda equina syndrome--a pictorial review. Ulster Med J 2013; 82:100-8. [PMID: 24082289 PMCID: PMC3756868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/01/2013] [Indexed: 10/31/2022]
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Stroncek DF, Berger C, Cheever MA, Childs RW, Dudley ME, Flynn P, Gattinoni L, Heath JR, Kalos M, Marincola FM, Miller JS, Mostoslavsky G, Powell DJ, Rao M, Restifo NP, Rosenberg SA, O'Shea J, Melief CJM. New directions in cellular therapy of cancer: a summary of the summit on cellular therapy for cancer. J Transl Med 2012; 10:48. [PMID: 22420641 PMCID: PMC3362772 DOI: 10.1186/1479-5876-10-48] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
A summit on cellular therapy for cancer discussed and presented advances related to the use of adoptive cellular therapy for melanoma and other cancers. The summit revealed that this field is advancing rapidly. Conventional cellular therapies, such as tumor infiltrating lymphocytes (TIL), are becoming more effective and more available. Gene therapy is becoming an important tool in adoptive cell therapy. Lymphocytes are being engineered to express high affinity T cell receptors (TCRs), chimeric antibody-T cell receptors (CARs) and cytokines. T cell subsets with more naïve and stem cell-like characteristics have been shown in pre-clinical models to be more effective than unselected populations and it is now possible to reprogram T cells and to produce T cells with stem cell characteristics. In the future, combinations of adoptive transfer of T cells and specific vaccination against the cognate antigen can be envisaged to further enhance the effectiveness of these therapies.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, USA.
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Valamehr B, Abujarour R, Robinson M, Le T, Robbins D, Shoemaker D, Flynn P. A novel platform to enable the high-throughput derivation and characterization of feeder-free human iPSCs. Sci Rep 2012; 2:213. [PMID: 22355727 PMCID: PMC3252544 DOI: 10.1038/srep00213] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 12/16/2011] [Indexed: 12/18/2022] Open
Abstract
Human induced pluripotent stem cells (hiPSCs) hold enormous potential, however several obstacles impede their translation to industrial and clinical applications. Here we describe a platform to efficiently generate, characterize and maintain single cell and feeder-free (FF) cultured hiPSCs by means of a small molecule cocktail media additive. Using this strategy we have developed an effective multiplex sorting and high-throughput selection platform where individual clonal hiPSC lines are readily obtained from a pool of candidate clones, expanded and thoroughly characterized. By promoting survival and self-renewal, the selected hiPSC clones can be rapidly expanded over multiple FF, single-cell passages while maintaining their pluripotency and genomic stability as demonstrated by trilineage differentiation, karyotype and copy number variation analysis. This study provides a robust platform that increases efficiency, throughput, scale and quality of hiPSC generation and facilitates the industrial and clinical use of iPSC technology.
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Khan A, Tracy M, Flynn P, Maheshwari R, Shingde V. Stitch in time: life-saving thoracotomy for treatment of neonatal haemothorax. J Paediatr Child Health 2011; 47:307-9. [PMID: 20604826 DOI: 10.1111/j.1440-1754.2010.01742.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Khan
- Department of Neonatology, Nepean Hospital, Penrith, New South Wales, Australia
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Purvis J, Gordon P, Flynn P, McCarron M. Recurrent posterior circulatory emboli from a mildly stenosed bicuspid aortic valve. J Stroke Cerebrovasc Dis 2010; 20:562-4. [PMID: 20833085 DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 02/04/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022] Open
Abstract
Bicuspid aortic valve (BAV) is a common condition but is only rarely associated with embolic complications. We describe a 42-year-old man with recurrent posterior circulatory ischemic strokes that resulted in ataxia and cognitive impairment. Transesophageal echocardiography demonstrated a BAV with mild stenosis, moderate calcification, and a dilated ascending aorta. The degree of calcification and the valve phenotype might be important factors implicating the BAV as a rare cause of ischemic stroke.
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Affiliation(s)
- John Purvis
- Department of Cardiology, Altnagelvin Hospital, Glenshane Road, Londonderry, UK
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Chousalkar KK, Flynn P, Sutherland M, Roberts JR, Cheetham BF. Recovery of Salmonella and Escherichia coli from commercial egg shells and effect of translucency on bacterial penetration in eggs. Int J Food Microbiol 2010; 142:207-13. [PMID: 20663580 DOI: 10.1016/j.ijfoodmicro.2010.06.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/15/2010] [Accepted: 06/25/2010] [Indexed: 11/25/2022]
Abstract
This experiment was conducted to study the prevalence of Salmonella and Escherichia coli (E. coli). from the surface of egg shells, egg shell membranes or pores, and internal contents from unwashed eggs collected from commercial caged layer farms in Australia. Egg shell swabs, shell crush and egg internal contents (yolk and albumen) of an individual egg were processed for bacteriological examination. Salmonella spp. were not detected from any of the egg shell surfaces, egg shell crush or egg internal contents. Thirty five E. coli isolates were isolated from the egg shell surface. Ten E. coli strains were also isolated from shell crush. However, the internal contents of eggs appeared to be sterile. Polymerase chain reaction was performed on forty-five E. coli isolates using primers for heat stable enterotoxin genes A and B (STa and STb) and also for colicin V gene (cvaC). STa gene was detected in four E. coli isolates isolated from egg shell surfaces. All the E. coli isolates were negative for STb and cvaC genes. These data provide useful information regarding the prevalence of virulent E. coli and Salmonella spp. on and in unwashed eggs collected from layer farms. These data also suggest that unwashed eggs collected from caged layer farms are unlikely to be sources of Salmonella outbreaks. Egg shell translucency could be due to changes in the mammillary layer and mamillary cores during the early phases of egg shell formation and has the potential to increase the incidence of microcracks in egg shells, and hence, may be responsible for bacterial penetration. There was a significant correlation between egg shell translucency and egg shell penetration by Salmonella Infantis and E coli. Both strains of bacteria were able to penetrate the translucent egg shells even at very low doses. The penetration, however, was hindered in both translucent and non translucent eggs at 4 degrees C, as compared with room temperature which highlights the importance of storage of eggs at refrigerated temperatures.
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Affiliation(s)
- K K Chousalkar
- School of Animal and Veterinary Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
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Affiliation(s)
- Peter Flynn
- Fate Therapeutics, Inc., 3535 General Atomics Drive, Suite 200, San Diego, CA 92121, USA
| | - Jessica Yingling
- Fate Therapeutics, Inc., 3535 General Atomics Drive, Suite 200, San Diego, CA 92121, USA
| | - Dan Shoemaker
- Fate Therapeutics, Inc., 3535 General Atomics Drive, Suite 200, San Diego, CA 92121, USA
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Tan W, Dueck A, Flynn P, Steen P, Anderson D, Rowland K, Nothfeldt D, Lingle W, Copland J, Perez E. N0539 Phase II Trial of Fulvstrant and Bevacizumab in Patients with Metastatic Breast Cancer Previously Treated with an Aromatase Inhibitor: A North Central Cancer Treatment Group Trial. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4096] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Treatment of aromatase refractory metastatic breast cancer (MBC) is difficult and challenging. Estrogen receptor (ER) resistance causes enhanced expression of the vascular endothelial growth factor (VEGF).Several studies have shown that the ER interacts with the VEGF pathway and is an important mechanism of resistance. Therefore we embarked on a phase II study of fulvestrant, a complete ER suppressor and bevacizumab, a well studied VEGF monoclonal antibody in aromatase refractory MBC patients. Methods: A single stage phase II study with an interim analysis of fulvestrant and bevacizumab was conducted with these objectives: 6 month progression-free survival rate (PFS), tumor response, toxicity, and overall survival. Regimen: fulvestrant 250 mg day1 and 15 (cycle 1) then day 1 (cycle 2 and beyond) and bevacizumab 10mg/kg days 1 and 15 of each 4 weeks is a cycle. Results: At the time of interim analysis, 11/20 evaluable patients achieved 3-month progression-free survival status while remaining on treatment for at least 3 months, not meeting the protocol specified efficacy requirements and thus halting accrual. 36 patients were enrolled from September 2007-December 2008; 33 patients were evaluable. Number of prior metastatic chemotherapy regimens: 0 in 26 patients and 1 in 7 patients. 22 (67%) patients received prior hormonal therapy in the metastatic setting. 18 (55%) had measurable disease. A median of 6 cycles (range 1-19) were administered. 12/33 evaluable patients (95% CI:20-55%) achieved 6-month progression-free survival status while remaining on treatment for a least 6 months. Among 18 patients with measurable disease, 2 (11%) patients CI:1.4-35%) had a confirmed tumor reponse (both PR). Additionally, 2 patients had stable disease for greater than 6 months, for a clinical benefit rate of 22%. Median follow up was 8.5 months (range 1.7-17.5 months). Median progression-free survival was 6.2 months (95% CI:5.4-10.1 months). The 6 -month overall survival rate was 84.8% (95% CI 73.5-98%). The median dose level administered was 250 mg for fulvestrant and 10 mg/kg for bevacizumab for cycles 1-19. The most common grade 3/4 adverse events (AEs) were hypertension 2 (6%), headache pain 2 (6%), and confusion 2 (6%). There was 1 grade 5 central nervous system hemorrhage. 13 (39%) patients experienced a grade 3 non-hematologic AE and 4 (12%) experience a grade 4+ non-hematologic AE. Conclusion: Fulvestrant/bevacizumab is safe and tolerable. Although this regimen did not meet its statistical endpoint, 22% of evaluable patients with aromatase refractory diesease achieved clinical benefit with minimal toxicity.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4096.
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Abstract
A case of sphenoid wing meningioma mimicking the presentation of a transient ischaemic attack (TIA) is described. Based on findings from neuroimaging in this case, possible explanations of the mechanism of this uncommon presentation of meningiomas are discussed and the literature is reviewed.
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Affiliation(s)
- C O Oluigbo
- Department of Neurosurgery, Royal Victoria Hospital, Belfast BT12 6BA, UK
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Abstract
A rare case of unilateral benign essential tremor is presented that responded to surgical excision of a posterior fossa arachnoid cyst.
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Affiliation(s)
- I Yousaf
- Department of Neurosurgery, Regional Neurosciences Unit, Royal Victoria Hospital, Belfast, UK
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Tan W, Allred J, Salim M, Flynn P, Kugler JW, Stella PJ, Wiesenfeld M, Bernath AM, Fitch TR, Perez EA. N0337: Phase II study of capecitabine in combination with vinorelbine and trastuzumab for the first or second treatment of HER2+ metastatic breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1020 Background: Trastuzumab-containing regimes have dramatically improved outcome of patients with HER2+ breast cancer. Efforts to improve efficacy and tolerability of combination regimens with this monoclonal antibody are important for patient care. Thus, we conducted a multi-institutional phase II study of a triplet combination in patients eligible to receive either first- or second-line treatment for HER2+ metastatic breast cancer (MBC). Methods: A phase II study designed to test that the true confirmed response rate (CRR) was at most 45% versus a true CRR of at least 65% was done (March 2005-June 2008). This design required that at least 25/45 confirmed responses in evaluable patients for the treatment to be considered promising. Patients received capecitabine 825 mg/m2 po (days 1–14), vinorelbine intravenously (IV) 25 mg/m2 days 1 and 8 every 3 weeks and trastuzumab IV 8mg/kg day 1, week 1, and then 6 mg/kg q 3 weeks. Tissue and blood have been collected for future studies on biomarkers. Results: 47 women were accrued, one patient cancelled participation prior to receiving any study drug, and another had a major protocol violation. 45 patients were evaluable and 30 (67%) achieved a confirmed response, (26 patients, 58% had a confirmed partial response and 4 patients, 9% had a confrimed complete response). Median progression free survival was 11.3 months (95% CI 8.4–23.2 months), median overall survival was 27.2 months (95% CI: 26.6-NA months), and among the 30 responders, the median duration of response time was 15.5 months (95% 7.7–26.1 months). The most common grade 3 events include neutropenia 61%, fatigue 13%, skin reaction-hand-foot 11%, and leukopenia 11%. Alopecia was not noted with this regimen. Conclusions: This triplet combination is effective, safe, and is promising in patients with HER2+ MBC. A phase III study should be conducted to compare the best doublet with this triplet combination whether this would lead to better clinical outcomes. [Table: see text]
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Affiliation(s)
- W. Tan
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - J. Allred
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - M. Salim
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - P. Flynn
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - J. W. Kugler
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - P. J. Stella
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - M. Wiesenfeld
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - A. M. Bernath
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - T. R. Fitch
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
| | - E. A. Perez
- Mayo Clinic Florida, Jacksonville, FL; Mayo Clinic, Rochester, MN; Saskatchewan Cancer Foundation, Saskatchewan, SK, Canada; Metro Minnesota Community Clinical Oncology Program, St. Louis Park, MN; Illinois Oncology Research Assn, Peroia, IL; Michigan Cancer Research Consortium, Ann Arbor, MI; Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Geisinger Clinic & Medical Center CCOP, Danville, PA; Mayo Clinic Arizona, Scottsdale, AZ
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Baer M, Sawa T, Flynn P, Luehrsen K, Martinez D, Wiener-Kronish JP, Yarranton G, Bebbington C. An engineered human antibody fab fragment specific for Pseudomonas aeruginosa PcrV antigen has potent antibacterial activity. Infect Immun 2009; 77:1083-90. [PMID: 19103766 PMCID: PMC2643635 DOI: 10.1128/iai.00815-08] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 07/31/2008] [Accepted: 12/15/2008] [Indexed: 12/16/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic pathogen that can cause acute lung injury and mortality through the delivery of exotoxins by the type III secretion system (TTSS). PcrV is an important structural protein of the TTSS. An engineered human antibody Fab fragment that binds to the P. aeruginosa PcrV protein with high affinity has been identified and has potent in vitro neutralization activity against the TTSS. The instillation of a single dose of Fab into the lungs of mice provided protection against lethal pulmonary challenge of P. aeruginosa and led to a substantial reduction of viable bacterial counts in the lungs. These results demonstrate that blocking of the TTSS by a Fab lacking antibody Fc-mediated effector functions can be sufficient for the effective clearance of pulmonary P. aeruginosa infection.
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Affiliation(s)
- Mark Baer
- Kalobios Pharmaceuticals, Inc, South San Francisco, California 94080, USA
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48
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Caird J, Flynn P, McConnell RS. Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris. Case report. J Neurosurg Pediatr 2008; 1:396-8. [PMID: 18447677 DOI: 10.3171/ped/2008/1/5/396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a case of progressive neurological deficit caused by syringomyelia in a 7-year-old boy with a normally positioned conus medullaris. This deficit responded favorably to surgical untethering of the filum terminale, with subsequent clinical and radiological improvement. The authors discuss the implications of their findings in the context of the current understanding of the pathophysiology of tethered cord syndrome, particularly in relation to the ongoing debate in the neurosurgical literature.
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Affiliation(s)
- John Caird
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, United Kingdom
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Fitzpatrick AS, Loughrey CM, Johnston P, McKee S, Spence W, Flynn P, Jones FGC, Morrow JI. Haematopoietic stem-cell transplant for adult cerebral adrenoleukodystrophy. Eur J Neurol 2008; 15:e21-2. [DOI: 10.1111/j.1468-1331.2007.02048.x] [Citation(s) in RCA: 10] [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: 11/30/2022]
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50
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Flynn P, Ahmed FB, Mitchell V, Patel A, Clarke S. A randomised comparison of the single use LMA Flexible with the reusable LMA Flexible in paediatric dental day-case patients. Anaesthesia 2007; 62:1281-4. [PMID: 17991266 DOI: 10.1111/j.1365-2044.2007.05234.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this study we compared the performance of the single use flexible laryngeal mask airway (LMA Flexible) with the original reusable LMA Flexible in paediatric dento-alveolar day-case surgery. The aim of the study was to determine whether these two supraglottic airway devices were clinically equivalent when used for simple dental extractions in children under general anaesthesia. This randomised comparative trial in 100 healthy children used first attempt airway insertion success as its primary outcome measure. Secondary outcomes included the adequacy of ventilation, incidence of airway obstruction and the requirement for device manipulation and the incidence of adverse airway outcomes during recovery from anaesthesia. No difference was found between the devices in first attempt insertion success rate (94% with reusable LMA Flexible and 90% with single use LMA Flexible, p = 0.358), and ease of insertion was also similar (p = 0.5). Both devices performed equally well during surgery, with no significant differences in episodes of intra-operative airway compromise (p = 0.387), and both the single use and reusable LMA Flexible displayed excellent recovery characteristics, with no occurrences of emergence airway obstruction. No blood was discovered within the inner LMA tube shaft in either device, implying that both protected against tracheobronchial soiling. We conclude therefore that the single use LMA Flexible is an acceptable alternative to the reusable LMA Flexible.
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Affiliation(s)
- P Flynn
- University College Hospital, London NW1 2BU, UK.
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