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Huang H, Wu J, Qin T, Xu Z, Qu S, Pan L, Cai W, Liu J, Wang H, Sun Q, Jiao M, Gao Q, Gale R, Xiao Z. Topic: AS01-Diagnosis/AS01c-Molecular aberrations (cytogenetic, genetic, gene expression). Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106679.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. DAS guidelines on the airway management of critically ill patients. Anaesthesia 2019; 73:1035-1036. [PMID: 30117585 DOI: 10.1111/anae.14352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Higgs A, McGrath B, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook T. Response to: ‘A team approach to the difficult airway’. Br J Anaesth 2018; 121:100. [DOI: 10.1016/j.bja.2018.04.007] [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] [Received: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022] Open
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Higgs A, McGrath B, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook T. Response to ‘Surgical cricothyroidotomy—the tracheal tube dilemma’. Br J Anaesth 2018; 120:1138-1139. [DOI: 10.1016/j.bja.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022] Open
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Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2017; 120:323-352. [PMID: 29406182 DOI: 10.1016/j.bja.2017.10.021] [Citation(s) in RCA: 437] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022] Open
Abstract
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.
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Affiliation(s)
- A Higgs
- Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK(8).
| | - B A McGrath
- Anaesthesia and Intensive Care Medicine, University Hospital South Manchester, Manchester, UK(9)
| | - C Goddard
- Anaesthesia & Intensive Care Medicine, Southport and Ormskirk Hospitals NHS Trust, Southport, UK(8)
| | - J Rangasami
- Anaesthesia & Intensive Care Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK(8)
| | - G Suntharalingam
- Intensive Care Medicine and Anaesthesia, London North West Healthcare NHS Trust, London, UK(10)
| | - R Gale
- Anaesthesia & Intensive Care Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK(11)
| | - T M Cook
- Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK(12)
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Smrity S, Benson A, Gupta R, Gale R, Green M, Walters G, Mackenzie S, Gough A. SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTI-PHOSPHOLIPID SYNDROMEE60. NEW OPHTHALMIC MONITORING OF HYDROXYCHLOROQUINE: WILL THIS LEAD TO MORE PATIENTS HAVING THEIR TREATMENT STOPPED? Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex063.059] [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: 11/12/2022] Open
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McKibbin M, Devonport H, Gale R, Gavin M, Lotery A, Mahmood S, Patel PJ, Ross A, Sivaprasad S, Talks J, Walters G. Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel. Eye (Lond) 2016; 29 Suppl 1:S1-S11. [PMID: 26156564 PMCID: PMC4506328 DOI: 10.1038/eye.2015.77] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Indexed: 11/09/2022] Open
Abstract
This paper provides expert recommendations on administration of aflibercept in wet age-related macular degeneration (AMD) after Year 1 (Y1), based on a roundtable discussion held in London, UK in November 2014. The goals of treatment after Y1 are to maintain visual and anatomical gains whilst minimising treatment burden and using resources effectively. The treatment decision should be made at the seventh injection visit (assuming the label has been followed) in Y1, and three approaches are proposed: (a) eyes with active disease on imaging/examination but with stable visual acuity (VA) at the end of Y1 should continue with fixed 8-weekly dosing; (b) eyes with inactive disease on imaging/examination and stable VA should be managed using a 'treat and extend' (T&E) regimen. T&E involves treating and then extending the interval until the next treatment, by 2-week intervals, to a maximum of 12 weeks, provided the disease remains inactive. If there is new evidence of disease activity, treatment is administered and the interval to the next treatment shortened; and (c) if there has been no disease activity for ≥3 consecutive visits, a trial of monitoring without treatment may be appropriate, initiated at the end of Y1 or at any time during Y2. Where possible, VA testing, OCT imaging and injection should be performed at the same visit. The second eye should be monitored to detect fellow eye involvement. In bilateral disease, the re-treatment interval should be driven by the better-seeing eye or, if the VA is similar, the eye with the more active disease.
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Affiliation(s)
- M McKibbin
- Ophthalmology Department, St James's University Hospital, Leeds, UK
| | - H Devonport
- Ophthalmology Department, Bradford Royal Infirmary, Bradford, UK
| | - R Gale
- Ophthalmology Department, The York Hospital, York, UK
| | - M Gavin
- Ophthalmology Department, NHS Greater Glasgow and Clyde, UK
| | - A Lotery
- Southampton General Hospital, Southampton, UK
| | - S Mahmood
- 1] Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK [2] Centre for Ophthalmology & Vision Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - P J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - A Ross
- Bristol Eye Hospital, Bristol, UK
| | - S Sivaprasad
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - J Talks
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Walters
- Department of Ophthalmology, Harrogate District Hospital, Harrogate, UK
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8
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Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Kelly S, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29:721-31. [PMID: 25882328 DOI: 10.1038/eye.2015.48] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient's age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and 'recalcitrant' n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.
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Affiliation(s)
- W M Amoaku
- Division of Clinical Neurosciences, Department of Ophthalmology, Academic Ophthalmology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, and the Royal Victoria Hospitals Trust, Belfast, UK
| | - R Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Gavin
- Department of Ophthalmology, Gartnavel Hospital, NHSGG, Glasgow, UK
| | - F Ghanchi
- Department of Ophthalmology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - J Gibson
- Department of Ophthalmology, School of Life and Health Sciences, Aston University and Heart of England NHS Foundation Trust, and Birmingham and Midland Eye Centre Birmingham, Birmingham, UK
| | - S Harding
- Department of Ophthalmology, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK
| | - R L Johnston
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - S Kelly
- Department of Ophthalmology, Royal Bolton Hospital, Bolton, UK
| | - A Lotery
- Department of Ophthalmology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mahmood
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Hospitals Foundation Trust, Manchester, UK
| | - G Menon
- Department of Ophthalmology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - S Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - J Talks
- Department of Ophthalmology, Newcastle University Hospirtals NHS Trust, Newcastle, UK
| | - A Tufail
- Department of Ophthalmology, Moorfields Hospital NHS Trust, London, UK
| | - Y Yang
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Wang J, Qin T, Xu Z, Zhang Y, Gale R, Fang L, Zhang H, Pan L, Hu N, Qu S, Li B, Xiao Z. 255 RESPONSE TO THALIDOMIDE AND CYCLOSPORINE IN PATIENTS WITH LOWER-RISK MYELODYSPLASTIC SYNDROME WITHOUT ISOLATED DEL(5Q). Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Morton B, Tang L, Gale R, Kelly M, Robertson H, Mogk M, Robin N, Welters I. Performance of influenza-specific triage tools in an H1N1-positive cohort: P/F ratio better predicts the need for mechanical ventilation and critical care admission. Br J Anaesth 2015; 114:927-33. [PMID: 25829394 DOI: 10.1093/bja/aev042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pandemic influenza presents a major threat to global health and socioeconomic well-being. Future demand for critical care may outstrip supply and force clinicians to triage patients for admission. We evaluated the Simple Triage Scoring System (STSS), Ontario Health Plan for an Influenza Epidemic (OHPIP) and PaO2 /FiO2 (P/F) ratio to determine utility in predicting need for mechanical ventilation. METHODS We conducted a retrospective case note review of patients admitted to two centres, Royal Liverpool University Hospital and Countess of Chester Hospital, during the UK influenza pandemic of 2010-11. Demand for critical care during this period forced hospitals in Cheshire and Merseyside to implement escalation policies and increase capacity. Inclusion criteria were polymerase chain reaction-confirmed H1N1 influenza and age >18 years. Exclusion criteria were no evidence of treatment for influenza, patient not admitted to hospital or the inability to locate case notes. RESULTS One hundred and one patients were included, 29 were admitted to critical care and 23 required mechanical ventilation. The P/F ratio predicted the need for mechanical ventilation with a receiver operating characteristic area under the curve (ROC AUC) of 0.885 (CI 0.817-0.952). Predictive ability was not reduced when the P/F ratio had to be estimated using the Pandharipande tool. The STSS score predicted the need for mechanical ventilation [ROC AUC 0.798 (CI 0.704-0.891)]. The reverse triage component of the OHPIP tool was a poor predictor of patient outcome. CONCLUSIONS The P/F ratio was a better predictor of need for mechanical ventilation than STSS. The P/F ratio is a simple and accepted determinant of hypoxaemia and should be used if secondary triaging becomes necessary during future influenza pandemics.
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Affiliation(s)
- B Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - L Tang
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R Gale
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - M Kelly
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - H Robertson
- Critical Care Department, Countess of Chester Hospital, UK
| | - M Mogk
- MoReData GmbH, Giessen, Germany
| | - N Robin
- Critical Care Department, Countess of Chester Hospital, UK
| | - I Welters
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
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11
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Gale R, Namestnic J, Singer P, Kagan I. PP261-SUN: Outstanding abstract: Calorie Requirements of Chronically Ventilated, Brain Impaired Children. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Win N, Madan B, Gale R, Matthey F. Intravenous immunoglobulin given to lymphoma patients with recurrent haemolytic transfusion reactions after transfusion of compatible blood. Hematology 2013; 10:375-8. [PMID: 16273724 DOI: 10.1080/10245330500155168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Accelerated destruction of red cells after transfusion of compatible blood has been reported in both sickle cell disease (SCD) and non-SCD patients. We report three patients with lymphoma, all of whom had recurrent haemolytic transfusion reactions after receiving compatible red cell units. The direct antiglobulin test (DAT) was negative and there were no detectable red cell alloantibodies in either pre-transfusion or post-transfusion samples. As there was no evidence of red cell antibody-mediated haemolysis and response to oral steroids, a trial of intravenous immunoglobulin (IVIg) was given. Immediate cessation of haemolysis with sustained haemoglobin level was achieved in all cases. The response to IVIg in these cases suggests that IVIg should be tried when recurrent non-antibody mediated haemolytic transfusion reactions occur in patients with a lymphoid malignancy.
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Affiliation(s)
- N Win
- Red Cell Immunohaematology, National Blood Service-Tooting Centre, 75 Cranmer Terr, London, ORB, UK.
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Willis TA, Potrata B, Ahmed M, Hewison J, Gale R, Downey L, McKibbin M. Understanding of and attitudes to genetic testing for inherited retinal disease: a patient perspective. Br J Ophthalmol 2013; 97:1148-54. [PMID: 23813418 PMCID: PMC3756432 DOI: 10.1136/bjophthalmol-2013-303434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background/aims The views of people with inherited retinal disease are important to help develop health policy and plan services. This study aimed to record levels of understanding of and attitudes to genetic testing for inherited retinal disease, and views on the availability of testing. Methods Telephone questionnaires comprising quantitative and qualitative items were completed with adults with inherited retinal disease. Participants were recruited via postal invitation (response rate 48%), approach at clinic or newsletters of relevant charitable organisations. Results Questionnaires were completed with 200 participants. Responses indicated that participants’ perceived understanding of genetic testing for inherited retinal disease was variable. The majority (90%) considered testing to be good/very good and would be likely to undergo genetic testing (90%) if offered. Most supported the provision of diagnostic (97%) and predictive (92%) testing, but support was less strong for testing as part of reproductive planning. Most (87%) agreed with the statement that testing should be offered only after the individual has received genetic counselling from a professional. Subgroup analyses revealed differences associated with participant age, gender, education level and ethnicity (p<0.02). Participants reported a range of perceived benefits (eg, family planning, access to treatment) and risks (eg, impact upon family relationships, emotional consequences). Conclusions Adults with inherited retinal disease strongly support the provision of publicly funded genetic testing. Support was stronger for diagnostic and predictive testing than for testing as part of reproductive planning.
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Affiliation(s)
- T A Willis
- Leeds Institute of Health Sciences, University of Leeds, UK
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Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Erratum: Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 2013. [DOI: 10.1038/eye.2013.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bourne R, Gale R. The Ophthalmology Specialty Group and the National Institute for Health Research: the first 6 years. Eye (Lond) 2013; 27:457-60. [PMID: 23575278 DOI: 10.1038/eye.2013.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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16
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Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 2013. [PMID: 23449508 DOI: 10.1038/eye.2014.11] [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: 12/17/2022] Open
Abstract
AIMS To evaluate the efficacy and safety of intravitreal ranibizumab in patients with choroidal neovascularisation secondary to pathological myopia (myopic CNV). Data are from a pre-planned, 6-month interim analysis. METHODS Phase II, open-label, single arm, multicentre, 12-month study, recruiting patients (aged ≥18 years) with active primary or recurrent subfoveal or juxtafoveal myopic CNV, with a best-corrected visual acuity (BCVA) score of 24-78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the study eye and a diagnosis of high myopia of at least -6 dioptres. Patients received 0.5 mg ranibizumab administered intravitreally to the study eye, followed by monthly injections given as needed (based on a predefined algorithm) for up to 11 months. RESULTS At 6 months, mean BCVA improved from baseline by 12.2 letters, as did central macular thickness (in this interim analysis defined as a measure of either central subfield macular thickness or centre point macular thickness) from baseline by 108 μm in the 48 study eyes of 48 patients. Fewer patients had centre-involving intraretinal oedema (13.0% vs 91.5%), intraretinal cysts (10.9% vs 57.4%), or subretinal fluid (13.0% vs 66.0%) at 6 months than at baseline. Patients received a mean of 1.9 retreatments, were satisfied with ranibizumab treatment, and well being was maintained. No new safety signals were identified. CONCLUSIONS Results from the planned interim analysis support the role of ranibizumab in the treatment of myopic CNV, with excellent efficacy achieved with a low number of injections and few serious adverse events.
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Affiliation(s)
- A Tufail
- Moorfields Eye Hospital, London, UK.
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17
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Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 2013; 27:709-15. [PMID: 23449508 DOI: 10.1038/eye.2013.8] [Citation(s) in RCA: 37] [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] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the efficacy and safety of intravitreal ranibizumab in patients with choroidal neovascularisation secondary to pathological myopia (myopic CNV). Data are from a pre-planned, 6-month interim analysis. METHODS Phase II, open-label, single arm, multicentre, 12-month study, recruiting patients (aged ≥18 years) with active primary or recurrent subfoveal or juxtafoveal myopic CNV, with a best-corrected visual acuity (BCVA) score of 24-78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the study eye and a diagnosis of high myopia of at least -6 dioptres. Patients received 0.5 mg ranibizumab administered intravitreally to the study eye, followed by monthly injections given as needed (based on a predefined algorithm) for up to 11 months. RESULTS At 6 months, mean BCVA improved from baseline by 12.2 letters, as did central macular thickness (in this interim analysis defined as a measure of either central subfield macular thickness or centre point macular thickness) from baseline by 108 μm in the 48 study eyes of 48 patients. Fewer patients had centre-involving intraretinal oedema (13.0% vs 91.5%), intraretinal cysts (10.9% vs 57.4%), or subretinal fluid (13.0% vs 66.0%) at 6 months than at baseline. Patients received a mean of 1.9 retreatments, were satisfied with ranibizumab treatment, and well being was maintained. No new safety signals were identified. CONCLUSIONS Results from the planned interim analysis support the role of ranibizumab in the treatment of myopic CNV, with excellent efficacy achieved with a low number of injections and few serious adverse events.
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Affiliation(s)
- A Tufail
- Moorfields Eye Hospital, London, UK.
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Amoaku W, Blakeney S, Freeman M, Gale R, Johnston R, Kelly SP, McLaughlan B, Sahu D, Varma D. Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care. Eye (Lond) 2012; 26 Suppl 1:S2-21. [PMID: 22302094 PMCID: PMC3292344 DOI: 10.1038/eye.2011.343] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)—a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMDdocument has been developed by eye health-care professionals and patient representatives, the Action on AMDgroup. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes.
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Affiliation(s)
- W Amoaku
- University Hospital, QMC, Nottingham, UK.
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Allen C, Weereratne H, Gale R, Beverley PCL, Huehns ER. The use of monoclonal antibodies UCH/β and UCHγ for the antenatal diagnosis of /β-thalassaemia. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1987.00193.x-i1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dyde R, Chapman A, Gale R, Mackintosh A, Tolan D. Precautions to be taken by radiologists and radiographers when prescribing hyoscine-N-butylbromide. Clin Radiol 2008; 63:739-43. [DOI: 10.1016/j.crad.2008.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/20/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
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Manshouri T, Freireich E, Zingaro R, Gale R, Andreff M, Kantarian H, Verstovesk S. 438 POSTER Organic and inorganic arsenics operate by different biochemical pathways to induce apoptosis in cancer cells. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70443-8] [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: 10/23/2022] Open
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Tarpey P, Thomas S, Sarvananthan N, Mallya U, Lisgo S, Talbot CJ, Roberts EO, Awan M, Surendran M, McLean RJ, Reinecke RD, Langmann A, Lindner S, Koch M, Woodruff G, Gale R, Degg C, Droutsas K, Asproudis I, Zubcov AA, Pieh C, Veal CD, Machado RD, Backhouse OC, Baumber L, Jain S, Constantinescu CS, Brodsky MC, Hunter DG, Hertle RW, Read RJ, Edkins S, O’Meara S, Parker A, Stevens C, Teague J, Wooster R, Futreal PA, Trembath RC, Stratton MR, Raymond FL, Gottlob I. Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus. Nat Genet 2006; 38:1242-4. [PMID: 17013395 PMCID: PMC2592600 DOI: 10.1038/ng1893] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 09/01/2006] [Indexed: 11/09/2022]
Abstract
Idiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability.
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Affiliation(s)
- P Tarpey
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - S Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - N Sarvananthan
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - U Mallya
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
| | - S Lisgo
- Institute of Human Genetics, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - CJ Talbot
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - EO Roberts
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - M Awan
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - M Surendran
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - RJ McLean
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - RD Reinecke
- Foerderer Eye Movement Centre for Children, Wills Eye Hospital, Philadelphia, Pennsylvania, 19107 USA
| | - A Langmann
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - S Lindner
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - M Koch
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - G Woodruff
- Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire PR2 9HT
| | - R Gale
- Ophthalmology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - C Degg
- Department of Medical Physics, University Hospitals of Leicester, Leicester, LE1 5WW, UK
| | - K Droutsas
- Department of Ophthalmology, Justus-Liebig-University, 35392 Giessen, Germany
| | - I Asproudis
- Department of Ophthalmology, Medical Faculty, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - AA Zubcov
- University Eye Hospital, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - C Pieh
- University Eye Hospital, Killianstr. 5, 79106 Freiburg, Germany
| | - CD Veal
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - RD Machado
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - OC Backhouse
- Ophthalmology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - L Baumber
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - S Jain
- Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire PR2 9HT
| | - CS Constantinescu
- Division of Clinical Neurology, School of Medical and Surgical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - MC Brodsky
- Arkansas Children’s Hospital, 800 Marshall, Little Rock, Arkansas 72202, UK
| | - DG Hunter
- Department of Ophthalmology, Children’s Hospital Boston, Harvard Medical School, Boston, Mass 02115, USA
| | - RW Hertle
- University of Pittsburgh Medical Centre, Division of Paediatric Ophthalmology, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - RJ Read
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
| | - S Edkins
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - S O’Meara
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - A Parker
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - C Stevens
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - J Teague
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - R Wooster
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - PA Futreal
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - RC Trembath
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - MR Stratton
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - FL Raymond
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
- Joint senior authors and corresponding authors and
| | - I Gottlob
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
- Joint senior authors and corresponding authors and
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Gale R, Van Vugt A, Rosen L, Chang L, Lorusso P, Valdivieso M, Malburg L, Struck R, Morgan L. Phase-1 study of isophosphoramide mustard (IPM)-lysine in advanced cancers. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9524] [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
9524 Background: IPM is a bi-functional alkylator which cross-links DNA through G:C base-pairs resulting in irreparable 7-atom inter-strand cross-links. IPM is the active moiety of ifosfamide (IFOS), a pro-drug of IPM. IPM is active in diverse cancer models but is unstable. We stabilized IPM with lysine (IPM-lysine; ZIO-201). ZIO-201 was active in pre-clinical models including human cancer cell lines, human-mouse xenografts and cancers resistant to cyclophosphamide (CPA) and IFOS. Because ZIO-201 is not metabolized to acrolein or chloroacetaldehyde, bladder and CNS toxicities are unlikely. Methods: Phase-1 trial in subjects with advanced cancers. ZIO-201 was given daily for 3 consecutive d at a starting dose of 30 mg/me2/d every 3 w. Neither mesna nor IV hydration were given. 11 dose levels were studied in 18 subjects up to 795 mg/me2/d; dose-escalation continues. Data on the 1st 15 subjects are available for analysis. Results: Median age was 59 y (range, 18–70 y); 10 subjects were male. Diagnoses included colorectal cancer (N=5), sarcoma (N=3) and 1 subject each with gastric, lung, bladder, prostate, ovary and thyroid cancers and mesothelioma. 7 had extensive and 8, limited disease. All subjects received extensive prior therapy. Median N cycles was 2 (range, 1–13). Toxicities ≥ grade-2 occurring in > 20% of subjects included anemia (N subjects=4) and diverse GI complaints (N=4). 4 of 8 subjects receiving doses > 445 mg/me2/d had transient proximal renal tubular acidosis. There was no hemorrhagic cystitis or CNS toxicity. 1 subject with mesothelioma had stable disease > 13 mo. Pharmacokinetic studies at 595 mg/me2/d showed a tmax = 13 min (SD ± 9 min), Cmax = 44.7 μg/mL (SD ± 34.1 μg/mL), t1/2 = 35 min (SD ± 7 min) and AUC0-∞ = 1.68 mg·min/ml (SD ± 1.26 mg·min/ml). Conclusions: These data suggest a possible role for ZIO-201 in IFOS-sensitive cancers (especially sarcoma and lymphoma). ZIO-201 may also be active in CPA and IFOS-resistant cancers. Comparable or greater efficacy with less toxicity is expected. [Table: see text]
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Affiliation(s)
- R. Gale
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - A. Van Vugt
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - L. Rosen
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - L. Chang
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - P. Lorusso
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - M. Valdivieso
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - L. Malburg
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - R. Struck
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
| | - L. Morgan
- ZIOPHARM Oncology, Inc., Charlestown, MA; Premiere Oncology, Santa Monica, CA; Karmanos Cancer Center, Detroit, MI; Cancermedica, Birmingham, AL; DEKK-TEC, New Orleans, LA
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Kornblau SM, Jackson CE, Worthing A, Faderl S, Beran M, Fayad L, Ravandi-Kashani F, Bothakur G, Gale R, Verstovsek S. A phase 1 trial of a novel organic arsenic S-dimethylarsino-glutathione (ZIO-101) in hematological malignancies. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16503 Background: Inorganic Arsenicals (IA, e.g. AS2O3) kill many human leukemia cell lines and have efficacy in APL. Evaluation of efficacy against other types of leukemia is limited by the substantial toxicity of IA. Organic Arsenicals (OA) are less toxic than IA. ZIO-101 (S-dimethylarsino-glutathione) is an OA with activity against diverse cancers in in vitro tests and animals mediated through mitochondrial damage and apoptosis induction. ZIO-101 may induce apoptosis by different mechanisms than As2O3 and can kill As2O3-resistant cancer cells. Compared to As2O3, the LD50 of ZIO-101 in mice is 50X higher and at equimolar extracellular arsenic concentrations ZIO-101 produces 15× higher intracellular arsenic concentration. These features make ZIO-101 attractive for evaluation in leukemia. Methods: A phase-1 study evaluating the safety and pharmacokinetic (PK) profile of ZIO-101 in subjects with advanced hematological malignancies is underway. 8 patients (PATS) with acute myelogenous leukemia (AML) (median 3 prior treatments) received ZIO-101 at doses of 78, 109 or 153 (n = 4, 3, 1) mg/m2/d IV for 5 d every mo. Results: Therapy with ZIO-101 has been safe and well-tolerated. Toxicities ≥ grade-2 included hyperglycemia (N = 3) and decreased albumin (N = 3) and Ca (N = 3) and 1 subject each had ≥ grade 2 elevations in LFT, or decreases in K, or PO4, febrile neutropenia and rash. Preexisting anemia and thrombocytopenia increased by 1 grade in 4 and 3 PATS each. Grade ≥3 neutropenia occurred in 2 PATS. No significant renal, liver or heart toxicity occurred, 1 patient with prior 10AV block had transient prolongation of QT interval non-recurring on rechallenge. PK studies at 109 mg/m2/d showed a tmax = 1.5 h (SD ± 0.7 h), Cmax = 402 ng/mL (±33 ng/mL), t1/2 = 14.4 h (±2.9 h) and AUC0-∞ = 8.93 μg · min/mL (±1.82 μgzmdmin/mL). 4 PATS progressed after 1 cycle, 3 had stable disease and received a 2nd cycle: 1 progressed and 2 remain on study. 1 patient is too early to evaluate. Blood myeloblasts decreased (9 to 1.1 × 10e9/L at day 13) in 1 subject and completely resolved in 2 (pre-therapy: 100 and 336 × 10e9/L). Bone marrow myeloblasts were unchanged. Conclusions: Administration of ZIO-101 to PATS with advanced AML was safe and dose-escalation continues and a modest antileukemic effect has been observed. [Table: see text]
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Affiliation(s)
- S. M. Kornblau
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - C. E. Jackson
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - A. Worthing
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - S. Faderl
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - M. Beran
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - L. Fayad
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - F. Ravandi-Kashani
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - G. Bothakur
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - R. Gale
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
| | - S. Verstovsek
- M. D. Anderson Cancer Center, Houston, TX; Zio Pharmaceuticals, New Haven, CT
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Rao A, Chalker J, Gale R, Linch D, Ancliff P, Leiper A, Webb D. Case forum: Therapy related myelodysplastic syndrome in a child during treatment for acute lymphoblastic leukemia: A case report. Leuk Res 2006. [DOI: 10.1016/s0145-2126(06)80044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Starke R, Harrison P, Mackie I, Wang G, Erusalimsky JD, Gale R, Massé JM, Cramer E, Pizzey A, Biggerstaff J, Machin S. The expression of prion protein (PrP(C)) in the megakaryocyte lineage. J Thromb Haemost 2005; 3:1266-73. [PMID: 15946217 DOI: 10.1111/j.1538-7836.2005.01343.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cellular prion protein (PrP(C)) is a naturally occurring protein in normal individuals which adopts an abnormal conformation, termed scrapie prion protein (PrP(Sc)) that is associated with disease. There is great concern that clinically asymptomatic variant Creutzfeldt-Jacob disease (vCJD) may transmit PrP(Sc) in blood transfusion products. PrP(C) is widely expressed and has been found in human blood. The majority of cellular borne PrP(C) is associated with platelets (84%). Although PrP(C) mRNA has been demonstrated in platelets, the quantity is unknown and may not reflect the total PrP(C) present. OBJECTIVE To investigate the expression of PrP(C) in the megakaryocyte lineage. METHODS The expression of PrP(C) was studied in CD34+ cells, cultured megakaryocytes and platelets using electron microscopy, flow cytometry, semi-quantitative RT-PCR and immunofluorescence confocal microscopy. RESULTS AND CONCLUSIONS The expression of PrP(C) appeared to increase with differentiation and polyploidization in the megakaryocyte lineage. PrP(C) was located within platelet alpha-granules and its source is likely to be from megakaryocyte precursors. If PrP(Sc) has a similar distribution, these results have implications for the selection of blood donors and preparation of cell-depleted blood products.
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Affiliation(s)
- R Starke
- Department of Haematology, University College London, London, UK.
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Ellis H, Spielmeyer W, Gale R, Rebetzke J, Richards A. "Perfect" markers for the Rht-B1b and Rht-D1b dwarfing genes in wheat. Theor Appl Genet 2002; 105:1038-1042. [PMID: 12582931 DOI: 10.1007/s00122-002-1048-4] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2001] [Accepted: 01/17/2002] [Indexed: 05/17/2023]
Abstract
PCR-based markers were developed to detect the point mutations responsible for the two major semi-dwarfing genes Rht-B1b ( Rht1) and Rht-D1b ( Rht2) in wheat. These markers were validated by testing 19 wheat varieties of known Rht genotype. They included Rht-B1b and Rht-D1b dwarfs, double-mutant varieties and tall wheats. These were correctly genotyped with the Rht-B1b and Rht-D1b-specific primers, as well as markers specific for the tall alleles Rht-B1a and Rht-D1a. Using a family of doubled-haploid lines segregating for Rht-B1b and Rht-D1b, the markers were mapped to the expected homoeologous regions of chromosomes 4B and 4D, respectively. Both markers were strongly correlated with a reduction in height, accounting for 23% ( Rht-B1b) and 44% ( Rht-D1b) of the phenotypic variance in the population. These markers will have utility in marker-assisted selection of the Rht-B1b and Rht-D1b genes in wheat breeding programs.
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Affiliation(s)
- H. Ellis
- CSIRO Plant Industry, GPO Box 1600, Canberra, ACT 2601, Australia,
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Shatwell RA, Gale R, McCaffery AJ, Sichel K. Studies of the emitting states of some metalloporphyrins by magnetically induced circular emission (MCE). J Am Chem Soc 2002. [DOI: 10.1021/ja00857a011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rowe MD, McCaffery AJ, Gale R, Copsey DN. Bonding studies from charge-transfer absorption and magnetic circular dichroism spectra. I. D4h complexes of iridium(IV). Inorg Chem 2002. [DOI: 10.1021/ic50118a043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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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Stevenson DK, Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, MacMahon JR, Yeung CY, Seidman DS, Gale R, Oh W, Bhutani VK, Johnson LH, Kaplan M, Hammerman C, Nakamura H. Prediction of hyperbilirubinemia in near-term and term infants. J Perinatol 2001; 21 Suppl 1:S63-72; discussion S83-7. [PMID: 11803421 DOI: 10.1038/sj.jp.7210638] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc), as a single measurement or in combination with serum total bilirubin (STB) measurements, can predict the development of hyperbilirubinemia during the first 7 days of life. METHODS From nine multinational clinical sites, 1370 neonates completed this cohort study from February 20, 1998 through February 22, 1999. Measurements of both ETCOc and STB were performed at 30+/-6 hours of life; STB also was measured at 96+/-12 hours and subsequently following a flow diagram based on a table of hours of age-specific STB. An infant was defined as hyperbilirubinemic if the hours of age-specific STB was greater than or equal to the 95th percentile as defined by the table at any time during the study. RESULTS A total of 120 (8.8%) of the enrolled infants became hyperbilirubinemic. Mean STB in breast-fed infants was 8.92+/-4.37 mg/dl at 96 hours versus 7.63+/-3.58 mg/dl in those fed formula only. The mean ETCOc at 30+/-6 hours for the total population was 1.48+/-0.49 ppm, whereas those of nonhyperbilirubinemic and hyperbilirubinemic infants were 1.45+/-0.47 and 1.81+/-0.59 ppm, respectively. Seventy-six percent (92 of 120) of hyperbilirubinemic infants had ETCOc greater than the population mean. An ETCOc greater than the population mean at 30+/-6 hours yielded a 13.0% positive predictive value (PPV) and a 95.8% negative predictive value (NPV) for STB > or =95th percentile. When infants with STB > or =95th percentile at <36 hours of age were excluded, the STB at 30+/-6 hours yielded a 16.7% PPV and a 98.1% NPV for STB >75th percentile. The combination of these two measurements at 30+/-6 hours (either ETCOc more than the population mean or STB >75th percentile) had a 6.4% PPV with a 99.0% NPV. CONCLUSIONS This prospective cohort study supports previous observations that measuring STB before discharge may provide some assistance in predicting an infant's risk for developing hyperbilirubinemia. The addition of an ETCOc measurement provides insight into the processes that contribute to the condition but does not materially improve the predictive ability of an hours of age-specific STB in this study population. The combination of STB and ETCOc as early as 30+/-6 hours may identify infants with increased bilirubin production (eg, hemolysis) or decreased elimination (conjugation defects) as well as infants who require early follow-up after discharge for jaundice or other clinical problems such as late anemia. Depending on the incidence of hyperbilirubinemia within an institution, the criteria for decision making should vary according to its unique population.
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Affiliation(s)
- D K Stevenson
- Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford, CA 94305-5208, USA
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Stevenson DK, Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, MacMahon JR, Yeung CY, Seidman DS, Gale R, Oh W, Bhutani VK, Johnson LH, Kaplan M, Hammerman C, Nakamura H. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics 2001; 108:31-9. [PMID: 11433051 DOI: 10.1542/peds.108.1.31] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc), as a single measurement or in combination with serum total bilirubin (STB) measurements, can predict the development of hyperbilirubinemia during the first 7 days of life. METHODS From 9 multinational clinical sites, 1370 neonates completed this cohort study from February 20, 1998, through February 22, 1999. Measurements of both ETCOc and STB were performed at 30 +/- 6 hours of life; STB also was measured at 96 +/- 12 hours and subsequently following a flow diagram based on a table of hours of age-specific STB. An infant was defined as hyperbilirubinemic if the hours of age-specific STB was greater than or equal to the 95th percentile as defined by the table at any time during the study. RESULTS A total of 120 (8.8%) of the enrolled infants became hyperbilirubinemic. Mean STB in breastfed infants was 8.92 +/- 4.37 mg/dL at 96 hours versus 7.63 +/- 3.58 mg/dL in those fed formula only. The mean ETCOc at 30 +/- 6 hours for the total population was 1.48 +/- 0.49 ppm, whereas those of nonhyperbilirubinemic and hyperbilirubinemic infants were 1.45 +/- 0.47 ppm and 1.81 +/- 0.59 ppm, respectively. Seventy-six percent (92 of 120) of hyperbilirubinemic infants had ETCOc greater than the population mean. An ETCOc greater than the population mean at 30 +/- 6 hours yielded a 13.0% positive predictive value (PPV) and a 95.8% negative predictive value (NPV) for STB >/=95th percentile. When infants with STB >95th percentile at <36 hours of age were excluded, the STB at 30 +/- 6 hours yielded a 16.7% PPV and a 98.1% NPV for STB >75th percentile. The combination of these 2 measurements at 30 +/- 6 hours (either ETCOc more than the population mean or STB >75th percentile) had a 6.4% PPV with a 99.0% NPV. Conclusions. This prospective cohort study supports previous observations that measuring STB before discharge may provide some assistance in predicting an infant's risk for developing hyperbilirubinemia. The addition of an ETCOc measurement provides insight into the processes that contribute to the condition but does not materially improve the predictive ability of an hours of age-specific STB in this study population. The combination of STB and ETCOc as early as 30 +/- 6 hours may identify infants with increased bilirubin production (eg, hemolysis) or decreased elimination (conjugation defects) as well as infants who require early follow-up after discharge for jaundice or other clinical problems such as late anemia. Depending on the incidence of hyperbilirubinemia within an institution, the criteria for decision making should vary according to its unique population.
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Affiliation(s)
- D K Stevenson
- Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford, California, USA
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Seidman DS, Paz I, Armon Y, Ergaz Z, Stevenson DK, Gale R. Effect of publication of the "Practice Parameter for the management of hyperbilirubinemia" on treatment of neonatal jaundice. Acta Paediatr 2001; 90:292-5. [PMID: 11332170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
UNLABELLED The aim of this study was to evaluate the change in the treatment of neonatal jaundice following introduction of the "American Academy of Pediatrics' Practice Parameter for the management of hyperbilirubinemia in the healthy term newborn". In a historical control observation cohort study, we examined the rate of phototherapy and exchange transfusions among full-term (> or = 37 wk gestation) and near-term (gestational age between 35 and 37 wk and birthweight > 2000 g) infants in two community hospitals. The study included all consecutive infants born during two 15-mo study periods immediately before and after the introduction of the new guidelines. Data were prospectively recorded in a computerized database. The rate of phototherapy significantly decreased in the second study period from 7.9% (514/6499) to 2.9% (251/8650) (p < 0.0001) among full-term infants, and from 20.9% (102/489) to 9.4% (47/502) (p < 0.0001) in near-term infants. The use of exchange transfusion was significantly higher (p < 0.001) in the first compared to the second period: 0.2% (15/6499) vs 0.03% (3/8650). A significant decrease was found when the data from each hospital were analyzed separately. CONCLUSION A significant decrease in the use of phototherapy and exchange transfusion occurred after the publication of the new practice parameters. This trend was observed for both term and preterm newborns, although the new guidelines were not intended for infants born before term.
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Affiliation(s)
- D S Seidman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel 52621.
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Paz I, Laor A, Gale R, Harlap S, Stevenson DK, Seidman DS. Term infants with fetal growth restriction are not at increased risk for low intelligence scores at age 17 years. J Pediatr 2001; 138:87-91. [PMID: 11148518 DOI: 10.1067/mpd.2001.110131] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the long-term cognitive outcome of small for gestational age (SGA) compared with appropriate for gestational age (AGA) infants. DESIGN Data from the Jerusalem Perinatal Study was matched with information from the army draft medical board. SGA and severe SGA were defined as birth weight below the 10th and 3rd percentiles for gestational age, respectively. A multiple linear regression analysis was performed to control for clinical, perinatal, and socio-demographic confounding variables. SUBJECTS A cohort of 13,454 consecutive singleton term infants born between 1974 and 1976. MAIN OUTCOME MEASURE IQ at age 17 years. RESULTS SGA infants had lower adjusted mean +/- SE IQ scores compared with their AGA peers: 102.2 +/- 0.9 versus 105.1 +/- 0.7 (P <.0001) for males and 102.5 +/- 0.9 versus 103.9 +/- 0.7 (P <.015) for females. SGA was not associated with lower academic achievements compared with AGA. CONCLUSION After controlling for multiple confounders, being born SGA at term is associated with slightly lower intelligence test scores at age 17 years. However, the clinical significance of the small difference is not evident in academic achievements.
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Affiliation(s)
- I Paz
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York 11219, USA
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Affiliation(s)
- R Gale
- Department of Neonatology, Bikur-Cholim Hospital, Jerusalem, Israel
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Gelfer MY, Waddon A, Schmidt-Rohr K, Gale R, Kleiner L, Berggren R. Annealing-induced increase of permeability and amorphous-phase mobility in an ethylene-vinylacetate copolymer. ACTA ACUST UNITED AC 2001. [DOI: 10.1002/polb.10033] [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: 11/11/2022]
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Seidman DS, Moise J, Ergaz Z, Laor A, Vreman HJ, Stevenson DK, Gale R. A new blue light-emitting phototherapy device: a prospective randomized controlled study. J Pediatr 2000; 136:771-4. [PMID: 10839875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a new phototherapy light source with a narrow luminous blue spectrum. The device, made with high-intensity gallium nitride light-emitting diodes (LEDs), was compared with conventional phototherapy at similar light intensities. SETTING Two university-affiliated community hospitals in Jerusalem. DESIGN Prospective open randomized study. PARTICIPANTS Sixty-nine jaundiced, but otherwise healthy, term infants who met the entry criteria for phototherapy set by the American Academy of Pediatrics' Practice Parameter. MAIN OUTCOME MEASURES The duration of phototherapy and the rate of decrease in total serum bilirubin (TSB) concentration. RESULTS The mean TSB concentrations at initiation and termination of treatment did not differ between newborns receiving LED and those receiving conventional phototherapy. The duration of phototherapy and the rate of decrease in TSB concentration were not statistically different in the 2 groups. The average rate of decrease in TSB after adjustment by a linear regression analysis for confounding factors was -3.16 micromol/L/h (95% confidence limits -4.81, -1.51) in newborns receiving LED phototherapy compared with -2.19 micromol/L/h (-3.99, -0.40) in those treated with conventional phototherapy (P <.14). No side effects were noted in any of the newborns. CONCLUSIONS The blue gallium nitride LED device is as effective as conventional phototherapy and is readily accepted by nursing staff. Future LED phototherapy devices can provide much higher irradiance, and thus greater efficacy, and offer a new highly versatile approach to the treatment of jaundice.
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Affiliation(s)
- D S Seidman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Seidman DS, Ergaz Z, Paz I, Laor A, Revel-Vilk S, Stevenson DK, Gale R. Predicting the risk of jaundice in full-term healthy newborns: a prospective population-based study. J Perinatol 1999; 19:564-7. [PMID: 10645520 DOI: 10.1038/sj.jp.7200274] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The need to recognize infants that are at high risk for developing significant jaundice is apparent in the era of routine early discharge. The aim of the present study was to prospectively determine the ability to predict severe hyperbilirubinemia in term healthy newborns (defined as total serum bilirubin of > 10.0 mg/dl at day 2, > 14.0 mg/dl at day 3, and > 17.0 mg/dl at days 4 and 5 of life). DESIGN Prospective study of 1177 healthy term newborns. SETTING Two university-affiliated community hospitals in Jerusalem. RESULTS Using a multiple logistic regression analysis, neonatal jaundice was best predicted (p < 0.0001) by day 1 serum bilirubin (adjusted odds ratio of 3.1 [per mg/dl] [95% confidence limits of 2.4 to 4.1]) and by a change in serum bilirubin from the first to the second day of life (2.4 [per mg/dl] [1.9 to 3.0]). Maternal blood type 0 (2.9 [1.5 to 5.8]), age (1.1 [per year] [1.0 to 1.2]), schooling (0.8 [per year] [0.7 to 0.9]), and full breastfeeding (0.4 [0.2 to 0.9]) were also associated with jaundice (p < 0.005). Other factors considered in the regression model but not found to be significantly related to jaundice included maternal ethnic origin, smoking, hypertension, diabetes mellitus, intranatal administration of oxytocin, meperidine, anesthesia, premature rupture of the membranes, parity, newborn sex, birth weight, gestational age, presentation. Apgar scores, blood type, hematocrit, cephalohematoma, and history of jaundice in other siblings. A model for predicting neonatal jaundice based on the above factors had a sensitivity of 81.8%, a specificity of 82.9%, a false positive rate of 80.2%, and a false negative rate of 1.1%. CONCLUSION Individual risk assessment on discharge in association with day 1 total serum bilirubin is of value in identifying infants at greater risk for neonatal jaundice.
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Affiliation(s)
- D S Seidman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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McCarthy P, Hurd D, Rowlings P, Crump M, Gale R, Lazarus H, Vaughan W, Weinberger B, Wiemann M, Freytes C, Cirenza E, Antman K. Autotransplants in men with breast cancer. ABMTR Breast Cancer Working Committee. Autologous Blood and Marrow Transplant Registry. Bone Marrow Transplant 1999; 24:365-8. [PMID: 10467324 DOI: 10.1038/sj.bmt.1701926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine the outcome of high-dose therapy with autologous hematopoietic stem cell support (autotransplants) in men with breast cancer. We studied 13 men receiving autotransplants for breast cancer and reported to the Autologous Blood and Marrow Transplant Registry (ABMTR) by 10 centers. Six men had stage 2 breast cancer, four had stage 3, and three had metastatic breast cancer. Of twelve tumors tested, all were estrogen receptor positive. Median age at transplant was 50 years. The most common conditioning regimen was cyclophosphamide, thiotepa and carboplatin (n = 5); the remaining eight men received other alkylator-based regimens. Three men received bone marrow, eight received blood stem cells, and two received both for hematopoietic support. All patients had hematopoietic recovery. There were no unexpected regimen-related toxicities. Of 10 men receiving autotransplants as adjuvant therapy, three relapsed 3, 5 and 50 months post-transplant and died 16, 19 and 67 months post-transplant. Seven of 10 are disease-free with median follow-up of 23 months (range 6-50 months). Of three men treated for metastatic breast cancer, one had progressive disease and two recurrent disease at 6, 7 and 16 months post-transplant. In conclusion, results of autotransplants for male breast cancer appear similar to those reported for women receiving autotransplants for breast cancer.
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Affiliation(s)
- P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Seidman DS, Paz I, Merlet-Aharoni I, Vreman H, Stevenson DK, Gale R. Noninvasive validation of tobacco smoke exposure in late pregnancy using end-tidal carbon monoxide measurements. J Perinatol 1999; 19:358-61. [PMID: 10685257 DOI: 10.1038/sj.jp.7200193] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether exposure to tobacco smoke in late pregnancy can be reliably estimated by measuring carbon monoxide (CO) in the mother and newborn breath. STUDY DESIGN Sixty-eight mothers and their healthy term singleton newborns, delivered at a university-affiliated community hospital in Jerusalem, were enrolled. End-tidal CO (corrected for inhaled air [ETCOc] was measured with a portable automated bedside CO analyzer. ETCOc, cotinine, and carboxyhemoglobin (COHb) levels were compared in 17 smoking, 31 passively exposed, and 20 nonsmoking mothers and their offspring. RESULTS The mean +/- SD ETCOc was significantly higher in women who smoked than in passively exposed and nonsmoking mothers (8.42 +/- 5.65 vs 1.95 +/- 0.98 vs 1.33 +/- 0.84 ppm. p < 0.0001, respectively). Newborns whose mothers smoked had higher ETCOc levels than those of infants of passively exposed and nonsmoking mothers (10.0 +/- 7.7 vs 2.51 +/- 1.4 vs 1.74 +/- 0.98 ppm, p < 0.0001, respectively). The number of cigarettes smoked by the mother was significantly correlated with maternal ETCOc (r = 0.755, p < 0.00001), and neonatal ETCOc (r = 0.805, p < 0.00001). Maternal ETCOc was highly correlated with neonatal ETCOc (r = 0.857, p < 0.00001), cotinine (r = 0.645, p < 0.00001), and COHb (r = 0.9, p < 0.00001) levels. Birth weight was significantly associated with neonatal ETCOc (p < 0.006) and maternal ETCOc (p < 0.007). CONCLUSION ETCOc levels in the newborn are well correlated with maternal smoking. Measurements of newborn ETCOc may be used as a noninvasive means to estimate exposure to maternal tobacco smoke immediately before delivery. These measurements will be useful for patient education and research.
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Affiliation(s)
- D S Seidman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Abstract
High intensity light-emitting diodes (LEDs) are being studied as possible light sources for the phototherapy of hyperbilirubinemic neonates. These power-efficient, low heat-producing light sources have the potential to deliver high intensity light of narrow wavelength band in the blue-green portion of the visible light spectrum, which overlaps the absorption spectrum of bilirubin (BR). We compared the efficacy between single LEDs of different color and then constructed a prototype phototherapy device using 300 blue LEDs. The efficacy of this device was compared with that of conventional phototherapy devices by measuring the in vitro photodegradation of BR in human serum albumin. When blue, blue-green, green, and white LEDs were compared, the blue light was the most effective in degrading BR by 28% of dark control, followed by blue-green (18% of control), and then white light (14% of control). Green light was the least effective (11% of control). The prototype device with three focused arrays, each with 100 blue LEDs, generated greater irradiance (> 200 microW.cm-2.nm-1) than any of the conventional devices tested. It also supported the greatest rate of BR photodegradation. We conclude that light from LEDs should be considered a more effective treatment for hyperbilirubinemia than light from presently used phototherapy devices. Furthermore, the unique characteristics of this light source may make it especially suitable for use in safe and lightweight home phototherapy devices.
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Affiliation(s)
- H J Vreman
- Department of Pediatrics, Stanford University School of Medicine, California 94305-5208, USA
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Jefferson T, Smith R, Yee Y, Drummond M, Pratt M, Gale R. Evaluating the BMJ guidelines for economic submissions: prospective audit of economic submissions to BMJ and The Lancet. JAMA 1998; 280:275-7. [PMID: 9676680 DOI: 10.1001/jama.280.3.275] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Editorial management of articles on health economics may benefit from guidelines for peer review and revision. OBJECTIVE To assess whether publication (in August 1996) of the BMJ guidelines on peer review of economics submissions made any difference to editorial and peer review processes, quality of submitted manuscripts, and quality of published manuscripts. DESIGN AND SETTING Before-after study conducted in the editorial offices of BMJ and The Lancet of the effect of the BMJ guidelines on review and revision of economics submissions, defined as those making explicit comments about resource allocation and/or costs of interventions. MAIN OUTCOME MEASURES Editorial fate and changes in the quality of submissions. RESULTS A total of 2982 manuscripts were submitted to the 2 journals during the before periods, 105 (3.5%) of which were economics submissions. Of these, 27 (24.3%) were full economics evaluations, and 78 (75.7%) were other economics submissions. Overall acceptance rate was 11.6% (12/105). During the after period 2077 manuscripts were submitted to the 2 journals, 87 (4.2%) of which were economics submissions. Eighteen (20.7%) were full economics evaluations, and 69 (79.3%) were other economics submissions. Overall acceptance rate was 6.9% (6/87). Although a number of manuscripts could not be traced to determine whether they were economics submissions, there appeared to be little difference between the 2 journals in numbers or editorial fate of the manuscripts. There was no change in the quality of submitted manuscripts, but BMJ editors found the guidelines and checklists useful and sent fewer economics submissions for external peer review in the after phase. CONCLUSIONS Publication of the guidelines helped the BMJ editors improve the efficiency of the editorial process but had no impact on the quality of economics evaluations submitted or published.
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Abstract
The use of pressure-sensitive adhesives (PSAs) for skin-contact applications is discussed. The requirements of such adhesives in various applications are examined in detail. Commercially available classes of PSAs used for skin-contact applications are the acrylics, the polyisobutylenes, and the silicones. The main application examined in this review is transdermal drug delivery. The roles played by the PSA in two types of transdermal designs are described. Correlations between in vivo and ex vivo measurements of adhesion are discussed. Also, the reported human studies of various commercially available transdermals are examined critically, with a view to assessing the relative performance capabilities of each type of transdermal design. Finally, a comprehensive listing of currently commercialized transdermals is given.
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Abstract
It has been suggested that the high rates of prematurity, low birth weight, perinatal morbidity and mortality in in-vitro fertilization (IVF) infants are due to the increased frequency of multiple gestations in this population. The aim of our study was to test this hypothesis by comparing the outcome of IVF twins with that of twins born after spontaneously conceived pregnancies. The perinatal outcome of 40 IVF twins was compared with that of 80 control twins, matched for maternal age, parity and ethnic origin. IVF twins had a higher rate of prematurity (P = 0.03), their mean birth weight was significantly lower (P < 0.01) and the frequency of very low birth weight infants was much higher (P < 0.003). There was no neonatal mortality in the control group, whereas four IVF twins died (P < 0.01). Neonatal morbidity was significantly greater in IVF twins (P < 0.05). Oxygen therapy and mechanical ventilation were administered more frequently to IVF twins (P < 0.007 and P < 0.05). We conclude that twins conceived by IVF are at a significantly higher risk for prematurity and associated neonatal morbidity and mortality than spontaneously conceived twins.
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Affiliation(s)
- J Moise
- Department of Neonatology and NICU, Bikur Cholim Hospital, Jerusalem, Israel
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Seidman DS, Laor A, Stevenson DK, Sivan E, Gale R, Shemer J. Macrosomia does not predict overweight in late adolescence in infants of diabetic mothers. Acta Obstet Gynecol Scand 1998; 77:58-62. [PMID: 9492720 DOI: 10.1034/j.1600-0412.1998.770113.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the predictive value of macrosomia for overweight later in adult life in infants of diabetic mothers. DESIGN Data from the computerized records of the Jerusalem Perinatal Study were matched to measurements made at age 17 obtained from the military draft medical examination records. PARTICIPANTS 10,891 infants born in Jerusalem between November 1974 and February 1976. MAIN OUTCOME MEASURES Macrosomia based on 90th percentile birth weight for gestational age and overweight defined as the 90th percentile for body mass index at age 17. RESULTS Diabetes was diagnosed in 87 (0.8%) of the mothers. Thirty-one (35.6%) of the infants of the diabetic mothers were macrosomic compared to 1012 (9.4%) of the siblings of nondiabetic mothers (p < 0.001). At 17 years of age 10.3% vs. 9.4% of the siblings of diabetic vs. nondiabetic mothers were overweight (p > 0.05). The rate of adolescent overweight in macrosomic vs. nonmacrosomic subjects was 12.3% vs. 9.7% (p < 0.01) in siblings of nondiabetic mothers, and 16.1% vs. 7.1% (p > 0.05) for diabetic mothers. The sensitivity and specificity, in diabetic mothers, of macrosomia for overweight at age 17 was 44.4% and 66.7%, respectively. The positive and negative predictive value of macrosomia for overweight at age 17 was 16.1% and 92.9%, respectively. CONCLUSIONS The risk of adolescent overweight was significantly increased among macrosomic infants, although this trend did not reach statistical significance in the smaller group of infants born to diabetic mothers. Macrosomia among infants of diabetic mothers had little predictive value for overweight in late adolescence.
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Affiliation(s)
- D S Seidman
- Department of Obstetrics & Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
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Laor A, Stevenson DK, Shemer J, Gale R, Seidman DS. Size at birth, maternal nutritional status in pregnancy, and blood pressure at age 17: population based analysis. BMJ 1997; 315:449-53. [PMID: 9284660 PMCID: PMC2127333 DOI: 10.1136/bmj.315.7106.449] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the effect of size at birth, maternal nutrition, and body mass index on blood pressure in late adolescence. DESIGN Population based analysis of birth weight corrected for gestational age, mother's weight before pregnancy and weight gain in pregnancy, obtained from the Jerusalem perinatal study, and blood pressure and body mass index at age 17, available from military draft records. SETTING Jerusalem, Israel. SUBJECTS 10,883 subjects (6684 men and 4199 women) born in Jerusalem during 1974-6 and subsequently drafted to the army. MAIN OUTCOME MEASURES Systolic and diastolic blood pressures measured at age 17 and their correlation with birth weight, size at birth, mother's body mass index and weight gain during pregnancy, and height and weight at age 17. RESULTS Systolic and diastolic blood pressures were significantly and positively correlated with body weight, height, body mass index at age 17, and with mother's body weight and body mass index before pregnancy, but not with birth weight or mother's weight gain in pregnancy. CONCLUSION Variables reflecting poor intrauterine nutrition, including low maternal body mass index before pregnancy, poor maternal weight gain in pregnancy, and being born small for gestational age, were not associated with a higher blood pressure in late adolescence.
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Affiliation(s)
- A Laor
- Department of Internal Medicine, Carmel Hospital, Haifa, Israel
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Van Buskirk GA, González MA, Shah VP, Barnhardt S, Barrett C, Berge S, Cleary G, Chan K, Flynn G, Foster T, Gale R, Garrison R, Gochnour S, Gotto A, Govil S, Gray VA, Hammar J, Harder S, Hoiberg C, Hussain A, Karp C, Llanos H, Mantelle J, Noonan P, Zrebe H. Scale-up of adhesive transdermal drug delivery systems. Pharm Res 1997; 14:848-52. [PMID: 9244139 DOI: 10.1023/a:1012135430056] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- G A Van Buskirk
- Novartis Pharmaceuticals Corp., East Hanover, New Jersey 07936, USA.
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Kerem E, Dollberg S, Paz I, Armon Y, Seidman DS, Stevenson DK, Gale R. Prenatal ritodrine administration and the incidence of respiratory distress syndrome in premature infants. J Perinatol 1997; 17:101-6. [PMID: 9134506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Prenatal exposure to ritodrine may be associated with a lower incidence of RDS in premature infants, independent of its effect on prolongation of pregnancy. OBJECTIVE The purpose of this study was to assess the neonatal respiratory outcome of premature infants according to whether their mothers were treated prenatally with ritodrine. STUDY DESIGN A retrospective review was done of all 247 infants born at 34 weeks of gestation or less in our hospital during a 6-year period. A multivariate logistic regression was used to adjust for possible confounding variables. RESULTS Among the ritodrine-exposed infants respiratory distress syndrome developed in 9.5% (4/42) compared with 28% (57/205) in the unexposed group (p < 0.012; adjusted odds ratio 4.88, 95% confidence interval 1.27 to 18.70). The gestational age and birth weight were similar in the two groups. The incidence of transient tachypnea of the newborn and other neonatal complications was not statistically different between the two groups. CONCLUSION Ritodrine was associated with a significantly lower incidence of respiratory distress syndrome in premature infants, independent of the effect of ritodrine on prolongation of pregnancy.
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Affiliation(s)
- E Kerem
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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