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Clarke R, Halsey J, Emberson J, Collins R, Leon DA, Kivimäki M, Shipley MJ. Lifetime and 10-year risks of cardiovascular mortality in relation to risk factors in middle and old age: 50-year follow-up of the Whitehall study of London Civil Servants. Public Health 2024; 230:73-80. [PMID: 38513300 DOI: 10.1016/j.puhe.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age. METHODS The Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967-1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively. RESULTS By July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2-13.4) vs 0.6% (0.1-1.2) 10-year risk of CVD mortality, a 61.4% (59.4-65.3) vs 31.3% (24.1-34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4-17.5) vs 0.8% (0.0-2.2) for 10-year risk and 42.1% (28.2-50.0) vs 30.3% (6.0-38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years. CONCLUSIONS Conventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD.
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Affiliation(s)
- R Clarke
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - J Halsey
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J Emberson
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Collins
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D A Leon
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Kivimäki
- University College London Brain Sciences, University College London, London, UK
| | - M J Shipley
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Dritsoula A, Clarke R, Hatziagorou E, Triaridis S, Talimtzi P, Elphick H. The role of rigid laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea: a case series of 65 children. J Laryngol Otol 2023:1-6. [PMID: 38018216 DOI: 10.1017/s0022215123002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To assess the role of laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea by identifying airway abnormalities at surgery, that occur separately or in addition to adenotonsillar hypertrophy, and examining the correlation with respiratory parameters. METHODS A retrospective study was conducted of children with obstructive sleep apnoea who underwent laryngo-tracheo-bronchoscopy intra-operatively, performed by a single ENT surgeon from February 2016 to July 2019. Pre- and post-operative minimum oxygen saturation, apnoea-hypopnoea index, and oxygen desaturation index were recorded. RESULTS Sixty-five children were identified; 34 were aged less than three years and 31 were aged three years or more. 77 per cent and 13 per cent respectively had an airway abnormality; the t-test showed a significantly higher mean oxygen desaturation index and lower mean minimum oxygen saturation pre-operatively compared to children without an airway abnormality. CONCLUSION An update of the surgical pathway for children aged less than three years with obstructive sleep apnoea is required to include laryngo-tracheo-bronchoscopy intra-operatively. A t-test analysis of the pre-operative respiratory parameters suggests that airway abnormalities contribute to obstructive sleep apnoea severity.
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Affiliation(s)
- Aikaterini Dritsoula
- ENT Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raymond Clarke
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elpis Hatziagorou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Triaridis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Persefoni Talimtzi
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heather Elphick
- Paediatric Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Leung BK, Merlin S, Walker AK, Lawther AJ, Paxinos G, Eapen V, Clarke R, Balleine BW, Furlong TM. Immp2l knockdown in male mice increases stimulus-driven instrumental behaviour but does not alter goal-directed learning or neuron density in cortico-striatal circuits in a model of Tourette syndrome and autism spectrum disorder. Behav Brain Res 2023; 452:114610. [PMID: 37541448 DOI: 10.1016/j.bbr.2023.114610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
Cortico-striatal neurocircuits mediate goal-directed and habitual actions which are necessary for adaptive behaviour. It has recently been proposed that some of the core symptoms of autism spectrum disorder (ASD) and Gilles de la Tourette syndrome (GTS), such as tics and other repetitive behaviours, may emerge because of imbalances in these neurocircuits. We have recently developed a model of ASD and GTS by knocking down Immp2l, a mitochondrial gene frequently associated with these disorders. The current study sought to determine whether Immp2l knockdown (KD) in male mice alters flexible, goal- or cue- driven behaviour using procedures specifically designed to examine response-outcome and stimulus-response associations, which underlie goal-directed and habitual behaviour, respectively. Whether Immp2l KD alters neuron density in cortico-striatal neurocircuits known to regulate these behaviours was also examined. Immp2l KD mice and wild type-like mice (WT) were trained on Pavlovian and instrumental learning procedures where auditory cues predicted food delivery and lever-press responses earned a food outcome. It was demonstrated that goal-directed learning was not changed for Immp2l KD mice compared to WT mice, as lever-press responses were sensitive to changes in the value of the food outcome, and to contingency reversal and degradation. There was also no difference in the capacity of KD mice to form habitual behaviours compared to WT mice following extending training of the instrumental action. However, Immp2l KD mice were more responsive to auditory stimuli paired with food as indicated by a non-specific increase in lever response rates during Pavlovian-to-instrumental transfer. Finally, there were no alterations to neuron density in striatum or any prefrontal cortex or limbic brain structures examined. Thus, the current study suggests that Immp2l is not necessary for learned maladaptive goal or stimulus driven behaviours in ASD or GTS, but that it may contribute to increased capacity for external stimuli to drive behaviour. Alterations to stimulus-driven behaviour could potentially influence the expression of tics and repetitive behaviours, suggesting that genetic alterations to Immp2l may contribute to these core symptoms in ASD and GTS. Given that this is the first application of this battery of instrumental learning procedures to a mouse model of ASD or GTS, it is an important initial step in determining the contribution of known risk-genes to goal-directed versus habitual behaviours, which should be more broadly applied to other rodent models of ASD and GTS in the future.
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Affiliation(s)
- Beatrice K Leung
- Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Sam Merlin
- School of Science, Western Sydney University, Campbelltown, Sydney, NSW, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, NSW, Australia
| | - Adam J Lawther
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia
| | - George Paxinos
- Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, University of New South Wales, NSW, Australia; Mental Health Research Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - Raymond Clarke
- Ingham Institute, Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Bernard W Balleine
- Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Teri M Furlong
- Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia.
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Taylor MJ, Patel T, Orton E, Watson MC, Hayes M, Clarke R, Stewart S, Timblin C, Kendrick D. Evaluating the effect of child home safety training upon three family support practitioner groups: a mixed-methods study. Perspect Public Health 2023:17579139231185999. [PMID: 37572017 DOI: 10.1177/17579139231185999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
AIMS Unintentional injuries in the home contribute substantially to preschool child morbidity and mortality. Practitioners such as health visitors, family mentors and children's centre staff are well-positioned to facilitate child injury prevention by providing home safety advice to families, and training may enhance their ability to do so. We aimed to assess the impact of child home safety training for these practitioners. METHODS An explanatory mixed-methods design was used. Practitioners completed questionnaires before, and up to 7 months after, receiving child home safety training and took part in interviews. Seventy-eight health visitors, 72 family mentors and 11 children's centre staff members completed questionnaires. Items were used to calculate scores on home safety knowledge, confidence to provide home safety advice and belief that child home safety promotion is important. Thematic analysis of interviews with seven health visitors and nine family mentors, open-ended responses to the questionnaires and an additional evaluation form was conducted to explore attendees' perceptions of the training and its impact. In addition, seven health visitors and six children's centre staff who had received no training were interviewed. RESULTS Knowledge was greater post-training than pre-training across all participants (p < .001). When practitioner groups were analysed separately, there were significant increases in family mentors' knowledge (p < .001) and belief (p = .016), and health visitors' confidence (p = .0036). Qualitative findings indicated that most training session attendees valued the training, believed their practice relating to child home safety had improved as a result, and felt further similar training sessions would be beneficial. Those who had not attended the sessions described a need for more child home safety training. CONCLUSIONS Delivering training to practitioners providing child home safety promotion to families with preschool children can enhance injury prevention knowledge, beliefs and confidence and positively impact on home safety promotion by practitioners.
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Affiliation(s)
- M J Taylor
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - T Patel
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - E Orton
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - M C Watson
- Institute of Health Promotion and Education, Lichfield, UK
| | - M Hayes
- Child Accident Prevention Trust, London, UK
| | - R Clarke
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Stewart
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - C Timblin
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - D Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Alejo A, Ahmed H, Krygier AG, Clarke R, Freeman RR, Fuchs J, Green A, Green JS, Jung D, Kleinschmidt A, Morrison JT, Najmudin Z, Nakamura H, Norreys P, Notley M, Oliver M, Roth M, Vassura L, Zepf M, Borghesi M, Kar S. Stabilized Radiation Pressure Acceleration and Neutron Generation in Ultrathin Deuterated Foils. Phys Rev Lett 2022; 129:114801. [PMID: 36154426 DOI: 10.1103/physrevlett.129.114801] [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] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2022] [Accepted: 04/28/2022] [Indexed: 06/16/2023]
Abstract
Premature relativistic transparency of ultrathin, laser-irradiated targets is recognized as an obstacle to achieving a stable radiation pressure acceleration in the "light sail" (LS) mode. Experimental data, corroborated by 2D PIC simulations, show that a few-nm thick overcoat surface layer of high Z material significantly improves ion bunching at high energies during the acceleration. This is diagnosed by simultaneous ion and neutron spectroscopy following irradiation of deuterated plastic targets. In particular, copious and directional neutron production (significantly larger than for other in-target schemes) arises, under optimal parameters, as a signature of plasma layer integrity during the acceleration.
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Affiliation(s)
- A Alejo
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
- Instituto Galego de Física de Altas Enerxías, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - H Ahmed
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - A G Krygier
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - R Clarke
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - R R Freeman
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - J Fuchs
- LULI-CNRS, CEA, UPMC Univ Paris 06: Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - A Green
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J S Green
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D Jung
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A Kleinschmidt
- Institut für Kernphysik, TU Darmstadt, D-64289 Darmstadt, Germany
| | - J T Morrison
- Propulsion Systems Directorate, Air Force Research Lab, Wright Patterson Air Force Base, Ohio 45433, USA
| | - Z Najmudin
- The John Adams Institute for Accelerator Science, Blackett Laboratory, Imperial College London, SW7 2AZ, United Kingdom
| | - H Nakamura
- The John Adams Institute for Accelerator Science, Blackett Laboratory, Imperial College London, SW7 2AZ, United Kingdom
| | - P Norreys
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
- Department of Physics, University of Oxford, Oxford OX1 3PU, United Kingdom
| | - M Notley
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - M Oliver
- Department of Physics, University of Oxford, Oxford OX1 3PU, United Kingdom
| | - M Roth
- Institut für Kernphysik, TU Darmstadt, D-64289 Darmstadt, Germany
| | - L Vassura
- LULI-CNRS, CEA, UPMC Univ Paris 06: Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - M Zepf
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Borghesi
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - S Kar
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
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Lamidi S, Williams KM, Hind D, Peckham-Cooper A, Miller AS, Smith AM, Saha A, Macutkiewicz C, Griffiths EA, Catena F, Coccolini F, Toogood G, Tierney GM, Boyd-Carson H, Sartelli M, Blencowe NS, Lockwood S, Coe PO, Lee MJ, Barreto SG, Drake T, Gachabayov M, Hill J, Ioannidis O, Lostoridis E, Mehraj A, Negoi I, Pata F, Steenkamp C, Ahmed S, Alin V, Al-Rashedy M, Atici SD, Bains L, Bandyopadhyay SK, Baraket O, Bates T, Beral D, Brown L, Buonomo L, Burke D, Caravaglios G, Ceresoli M, Chapman SJ, Cillara N, Clarke R, Colak E, Daniels S, Demetrashvili Z, Di Carlo I, Duff S, Dziakova J, Elliott JA, El Zalabany T, Engledow A, Ewnte B, Fraga GP, George R, Giuffrida M, Glasbey J, Isik A, Kechagias A, Kenington C, Kessel B, Khokha V, Kong V, Laloë P, Litvin A, Lostoridis E, Marinis A, Martínez-Pérez A, Menzies D, Mills R, Monzon BI, Morgan R, Neri V, Nita GE, Perra T, Perrone G, Porcu A, Poskus T, Premnath S, Sall I, Sarma DR, Slavchev M, Spence G, Tarasconi A, Tolonen M, Toro A, Venn ML, Vimalachandran D, Wheldon L, Zakaria AD. Defining core patient descriptors for perforated peptic ulcer research: international Delphi. Br J Surg 2022; 109:603-609. [PMID: 35467718 DOI: 10.1093/bjs/znac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 10/13/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remains a common condition globally with significant morbidity and mortality. Previous work has demonstrated variation in reporting of patient characteristics in PPU studies, making comparison of studies and outcomes difficult. The aim of this study was to standardize the reporting of patient characteristics, by creating a core descriptor set (CDS) of important descriptors that should be consistently reported in PPU research. METHODS Candidate descriptors were identified through systematic review and stakeholder proposals. An international Delphi exercise involving three survey rounds was undertaken to obtain consensus on key patient characteristics for future research. Participants rated items on a scale of 1-9 with respect to their importance. Items meeting a predetermined threshold (rated 7-9 by over 70 per cent of stakeholders) were included in the final set and ratified at a consensus meeting. Feedback was provided between rounds to allow refinement of ratings. RESULTS Some 116 clinicians were recruited from 29 countries. A total of 63 descriptors were longlisted from the literature, and 27 were proposed by stakeholders. After three survey rounds and a consensus meeting, 27 descriptors were included in the CDS. These covered demographic variables and co-morbidities, risk factors for PPU, presentation and pathway factors, need for organ support, biochemical parameters, prognostic tools, perforation details, and surgical history. CONCLUSION This study defines the core descriptive items for PPU research, which will allow more robust synthesis of studies.
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Schmidt L, Clarke R, Von Ende A, Yin X, Theofilatos K, Hopewell J, Mayr M. Multiplexed apolipoprotein profiling advances the assessment of residual lipid-related cardiovascular risk. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background and Purpose
Low-density lipoprotein cholesterol (LDL-C) is among the conventional lipid parameters used to predict risk of cardiovascular disease (CVD). Statins lower blood levels of pro-atherogenic LDL-C, but a residual cardiovascular risk remains in some individuals with therapeutically optimised LDL-C levels. Although the metabolism of LDL-C and other lipoprotein particles is governed by a range of different apolipoproteins, only apolipoproteins A-I and B are measured in clinical assays. Using a more comprehensive apolipoprotein panel in a large epidemiological cohort, this study aimed to determine the association of individual apolipoprotein levels with risk of coronary heart disease (CHD).
Methods
Bottom-up multiple reaction monitoring–mass spectrometry (MRM–MS) was used in conjunction with stable isotope-labelled peptide standards to quantify plasma levels of 13 apolipoproteins in participants of the Precocious Coronary Artery Disease (PROCARDIS) study (N = 1916; 941 cases of CHD, 975 controls). The relationship between apolipoprotein levels and CHD was assessed after adjusting for established risk factors for CVD and correcting for statin use.
Results
The strongest positive associations with CHD in the PROCARDIS study were seen for triglyceride-related apolipoproteins C-I (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.63–3.46), C-III (OR 2.95, 95% CI 1.85–4.71) and E (OR 2.35, 95% CI 1.54–3.58), as well as for apolipoprotein (a) (kringle IV type 2 repeat, OR 2.84, 95% CI 2.04–3.95). Comparing these with associations of apolipoproteins with CVD in the Bruneck study (N = 688) revealed consistency across the two cohorts. Robust inverse associations with CHD were observed for apolipoproteins A-IV (OR 0.45, 95% CI 0.31–0.65) and M (OR 0.29, 95% CI 0.19–0.44).
Conclusion
Analysing two large epidemiological cohorts, Bruneck and PROCARDIS, demonstrated that multiplexed apolipoprotein profiling improves the understanding of cardiovascular risk independent of conventional lipid parameters. Most prominently, triglyceride-related apolipoproteins were shown to positively associate with residual cardiovascular risk. The findings of this study support the need for development and implementation of standardised, MRM–MS-based apolipoprotein profiling assays to guide novel lipid-modifying therapies beyond statins.
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Affiliation(s)
- L Schmidt
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - R Clarke
- University of Oxford , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - A Von Ende
- University of Oxford , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - X Yin
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - K Theofilatos
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - J Hopewell
- University of Oxford , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - M Mayr
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
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10
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Martin P, Ahmed H, Doria D, Alejo A, Clarke R, Ferguson S, Fernández-Tobias J, Freeman RR, Fuchs J, Green A, Green JS, Gwynne D, Hanton F, Jarrett J, Jung D, Kakolee KF, Krygier AG, Lewis CLS, McIlvenny A, McKenna P, Morrison JT, Najmudin Z, Naughton K, Nersisyan G, Norreys P, Notley M, Roth M, Ruiz JA, Scullion C, Zepf M, Zhai S, Borghesi M, Kar S. Absolute calibration of Fujifilm BAS-TR image plate response to laser driven protons up to 40 MeV. Rev Sci Instrum 2022; 93:053303. [PMID: 35649771 DOI: 10.1063/5.0089402] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
Image plates (IPs) are a popular detector in the field of laser driven ion acceleration, owing to their high dynamic range and reusability. An absolute calibration of these detectors to laser-driven protons in the routinely produced tens of MeV energy range is, therefore, essential. In this paper, the response of Fujifilm BAS-TR IPs to 1-40 MeV protons is calibrated by employing the detectors in high resolution Thomson parabola spectrometers in conjunction with a CR-39 nuclear track detector to determine absolute proton numbers. While CR-39 was placed in front of the image plate for lower energy protons, it was placed behind the image plate for energies above 10 MeV using suitable metal filters sandwiched between the image plate and CR-39 to select specific energies. The measured response agrees well with previously reported calibrations as well as standard models of IP response, providing, for the first time, an absolute calibration over a large range of proton energies of relevance to current experiments.
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Affiliation(s)
- P Martin
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - H Ahmed
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - D Doria
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A Alejo
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - R Clarke
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - S Ferguson
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J Fernández-Tobias
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - R R Freeman
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - J Fuchs
- LULI - CNRS, CEA, UPMC Univ Paris 06 : Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris - F-91128 Palaiseau cedex, France
| | - A Green
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J S Green
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D Gwynne
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - F Hanton
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J Jarrett
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, United Kingdom
| | - D Jung
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - K F Kakolee
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A G Krygier
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - C L S Lewis
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A McIlvenny
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - P McKenna
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, United Kingdom
| | - J T Morrison
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, Colorado 80523, USA
| | - Z Najmudin
- Blackett Laboratory, Department of Physics, Imperial College, London, SW7 2AZ, United Kingdom
| | - K Naughton
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - G Nersisyan
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - P Norreys
- Department of Physics, University of Oxford, Oxford, OX1 3PU, United Kingdom
| | - M Notley
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - M Roth
- Institut für Kernphysik, Technische Universität Darmstadt, Schloßgartenstrasse 9, 64289 Darmstadt, Germany
| | - J A Ruiz
- Instituto de Fusion Nuclear, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - C Scullion
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Zepf
- Helmholtz Institut Jena, 07743 Jena, Germany
| | - S Zhai
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Borghesi
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - S Kar
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
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11
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Chaikovsky I, Lebedev E, Du H, Chen Y, Ponomarev V, Guo Y, Bian Z, Li L, Chen Z, Clarke R. Inter-relationships of different electrocardiographic indicators of left ventricular hypertrophy in 25,000 Chinese adults. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Several electrocardiographic (ECG) indices have previously been proposed to diagnose left ventricular hypertrophy (LVH). Such indices utilize different criteria, including increased QRS voltage, prolonged QRS duration, left axis deviation, and LAFB and LBBB-like patterns in varying combinations. However, the inter-relationships of these different electrocardiographic indices of LVH with each otherare not fully understood.
The purpose of this study is to estimate the relationships between the different LVH indices.
Methods
Electronic tracings of 12-lead ECGs recorded in 24,786 adult participants in the China Kadoorie Biobank recorded in 2014 were accessed to detect presence of LVH. ECG parameters of LVH, including individual and combinations of such parameters (voltage-only criteria such as Sokolov-Lyon, Cornell, Gubner as well as scores such as Romhilt-Estes point score) were estimated using customized computer software (Cardiolyse Oy, Finland) and compared proprietary LVH point score algorithms (Mortara, USA). Relationships between the different indices were assessed using a correlation matrix to explore associations between individual parameters and combined indices of such parameters. The matrices were used to construct heat maps and identify clustering of individual parameters.
Results
Overall, approximately 10% of the population had LVH assessed by Mortara algorithms. This graph shows that along with the free standing peaks, the rest are divided into two clusters of interconnected individual parameters. In the center of the largest cluster is the parameter, reflecting R-peak magnitude in aVL lead. In the center of another cluster was the left ventricular strain pattern, as described in Romhilt-Estes point score system. Overall, the Sokolov-Lyon index and LVH point score in Veritas algorithm had the strongest relationships with each other, but the Gubner and Cornell indices had relatively weak correlations with the other indices (Table 1). The mean correlation coefficient between five combined LVH indices was as follows: Veritas (Mortara) – 0.58, Sokolov-Lyon – 0.56, Romhilt-Estes – 0.45, Gubner – 0,32, Cornell – 0,3.
Conclusions
Parameters such as R-peak magnitude in aVL and left ventricular strain pattern were the most strongly related with each other. Aggregate indices, such as the Sokolov-Lyon index and LVH point score in Veritas algorithm were the most strongly related with all other indices, but the Gubner and Cornell indices were only weakly correlated. The results reinforce the utility of Sokolov-Lyon index and Mortara algorithms as the optimum measures of LVH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Chaikovsky
- Glushkov Institute for cybernetics, Kiev, Ukraine
| | - E Lebedev
- Glushkov Institute for cybernetics, Kiev, Ukraine
| | - H Du
- University of Oxford, Nuffield Department of Population health, Oxford, United Kingdom
| | - Y Chen
- University of Oxford, Nuffield Department of Population health, Oxford, United Kingdom
| | - V Ponomarev
- Glushkov Institute for cybernetics, Kiev, Ukraine
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - L Li
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Chen
- University of Oxford, Nuffield Department of Population health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Nuffield Department of Population health, Oxford, United Kingdom
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12
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Clarke R. 921 Management of Acute Cholecystitis - the MACHO Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Acute cholecystitis is a common surgical condition. Gold standard treatment is index cholecystectomy, although there are reasons this might not be offered. The aim of this study was to explore treatments and outcomes in patients with acute cholecystitis.
Method
A multicentre retrospective study was carried out to identify a historic three-month cohort. Patients were identified through clinical coding. Demographics, clinical outcomes, comorbidities, Tokyo grade, and intervention descriptors were collected. Logistic regression was performed to identify characteristics of patients receiving a drain, and to propensity match for clinical outcomes.
Results
Seven centres reported on 1130 patients. Median age was 62 years, and 145 (12.8%) had grade III cholecystitis. Grade III cholecystitis was present in 19 (25.6%) of those who underwent cholecystostomy, 34 (9.3%) of those who underwent index cholecystectomy, and 92 (13.3%) of those who were conservatively managed. Overall complication rates were higher for those managed with cholecystostomy (36.5%) or conservatively (22.6%) vs index cholecystectomy (7.5%) (p < 0.001). Logistic regression found CCI and grade III cholecystitis were associated with increased rates of any complication. Increased CCI and grade II/III cholecystitis were associated with increased rates of major complications.
Conclusions
'Hot' laparoscopic cholecystectomy seems to be offered to mild cases in fit patients. Patients with grade III disease and moderate comorbidities may not have cholecystectomy in a timely manner, leaving them at risk of repeated severe episodes.
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Affiliation(s)
- R Clarke
- Macho Collaborators, Sheffield, United Kingdom
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13
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Poorthuis MHF, Morris DR, de Borst GJ, Bots ML, Greving JP, Visseren FLJ, Sherliker P, Clack R, Clarke R, Lewington S, Bulbulia R, Halliday A. Detection of asymptomatic carotid stenosis in patients with lower-extremity arterial disease: development and external validations of a risk score. Br J Surg 2021; 108:960-967. [PMID: 33876207 PMCID: PMC10364916 DOI: 10.1093/bjs/znab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recommendations for screening patients with lower-extremity arterial disease (LEAD) to detect asymptomatic carotid stenosis (ACS) are conflicting. Prediction models might identify patients at high risk of ACS, possibly allowing targeted screening to improve preventive therapy and compliance. METHODS A systematic search for prediction models for at least 50 per cent ACS in patients with LEAD was conducted. A prediction model in screened patients from the USA with an ankle : brachial pressure index of 0.9 or less was subsequently developed, and assessed for discrimination and calibration. External validation was performed in two independent cohorts, from the UK and the Netherlands. RESULTS After screening 4907 studies, no previously published prediction models were found. For development of a new model, data for 112 117 patients were used, of whom 6354 (5.7 per cent) had at least 50 per cent ACS and 2801 (2.5 per cent) had at least 70 per cent ACS. Age, sex, smoking status, history of hypercholesterolaemia, stroke/transient ischaemic attack, coronary heart disease and measured systolic BP were predictors of ACS. The model discrimination had an area under the receiver operating characteristic (AUROC) curve of 0.71 (95 per cent c.i. 0.71 to 0.72) for at least 50 per cent ACS and 0.73 (0.72 to 0.73) for at least 70 per cent ACS. Screening the 20 per cent of patients at greatest risk detected 12.4 per cent with at least 50 per cent ACS (number needed to screen (NNS) 8] and 5.8 per cent with at least 70 per cent ACS (NNS 17). This yielded 44.2 and 46.9 per cent of patients with at least 50 and 70 per cent ACS respectively. External validation showed reliable discrimination and adequate calibration. CONCLUSION The present risk score can predict significant ACS in patients with LEAD. This approach may inform targeted screening of high-risk individuals to enhance the detection of ACS.
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Affiliation(s)
- M H F Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D R Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J P Greving
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - P Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Clack
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - S Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - R Bulbulia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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14
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Webster AJ, Gaitskell K, Turnbull I, Cairns BJ, Clarke R. Characterisation, identification, clustering, and classification of disease. Sci Rep 2021; 11:5405. [PMID: 33686097 PMCID: PMC7940639 DOI: 10.1038/s41598-021-84860-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/21/2020] [Accepted: 02/17/2021] [Indexed: 12/25/2022] Open
Abstract
The importance of quantifying the distribution and determinants of multimorbidity has prompted novel data-driven classifications of disease. Applications have included improved statistical power and refined prognoses for a range of respiratory, infectious, autoimmune, and neurological diseases, with studies using molecular information, age of disease incidence, and sequences of disease onset (“disease trajectories”) to classify disease clusters. Here we consider whether easily measured risk factors such as height and BMI can effectively characterise diseases in UK Biobank data, combining established statistical methods in new but rigorous ways to provide clinically relevant comparisons and clusters of disease. Over 400 common diseases were selected for analysis using clinical and epidemiological criteria, and conventional proportional hazards models were used to estimate associations with 12 established risk factors. Several diseases had strongly sex-dependent associations of disease risk with BMI. Importantly, a large proportion of diseases affecting both sexes could be identified by their risk factors, and equivalent diseases tended to cluster adjacently. These included 10 diseases presently classified as “Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified”. Many clusters are associated with a shared, known pathogenesis, others suggest likely but presently unconfirmed causes. The specificity of associations and shared pathogenesis of many clustered diseases provide a new perspective on the interactions between biological pathways, risk factors, and patterns of disease such as multimorbidity.
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Affiliation(s)
- A J Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - K Gaitskell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - I Turnbull
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - B J Cairns
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Clarke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Carter J, Re F, Hammami I, Littlejohns T, Arnold M, Clarke R. Effects of within-person variability in spot urinary sodium measurements on the associations with blood pressure and risk of cardiovascular disease in 0.5 Million adults in UK Biobank. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomised control trials have demonstrated direct positive and causal associations of 24-hr measurements of urinary sodium excretion on blood pressure. However, prospective studies, which often used spot (not 24-hr) measurements of urinary sodium, have reported J-shaped associations with higher risks of cardiovascular disease (CVD) at sodium intake <4 g/day. The reasons for the discrepant results are not fully understood, but have prompted some to question the World Health Organisation's recommendations to restrict sodium intake to <2.3g/day.
Purpose
We examined the effects of within-person variability in spot urinary sodium (UNa) measurements on immediate and delayed associations of UNa with blood pressure at baseline and at resurvey, and with incident cardiovascular disease in the UK Biobank (UKB).
Methods
Baseline spot urine samples were measured in 502,619 adults at baseline and in 20,346 participants who were resurveyed at 4 years after baseline. Linear regression was used to assess associations of baseline UNa measurements with systolic blood pressure (SBP; mmHg) at baseline and at resurvey. Cox regression was used estimate the associations between baseline measures of UNa with incident CVD events (recorded from linkage with hospital records). All analyses were adjusted for confounders and corrected for regression dilution bias.
Results
After excluding participants with prevalent diseases, the primary analyses involved 386,060 adults who were followed-up for a median of 7.8 years, during which ∼13,000 CVD events occurred. Estimated mean (SD) urinary sodium excretion was 77.4 mmol/L (SD 44.4, IQR = 42.8–103.7 mmol/L), and mean SBP/DBP were 137.5/82.3 (SD 18.5/10.1) mmHg, respectively. Within-person variability in UNa was high, with a self-correlation of 0.35 at 4 years between measurements. After adjustment for confounders and correction for regression dilution bias, a 100 mmol/L higher UNa was associated with an immediate 3.2 mmHg higher SBP (95% confidence interval [CI]: 2.8–3.6) in cross-sectional analyses (Figure 1). However, the corresponding associations of baseline UNa with SBP at resurvey was completely attenuated (p=0.20). The predicted risk of CVD was 1.06 (95% CI 1.06–1.07, p<0.001) for a 3.2 mmHg higher SBP, but the observed risk for a 100 mmol/L higher UNa was 0.95 (95% CI 0.82–1.10, p=0.47) (Figure 1).
Conclusions
While spot measurements of UNa were strongly associated with immediate effects on SBP, the magnitude of within-person variability in UNa precluded detection of associations with SBP several years after baseline or with risk of CVD. The extreme within-person variability in spot UNa may explain the discrepant results of the trials and observational studies of sodium and blood pressure.
Figure 1. Spot UNa with SBP and CVD in UK Biobank
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Core funding from the Medical Research Council-Population Health Research Unit, British Heart Foundation
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Affiliation(s)
- J Carter
- University of Oxford, Oxford, United Kingdom
| | - F Re
- University of Oxford, Oxford, United Kingdom
| | - I Hammami
- University of Oxford, Oxford, United Kingdom
| | | | - M Arnold
- University of Oxford, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Oxford, United Kingdom
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16
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Linden A, Clarke R, Hopewell J, Whiteley W, Walters R, Li L, Chen Z, Parish S. Height and risk of ischaemic stroke subtypes: a Mendelian randomisation study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Taller adult height is associated with lower risks of ischaemic heart disease in both conventional and Mendelian randomisation studies, providing support for a causal association, but the associations of height with ischaemic stroke and ischaemic stroke subtypes are uncertain.
Purpose
To examine the causal relevance of height for ischaemic stroke and ischaemic stroke subtypes.
Methods
Two-sample Mendelian randomisation analyses were used to examine the associations of height with: (i) ischaemic stroke and ischaemic stroke subtypes in MEGASTROKE (using summary data from 34 217 ischaemic stroke cases), and with (ii) established cardiovascular and other risk factors using individual data from 336 433 participants in UK Biobank and 57 785 in the China Kadoorie Biobank. Instruments for Mendelian randomisation were constructed from up to 3280 height-associated genetic variants, previously identified as having genome-wide significant effects on height.
Results
Genetically-determined taller height was inversely associated with ischaemic stroke (3% [95% CI: 1–6] lower risk per 1 standard deviation taller height) in MEGASTROKE but this masked much stronger opposing associations on risks of different ischaemic stroke subtypes: 15% (95% CI: 9–21) higher risk of cardioembolic stroke, 10% (4–15) lower risk of large-artery atherosclerotic stroke, and 15% (10–20) lower risk of small-vessel stroke (Figure). Genetically-determined taller height was strongly associated with atrial fibrillation and higher lean body mass and lung function but more weakly associated with lower levels of LDL cholesterol and blood pressure.
Conclusions
The findings support a causal association between taller adult height and risk of atrial fibrillation and cardioembolic stroke. The opposing associations of height with other ischaemic stroke subtypes provide further support for considering ischaemic stroke subtypes as distinct diseases in both research and clinical practice.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Medical Research Council, British Heart Foundation
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Affiliation(s)
- A Linden
- University of Oxford, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J.C Hopewell
- University of Oxford, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - W.N Whiteley
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom
| | - R.G Walters
- University of Oxford, MRC PHRU, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - L Li
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Chen
- University of Oxford, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - S Parish
- University of Oxford, MRC PHRU, CTSU, Nuffield Department of Population Health, Oxford, United Kingdom
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Clarke R, Chaikovsky I, Wright N, Du H, Chen Y, Guo Y, Bian Z, Li L, Chen Z. Independent relevance of left ventricular hypertrophy for risk of ischaemic heart disease in 25,000 Chinese adults. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The prevalence of left ventricular hypertrophy (LVH) is strongly related with established cardiovascular disease (CVD) risk factors and, hence, there has been some uncertainty about its independent relevance for ischaemic heart disease (IHD) after taking account of such risk factors.
Purpose
To examine the associations of LVH with prevalent and incident cases of IHD after adjustment for established risk factors for CVD in a population-based study of Chinese adults.
Methods
The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey in 2004–2008. A random sample of 24,786 participants had a 12-lead electrocardiogram (ECG) recorded at the second resurvey in 2013–2014. Electronic records of ECG tracings were used to estimate LVH using 5 different criteria (Sokolov, Cornell, Romhilt-Estes, Gubner and Mortara). IHD cases were recorded by linkage to electronic records of hospitalisation, death and disease registries. Cox regression was used to estimate the associations of LVH with prevalent (n=1325) and incident (n=900) cases of IHD after adjustment for age, sex, region, prior vascular disease, smoking, alcohol, SBP, diabetes, lipids and body mass index (BMI).
Results
The overall prevalence of LVH in the population varied depending on the criteria used for detection (Mortara [10%], Sokolov [14%], Cornell [6%], Romhilt-Estes [4%] and Gubner [1%]). The prevalence of LVH (using Sokolov) increased with age and was higher in men than women (20% vs 10%) and linearly with levels of SBP, but also by ∼10-fold between the 10 regions in China. Irrespective of which criteria were used for detection (Table), LVH was strongly associated with both prevalent and incident cases of IHD after adjustment for age, sex, region and established CVD risk factors. Any one measure of LVH was associated with an adjusted OR (95% CI) of 1.30 (1.10, 1.53) for prevalent IHD and 1.40 (1.20, 1.64) for incident IHD, respectively.
Conclusions
Overall, 1 in 10 Chinese adults had LVH, and LVH was associated with 30% higher risk of prevalent IHD and 40% higher risk of IHD independent of established CVD risk factors.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): UK Wellcome Trust
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Affiliation(s)
- R Clarke
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - I Chaikovsky
- Glushkov Institute for cybernetics, Kiev, Ukraine
| | - N Wright
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - H Du
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - Y Chen
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - L Li
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Chen
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
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18
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Liu EJ, Aiuppa A, Alan A, Arellano S, Bitetto M, Bobrowski N, Carn S, Clarke R, Corrales E, de Moor JM, Diaz JA, Edmonds M, Fischer TP, Freer J, Fricke GM, Galle B, Gerdes G, Giudice G, Gutmann A, Hayer C, Itikarai I, Jones J, Mason E, McCormick Kilbride BT, Mulina K, Nowicki S, Rahilly K, Richardson T, Rüdiger J, Schipper CI, Watson IM, Wood K. Aerial strategies advance volcanic gas measurements at inaccessible, strongly degassing volcanoes. Sci Adv 2020; 6:6/44/eabb9103. [PMID: 33127674 PMCID: PMC7608812 DOI: 10.1126/sciadv.abb9103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
Volcanic emissions are a critical pathway in Earth's carbon cycle. Here, we show that aerial measurements of volcanic gases using unoccupied aerial systems (UAS) transform our ability to measure and monitor plumes remotely and to constrain global volatile fluxes from volcanoes. Combining multi-scale measurements from ground-based remote sensing, long-range aerial sampling, and satellites, we present comprehensive gas fluxes-3760 ± [600, 310] tons day-1 CO2 and 5150 ± [730, 340] tons day-1 SO2-for a strong yet previously uncharacterized volcanic emitter: Manam, Papua New Guinea. The CO2/ST ratio of 1.07 ± 0.06 suggests a modest slab sediment contribution to the sub-arc mantle. We find that aerial strategies reduce uncertainties associated with ground-based remote sensing of SO2 flux and enable near-real-time measurements of plume chemistry and carbon isotope composition. Our data emphasize the need to account for time averaging of temporal variability in volcanic gas emissions in global flux estimates.
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Affiliation(s)
- E J Liu
- University College London, London WC1E6BS, UK.
- University of Cambridge, Cambridge CB23EQ, UK
| | - A Aiuppa
- Università di Palermo, 90123 Palermo, Italy
| | - A Alan
- GasLAB, Universidad de Costa Rica, San José, Costa Rica
| | - S Arellano
- Chalmers University of Technology, Göteborg, Sweden
| | - M Bitetto
- Università di Palermo, 90123 Palermo, Italy
| | - N Bobrowski
- Heidelberg University, Heidelberg, Germany
- Max Planck Institute for Chemistry, Mainz, Germany
| | - S Carn
- Michigan Technological University, Houghton, MI 49931, USA
| | - R Clarke
- University of Bristol, Bristol, BS8 1TR, UK
| | - E Corrales
- GasLAB, Universidad de Costa Rica, San José, Costa Rica
| | - J M de Moor
- Universidad Nacional, Heredia, 40101-3000 Costa Rica
| | - J A Diaz
- GasLAB, Universidad de Costa Rica, San José, Costa Rica
| | - M Edmonds
- University of Cambridge, Cambridge CB23EQ, UK
| | - T P Fischer
- University of New Mexico, Albuquerque, NM 87131, USA
| | - J Freer
- University of Bristol, Bristol, BS8 1TR, UK
- University of Saskatchewan, Centre for Hydrology, Canmore, Alberta T1W 3G1, Canada
| | - G M Fricke
- University of New Mexico, Albuquerque, NM 87131, USA
| | - B Galle
- Chalmers University of Technology, Göteborg, Sweden
| | - G Gerdes
- Chalmers University of Technology, Göteborg, Sweden
| | - G Giudice
- INGV, Osservatorio Etneo, Sezione di Catania, 95125 Catania, Italy
| | - A Gutmann
- Johannes Gutenberg-Universität, Mainz 55128, Germany
| | - C Hayer
- University of Manchester, Manchester, M13 9PL, UK
| | - I Itikarai
- Rabaul Volcanological Observatory, Rabaul, Papua New Guinea
| | - J Jones
- University of New Mexico, Albuquerque, NM 87131, USA
| | - E Mason
- University of Cambridge, Cambridge CB23EQ, UK
| | | | - K Mulina
- Rabaul Volcanological Observatory, Rabaul, Papua New Guinea
| | - S Nowicki
- University of New Mexico, Albuquerque, NM 87131, USA
| | - K Rahilly
- University of New Mexico, Albuquerque, NM 87131, USA
| | | | - J Rüdiger
- Johannes Gutenberg-Universität, Mainz 55128, Germany
| | - C I Schipper
- Victoria University of Wellington, Wellington 6012, New Zealand
| | - I M Watson
- University of Bristol, Bristol, BS8 1TR, UK
| | - K Wood
- University of Bristol, Bristol, BS8 1TR, UK
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19
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Cyrus E, Clarke R, Hadley D, Bursac Z, Trepka MJ, Dévieux JG, Bagci U, Furr-Holden D, Coudray M, Mariano Y, Kiplagat S, Noel I, Ravelo GJ, Paley M, Wagner E. The impact of COVID-19 on African American communities in the United States. medRxiv 2020. [PMID: 32511486 PMCID: PMC7273254 DOI: 10.1101/2020.05.15.20096552] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Importance: The novel Coronavirus Disease 2019 (COVID-19), declared a pandemic in March 2020, may present with disproportionately higher rates in underrepresented racial/ethnic minority populations in the United States, including African American communities who have traditionally been over-represented in negative health outcomes. Study Objective: To understand the impact of the density of African American communities (defined as the percentage of African Americans in a county) on COVID-19 prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Design: An ecological study using linear regression was employed for the study. Setting: The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. Participants: Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. Main outcome measures: Linear regression was used to determine the association between African American density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. Results: There was a direct association between African American density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<.01). There was also an association between county AA density and COVID-19 deaths, such; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=.02). Conclusion: These study findings indicate that communities with a high African American density have been disproportionately burdened with COVID-19. Further study is needed to indicate if this burden is related to environmental factors or individual factors such as types of employment or comorbidities that members of these community have.
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Affiliation(s)
- E Cyrus
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - R Clarke
- Community-Based Research Institute, Florida International University, Miami, FL 33199
| | - D Hadley
- College of Medicine, University of Central Florida, Orlando, FL 32827
| | - Z Bursac
- Department of Biostatistics, Florida International University, Miami, FL 33199
| | - M J Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - J G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - U Bagci
- Center for Research in Department of Computer Vision (CRCV), Science, University of Central Florida, Orlando, FL, 32816
| | - D Furr-Holden
- Division of Public Health, College of Medicine, Michigan State University, Flint, MI 48502
| | - M Coudray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Fl 33199
| | - Y Mariano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - S Kiplagat
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - I Noel
- Department of Psychology, University of San Diego, San Diego, CA 92110
| | - G J Ravelo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199
| | - M Paley
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136
| | - E Wagner
- Community-Based Research Institute, Florida International University, Miami, FL 33199
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20
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Peng K, Yao P, Yang L, Kartsonaki C, Bennett D, Tian M, Guo Y, Bian Z, Chen Y, Chen Z, Woodward M, Ivers R, Clarke R. Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China. Osteoporos Int 2020; 31:783-791. [PMID: 31768588 PMCID: PMC7075818 DOI: 10.1007/s00198-019-05185-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/01/2019] [Indexed: 12/02/2022]
Abstract
This prospective study of Chinese adults demonstrated an inverse J-shaped association of number of children with risk of hip fracture in both men and postmenopausal women aged 50 years or older. Women with 2 or 3 children and men with 4 children had the lowest risk of hip fracture. INTRODUCTION Women have higher absolute risks of fracture than men, which is believed to reflect differences in oestrogen exposure. The aim of this study was to compare the associations of number of children with risk of hip fracture between men and women aged over 50 years. METHODS The China Kadoorie Biobank (CKB) recruited 133,399 women and 110,296 men, aged 50 years or older between 2004 and 2008. During 10-year follow-up, 2068 participants (1394 women and 674 men) suffered a hip fracture. Cox regression analysis was used to estimate sex-specific adjusted hazard ratios (HRs) and 95% CI for incident hip fracture. RESULTS Over 98% of both subsets of men and women aged 50 or older reported having children. Women who had 2 or 3 children had the lowest risks of hip fracture compared with other groups. Compared with nulliparous women, the adjusted HR for hip fracture were 0.89 (95% CI; 0.72, 1.10) for 1 child, 0.79 (0.70, 0.90) for 2 children, 0.79 (0.72, 0.87) for 3 children, 0.81 (0.72, 0.91) for 4 children, and 0.95 (0.83, 1.10) for those with 5 or more children. The associations of number of children with hip fracture were broadly consistent in men of a similar age. CONCLUSIONS The concordant effects of the number of children with risk of hip fracture between men and women suggest that the lower risks in multiparous women are not due to differences in oestrogen exposure or other biological effects, but may reflect residual confounding by socioeconomic or lifestyle factors.
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Affiliation(s)
- K Peng
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - P Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - L Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - C Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - D Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Tian
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Y Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Z Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Woodward
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, Oxford University, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - R Ivers
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - R Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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21
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Peng K, Yao P, Yang L, Kartsonaki C, Bennett D, Tian M, Guo Y, Bian Z, Chen Y, Chen Z, Woodward M, Ivers R, Clarke R. Publisher Correction: Parenthood and risk of hip fracture: a 10-year follow-up prospective study of middle-aged women and men in China. Osteoporos Int 2020; 31:793. [PMID: 32047950 PMCID: PMC7645435 DOI: 10.1007/s00198-019-05272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The original version of this article, published on 25 November 2019, unfortunately contained a mistake.
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Affiliation(s)
- K Peng
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - P Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - L Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - C Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - D Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Tian
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Y Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Z Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Woodward
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, Oxford University, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - R Ivers
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - R Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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22
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Karim M, Lin K, Millwood IY, Kartsonaki C, Hill M, Guo Y, Bian Z, Yu C, Li L, Clarke R, Chen Z, Walters RG, Holmes MV. P5505Inflammation implicated in the aetiology of major vascular and non-vascular diseases in East Asians. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mendelian randomisation (MR) studies using genetic variants in the IL6R gene encoding the interleukin-6 (IL-6) receptor have demonstrated that IL-6 plays a causal role in the aetiology of coronary heart disease (CHD) in European populations, with implications for the development of drugs targeting inflammation-related pathways. It is less clear whether IL-6 signalling plays a causal role in vascular disease or major non-vascular diseases in East Asians.
Purpose
Using an MR approach, we investigated associations of altered IL-6 signalling with subtypes of CHD, stroke, cancer and respiratory disease in a large East Asian cohort.
Methods
In approximately 150,000 Chinese adults from the China Kadoorie Biobank, we investigated associations of rs7529229 (in strong linkage disequilibrium, r2=0.99, with the IL6R Asp358Ala variant rs2228145) with blood biomarkers and selected disease events in which inflammation has previously been implicated. First, we used linear regression to quantify the per-allele association of rs7529229 with levels in plasma of log-transformed C-reactive protein (CRP) (n=17,866), fibrinogen (n=9,255), and IL-6 protein (n=633). Second, we used logistic regression to evaluate the association of rs7529229 with incidence of CHD, stroke, cancer, and respiratory disease events. All models were adjusted for age, age-squared, sex (except breast cancer), and case ascertainment (for CRP and fibrinogen), and stratified by recruitment region. We assessed significance at a 5% false discovery rate.
Results
IL6R rs7529229 C-allele was associated with lower log CRP (–0.11 SDs per C-allele; p=4.9x10–25) and log fibrinogen (–0.07 SDs; p=2.2x10–7), and higher log IL-6 (0.15 SDs; p=0.011) (Figure 1), mimicking therapeutic blockade of IL6R. IL6R rs7529229 was associated with a lower risk of acute myocardial infarction (n=4,047 cases; OR: 0.92 [95% CI 0.88–0.96] per C-allele; p=2.8x10–4), with the association similar for fatal and non-fatal cases (Figure 2). There was no evidence of association with ischaemic stroke (n=18,315; OR: 1.00 [0.98–1.03]; p=0.90) or intracerebral haemorrhage (n=7,372; OR: 1.03 [0.99–1.07]; p=0.10). For non-cardiovascular diseases, the IL6R rs7529229 was associated with a lower risk of oesophageal (n=824; OR: 0.88 [0.79–0.97] per C-allele; p=0.013) and colorectal (n=1,151; OR: 0.89 [0.82–0.97]; p=8.3x10–3) cancers, but a higher risk of tuberculosis (n=1,017; OR: 1.15 [1.05–1.26]; p=2.4x10–3).
Conclusion
The results of the present study are consistent with a causal role for the IL-6 signalling pathway in the aetiology of myocardial infarction and some cancers, but not of stroke. These findings provide further genetic support for drug development targeting inflammation in the prevention and treatment of coronary and selected cancer outcomes.
Acknowledgement/Funding
Kadoorie Charitable Foundation, UK Wellcome Trust, Chinese Ministry of Science and Technology, BHF, CRUK, NIHR
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Affiliation(s)
- M Karim
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - K Lin
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - I Y Millwood
- Medical Research Council of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - C Kartsonaki
- Medical Research Council of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - M Hill
- Medical Research Council of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - C Yu
- Peking University, Department of Epidemiology, School of Public Health, Beijing, China
| | - L Li
- Peking University, Department of Epidemiology, School of Public Health, Beijing, China
| | - R Clarke
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Z Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R G Walters
- Medical Research Council of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - M V Holmes
- Medical Research Council of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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23
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Chen Y, Wright N, Clarke R, Kartsonaki C, Turnbull I, Guo Y, Zheng B, Li L, Chen Z. P2777Natural history and long-term prognosis of stroke types in urban and rural China: a 9-year prospective study of 0.5 million adults. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Stroke is a major cause of premature death and disability worldwide. However, relatively little is known about the natural history and long-term prognosis following stroke in many low and middle income countries, including China.
Methods
The prospective China Kadoorie Biobank recruited 512,000 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) areas in China during 2004–08. Information about death and hospitalisation for specific causes was collected by linkage with mortality registries and nationwide health insurance systems. During a 9-year follow-up, 45,732 incident cases of stroke (∼92% confirmed by neuroimaging) were recorded among individuals without prior vascular disease at baseline. The adjusted 28-day case-fatality rates and long-term cumulative risks of recurrent stroke, major vascular events, and mortality following first-ever stroke were estimated by stroke types.
Results
Of the 45,732 first-ever stroke cases reported, 80% (36,588) had IS, 17% (7440) had intracerebral haemorrhage (ICH), 2% (702) had subarachnoid haemorrhage (SAH), and only 1002 (1%) had an unspecified stroke type. The overall 28-day case-fatality following first stroke was 11%, but increased with age and was higher in those in rural than in urban areas (16% vs 6%) and in men than in women (13% vs 10%). The 28-day case-fatality was highest for ICH (47%), lowest for IS (3%) and intermediate for SAH (19%) and unspecified strokes (24%). Among those who survived beyond 28 days, 17% died (28% for ICH, 16% for IS) and 41% had a recurrent stroke (44% for ICH, 41% for IS) at 5 years. For those with first-ever IS, 91% of the subsequent recurrent strokes involved same pathological type, while for ICH, 41% of the recurrent strokes were IS.
Stroke prognosis
Conclusions
Among Chinese adults, the short- and long-term prognosis following first-ever stroke were poor, highlighting the urgent need to implement more effective treatment and secondary prevention strategies for stroke cases.
Acknowledgement/Funding
UK MRC, UK Wellcome Trust, British Heart Foundation, Cancer Research UK, The Chinese Ministry of Science and Technology, the Chinese National Science
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Affiliation(s)
- Y Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - N Wright
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - C Kartsonaki
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - I Turnbull
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - B Zheng
- Chinese Academy of Medical Sciences, Beijing, China
| | - L Li
- Beijing University, Department of Epidemiology and Biostatistics, Beijing, China
| | - Z Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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24
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Bragg F, Halsey J, Guo Y, Chen Y, Bian Z, Clarke R, Li L, Chen Z. P2494Cardiovascular disease burden attributed to high blood pressure in Chinese adults with type 2 diabetes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular diseases (CVD) are the most common cause of death among people with diabetes, reflecting in part co-existence with other CVD risk factors, including high blood pressure. However, controversy persists about the nature of the relationship of blood pressure with risk of CVD in individuals with diabetes, and about the associated disease burden.
Methods
We analysed data from 26,315 men and women aged 30–79 years with type 2 diabetes but no prior history of CVD, who were recruited into the China Kadoorie Biobank in 2004–2008 from 10 diverse areas in China. During ∼10 years' follow-up 1,190 major coronary events (MCE), 4,362 ischaemic stroke (IS), 469 intra-cerebral haemorrhage (ICH) events and 4,503 deaths (including 1,807 CVD deaths) were recorded. Usual systolic (SBP) and diastolic (DBP) blood pressure and uncontrolled hypertension were related to risks of incident CVD and all-cause mortality, after adjustment for relevant confounders.
Results
Overall, 75.7% of participants had prior doctor-diagnosed (24.8%) or screen-detected (67.7%) hypertension, compared with 54.3% among those without diabetes. The age-adjusted prevalence of hypertension was higher among men and in rural areas. Among those with previously diagnosed hypertension, 39.3% reported use of anti-hypertensive medications (on average, 1 agent) and 8.5% had controlled hypertension (<130/80 mmHg). Usual SBP was continuously and positively associated with the risk of CVD, with no evidence of a threshold throughout the range examined (120–180 mmHg). Each 10 mmHg higher SBP was associated with a 27% higher risk for CVD death (HR 1.27, 95% CI 1.25–1.30). Strong positive associations were also seen for MCE (1.16, 1.12–1.21), IS (1.15, 1.13–1.18), and ICH (1.46, 1.34–1.60). Overall, uncontrolled hypertension accounts for an estimated 39% (32–45%), 30% (21–38%), 24% (20–28%) and 48% (34–58%) of CVD deaths, MCE, IS and ICH, respectively, among Chinese adults with diabetes.
Conclusion
Hypertension is common but frequently undetected and uncontrolled among adults with type 2 diabetes in China. Effective diagnosis and management of hypertension among individuals with diabetes would be expected to achieve substantial reductions in CVD morbidity and mortality.
Acknowledgement/Funding
Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Foundation, MoST, NSFC
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Affiliation(s)
- F Bragg
- University of Oxford, Oxford, United Kingdom
| | - J Halsey
- University of Oxford, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Y Chen
- University of Oxford, Oxford, United Kingdom
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - R Clarke
- University of Oxford, Oxford, United Kingdom
| | - L Li
- Peking University, Beijing, China
| | - Z Chen
- University of Oxford, Oxford, United Kingdom
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Gnatiuc L, Alegre-Diaz J, Garcilazo-Avila A, Ramirez R, Gonzales-Carballo C, Solano-Sanchez M, Chiquete E, Wade R, Clarke R, Herrington WG, Collins R, Peto R, Tapia-Conyer R, Kuri-Morales P, Emberson J. P3824Body composition and mortality from vascular or metabolic causes among 150,000 participants in the Mexico City Prospective Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher body-mass index is associated with increased mortality from vascular disease, renal disease and other metabolic causes. However, body mass reflects both fat and lean mass, which may have very different effects on risk. We investigated the individual and joint relevance of fat and lean mass to mortality from these causes, using data from the Mexico City Prospective Study.
Methods
Between 1998 and 2004, 150,000 adults from Mexico City were recruited into a prospective study and tracked for cause-specific mortality for 14 years. Fat and lean mass at recruitment were predicted using Mexican-specific anthropometric equations, validated in a subset of participants with additional bio-impedance measures. Cox regression was used to assess the relevance of fat and lean mass at recruitment to mortality from a vascular, renal, or other metabolic cause at ages 35–74 years. Analyses were adjusted for age at risk, sex, residential district, education, recreational physical activity, smoking and alcohol consumption. To avoid reverse causality, analyses excluded those with diabetes or other chronic diseases at recruitment, and deaths in the first 5 years of follow-up. Mortality rate ratios (RRs) relate to the differences per SD of the usual values of various factors or the differences between the top tenth and bottom fifth of the values.
Results
Among 112,923 participants aged 35–74 years, mean (SD) fat mass in men and women was 22.0 (6.4) kgs and 29.4 (7.8) kgs respectively, while mean (SD) lean mass was 54.9 (7.2) kgs and 39.2 (5.0) kgs respectively. In both men and women, equation-predicted fat and lean mass closely matched the bio-impedance values (all r>0.86). Both fat and lean mass were positively and approximately log-linearly associated with mortality from a vascular or metabolic cause. However, the association of lean mass with mortality was more than accounted for by the correlation of lean with fat mass. Hence, after adjustment for fat mass, lean mass was inversely associated with risk. For a given amount of fat mass, the RR for vascular/metabolic mortality comparing those in the top tenth versus bottom fifth of the predicted lean mass was 0.35 (95% CI 0.24–0.52). Conversely, for a given amount of lean mass, the RR comparing those in the top tenth versus bottom fifth of the predicted fat mass was 4.06 (3.06–5.39). The RRs associated with each SD higher fat mass (1.51, 1.40–1.63) or lean mass (0.79, 0.73–0.86) appeared to be little affected by age, sex, or levels of other confounders, and were broadly similar for the major vascular, renal, and other metabolic mortality. The height-adjusted RRs were 1.41 (1.30–1.53) for fat mass and 0.91 (0.82–1.00) for lean mass.
Conclusions
In this Mexican cohort, predicted fat and lean mass had opposing effects on vascular and other metabolic deaths, with no evidence of any thresholds throughout the ranges studied.
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Affiliation(s)
- L Gnatiuc
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - J Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - A Garcilazo-Avila
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - C Gonzales-Carballo
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - M Solano-Sanchez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - E Chiquete
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - W G Herrington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Peto
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - P Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
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26
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Gan W, Bennett D, Mahajan A, Du H, Chen Z, McCarthy M, Clarke R. P6231Iron status and risk of cardio-metabolic diseases in European adults: a Mendelian randomization study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Observational studies have reported conflicting results about the associations of iron status with risk of cardio-metabolic diseases but such studies are constrained by confounding and reverse causality.
Purpose
To assess the causal relevance of iron status biomarkers (transferrin, serum iron, and ferritin) for risk of coronary artery diseases (CAD), ischaemic stroke (IS), and type 2 diabetes (T2D), using Mendelian randomization (MR).
Methods
Effect size estimates for genetic variants associated with iron status biomarkers were obtained from the Genetics of Iron Status consortium (transferrin saturation, serum iron, and ferritin: n=48,972). The corresponding effects of these variants on the risk of CAD, IS and T2D were obtained from a meta-analysis of unrelated participants of European ancestry in the UK Biobank (UKB), together with previously recruited participants in CARDIOGRAMplusC4D (total n=90,377 CAD cases), MEGASTROKE (total n=43,381 IS cases) and DIAGRAM (total n=74,124 T2D cases), respectively. The main analysis used a two-sample inverse-variance weighted MR, while the sensitivity analyses used weighted-median, weighted-mode, MR-PRESSO, and MR-Egger approaches.
Results
MR analysis demonstrated significant inverse association of each of the three genetically-instrumented iron status biomarker with risk of CAD (transferrin saturation OR=0.96 [95% CI: 0.92–0.99], p=0.02; serum iron OR=0.93 [0.89–0.97], p=0.001; and ferritin OR=0.86 (0.79–0.94), p=0.001, per 1 SD higher level). In contrast, these iron status biomarkers showed positive associations with risk of T2D (transferrin saturation OR=1.06 [1.01–1.11], p=0.01; serum iron OR=1.06 [0.99–1.13], p=0.07; and ferritin OR=1.12 [0.99–1.26], p=0.06, per 1 SD higher level). There was positive, but non-significant, association of IS with each of the iron status biomarker analysed. Sensitivity analyses using several different MR approaches yielded concordant results.
Conclusions
Among European adults, iron status appeared to have causal associations, but in opposite directions, with the risk of CHD and T2D. Our findings highlight the need for caution about strategies for advocating iron supplementation in individuals with normal haemoglobin levels for prevention of CAD.
Acknowledgement/Funding
British Heart Found, Medical Research Council, Wellcome Trust, NIHR Biomedical Research Centre, Oxford
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Affiliation(s)
- W Gan
- University of Oxford, Clinical Trial Service Unit, Nuffield Department of Population Health, Oxford, United Kingdom
| | - D Bennett
- University of Oxford, Clinical Trial Service Unit, Nuffield Department of Population Health, Oxford, United Kingdom
| | - A Mahajan
- University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom
| | - H Du
- University of Oxford, Clinical Trial Service Unit, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Z Chen
- University of Oxford, Clinical Trial Service Unit, Nuffield Department of Population Health, Oxford, United Kingdom
| | - M McCarthy
- University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Clinical Trial Service Unit, Nuffield Department of Population Health, Oxford, United Kingdom
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Stiby A, Clarke R, Parish S, Hopewell JC. P1228Impact of history of vascular disease on lipoprotein(a) associations with cardiovascular outcomes: a Mendelian randomisation study in 283,658 UK Biobank participants. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mendelian randomisation (MR) studies have been widely used to assess the causal relevance of risk factors for disease and to elucidate the likely effects of novel drug targets. MR studies have confirmed the causal relevance of lipoprotein(a) [Lp(a)] for risk of coronary heart disease (CHD), but the impact of prior vascular disease on these associations remains unclear, and is potentially important when testing the effects of Lp(a) lowering therapies.
Purpose
To examine the associations of LPA variants, as a proxy for Lp(a) levels, with risk of CHD, ischaemic stroke and peripheral vascular disease (PVD), by history of vascular disease in UK Biobank (UKB).
Methods
An LPA genotype score was constructed in 283,658 unrelated white British UKB participants, using 2 SNPs (rs3798220 and rs10455872) previously shown to be independently associated with, and explain ∼40% of the variance in, Lp(a) levels. The LPA score was tested for association with hospitalisation for CHD (n=23,165), presumed ischaemic stroke (n=2,579) and PVD (n=3,780) using Cox PH models. Estimated hazard ratios (per LPA variant) for cardiovascular outcomes are reported both overall and by history of vascular disease (CHD, ischaemic stroke or PVD) at baseline.
Results
As observed in previous studies, LPA was associated with a higher risk of CHD (Hazard ratio [HR] 1.27 per LPA variant; 95% CI: 1.24–1.31). However, the effect was substantially attenuated in participants with versus without prior vascular disease (p-interaction = 3x10–5; Figure). The effect of the LPA score on PVD was comparable to that for CHD (p-heterogeneity = 0.25), whilst the effect on ischaemic stroke was significantly weaker than that for CHD (p-heterogeneity = 6x10–3). As for CHD, the effects of the LPA score on both ischaemic stroke and PVD were weaker in those with versus those without prior vascular disease. Furthermore, the heterogeneity between the effects on cardiovascular outcomes was more extreme when stratified by history of CHD.
Conclusions
This MR study shows that the effects of LPA on risk of CHD, ischaemic stroke and PVD are weaker in individuals with a history of vascular disease, perhaps reflecting the effects of medications used in this setting. Therefore, MR studies in the general population may overestimate the anticipated effects of Lp(a)-lowering therapies in randomised trials, which are typically conducted in individuals with prior vascular disease.
Acknowledgement/Funding
British Heart Foundation
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Affiliation(s)
- A Stiby
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - S Parish
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J C Hopewell
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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Turnbull IJ, Clarke R, Guo Y, Hacker A, Kartsonaki C, Bian Z, Sansome S, Chen H, Wu H, Xu X, Li L, Chen Z, Chen Y. P2780Accuracy of electronic healthcare records for diagnosis of stroke types in a large community-based prospective cohort study in China. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Reliable assessment of the determinants of major pathological types of stroke is dependent on the accuracy of diagnosis in population-based studies. We evaluated the diagnostic accuracy of stroke types in a large community-based cohort study involving health records collected in China.
Methods
In 2004–08, >0.5 million adults aged 30–79 years were recruited from general populations of 10 diverse areas (5 urban, 5 rural) in China. During an approximate 7-year follow-up, 37,694 stroke cases had been reported by linkage to electronic health records from disease-specific and mortality registries and from national health insurance agencies. For all reported stroke cases, hospital medical records were retrieved systematically and relevant data extracted for subsequent adjudication by specialists using bespoke electronic platforms.
Results
Among all reported incident stroke cases, 80% were ischaemic stroke (IS), 17% were intracerebral haemorrhage (ICH), and 1% were subarachnoid haemorrhage (SAH). To date, medical records have been retrieved for 29,632 cases, with reports of stroke diagnosis verified by public health staff in 27,115 (92%) cases, of which 3,778 (14%) were secondary diagnoses. Evidence of neuroimaging was found in 92% of all verified stroke cases. Of 23,337 primary stroke cases sent for specialist adjudication, a diagnosis of pathological stroke type was confirmed in 19,718 cases with the positive predictive values being 82.4% (95% confidence interval [CI], 82.0% - 82.8%) for IS, 97.8% (97.6 - 97.9) for ICH, and 98.2% (98.1 - 98.3) for SAH. Overall, the strength of association of systolic blood pressure was over 6-fold greater for confirmed than non-confirmed stroke cases and was nearly 3-fold greater for confirmed ICH than IS cases.
Diagnostic accuracy by stroke type Reported Retrieved Verified Adjudicated Confirmed Approximate 95% CI n n % n % n % n PPV, % IS 30,143 25,477 85 23,551 92 20,045 85 16,515 82.4 (82.0–82.8) ICH 6,484 3,486 54 3,079 88 2,919 95 2,854 97.8 (97.6–97.9) SAH 557 397 71 326 82 279 86 274 98.2 (98.1–98.3) Other 510 272 53 159 59 94 59 75 79.8 (79.4–80.2) IS indicates ischaemic stroke; ICH, intracerebral haemorrhage; SAH, subarachnoid haemorrhage; and PPV, positive predictive value.
Conclusions
The overall diagnostic accuracy of pathological stroke types obtained from hospital records in China is comparable to reports from Western populations. Despite advances in electronic healthcare records, reliable classification of stroke types requires clinical adjudication using additional relevant investigations.
Acknowledgement/Funding
Kadoorie Charitable Foundation, UK Wellcome Trust & National Natural Science Foundation and National Key Research and Development Program of China
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Affiliation(s)
- I J Turnbull
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - A Hacker
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - C Kartsonaki
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - S Sansome
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - H Chen
- Center for Disease Control and Prevention, Non-Communicable Disease Prevention and Control Department, Huixian, China
| | - H Wu
- Center for Disease Control and Prevention, Non-Communicable Disease Prevention and Control Department, Huixian, China
| | - X Xu
- Center for Disease Control and Prevention, Liuyang, China
| | - L Li
- Chinese Academy of Medical Sciences, Beijing, China
| | - Z Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - Y Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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29
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Kreilaus F, Chesworth R, Eapen V, Clarke R, Karl T. First behavioural assessment of a novel Immp2l knockdown mouse model with relevance for Gilles de la Tourette syndrome and Autism spectrum disorder. Behav Brain Res 2019; 374:112057. [PMID: 31233820 DOI: 10.1016/j.bbr.2019.112057] [Citation(s) in RCA: 14] [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: 03/26/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/26/2022]
Abstract
Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder, which shares some clinical features with Autism spectrum disorder (ASD). The genetic factors relevant to the development of both disorders are yet to be fully understood, however, some genetic association studies have identified inner mitochondrial membrane peptidase subunit 2 (IMMP2L) as a potential risk gene for both GTS and ASD. The impact of Immp2l deficiency on behavioural domains is currently unknown. A new genetic mouse model for Immp2l was developed. Adult heterozygous (HET) and homozygous (HOMO) Immp2l knockdown (Immp2l KD) mice of both sexes were compared to wild type-like (WT) littermates in the open field (OF), social interaction, novel object recognition, marble burying, and prepulse inhibition (PPI). The effect of acute dexamphetamine (2 mg/kg) on OF behaviour was also determined. OF locomotion was significantly higher in HET compared to HOMO male littermates. Male and female HOMO mice were much more sensitive to the locomotor-stimulating effects of dexamphetamine (DEX), whereas only HOMO males exhibited significant increased DEX-induced OF exploration compared to control groups. HOMO females failed to habituate to an acoustic startle stimulus. Furthermore, compared to HOMO females, HET females showed reduced social interaction, and a similar trend was seen in HET males. The Immp2l KD mouse model possesses moderate face validity for preclinical research into GTS and ASD, in particular as dysfunctional dopaminergic neurotransmission appears to be one mechanism leading to disease presentation. The sex-dependent differences observed in most findings reinforce the strong influence of sex in the pathophysiology of GTS and ASD.
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Affiliation(s)
- Fabian Kreilaus
- School of Medicine, Western Sydney University, NSW 2560, Australia
| | - Rose Chesworth
- School of Medicine, Western Sydney University, NSW 2560, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine and Ingham Institute, University of New South Wales, NSW, 2052, Australia
| | - Raymond Clarke
- School of Psychiatry, Faculty of Medicine and Ingham Institute, University of New South Wales, NSW, 2052, Australia.
| | - Tim Karl
- School of Medicine, Western Sydney University, NSW 2560, Australia; Neuroscience Research Australia (NeuRA), NSW, 2031, Australia; School of Medical Sciences, University of New South Wales, NSW, 2052, Australia.
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30
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White TG, Oliver MT, Mabey P, Kühn-Kauffeldt M, Bott AFA, Döhl LNK, Bell AR, Bingham R, Clarke R, Foster J, Giacinti G, Graham P, Heathcote R, Koenig M, Kuramitsu Y, Lamb DQ, Meinecke J, Michel T, Miniati F, Notley M, Reville B, Ryu D, Sarkar S, Sakawa Y, Selwood MP, Squire J, Scott RHH, Tzeferacos P, Woolsey N, Schekochihin AA, Gregori G. Supersonic plasma turbulence in the laboratory. Nat Commun 2019; 10:1758. [PMID: 30988285 PMCID: PMC6465398 DOI: 10.1038/s41467-019-09498-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
The properties of supersonic, compressible plasma turbulence determine the behavior of many terrestrial and astrophysical systems. In the interstellar medium and molecular clouds, compressible turbulence plays a vital role in star formation and the evolution of our galaxy. Observations of the density and velocity power spectra in the Orion B and Perseus molecular clouds show large deviations from those predicted for incompressible turbulence. Hydrodynamic simulations attribute this to the high Mach number in the interstellar medium (ISM), although the exact details of this dependence are not well understood. Here we investigate experimentally the statistical behavior of boundary-free supersonic turbulence created by the collision of two laser-driven high-velocity turbulent plasma jets. The Mach number dependence of the slopes of the density and velocity power spectra agree with astrophysical observations, and supports the notion that the turbulence transitions from being Kolmogorov-like at low Mach number to being more Burgers-like at higher Mach numbers.
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Affiliation(s)
- T G White
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
- Department of Physics, University of Nevada, Reno, NV, 89557, USA.
| | - M T Oliver
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- Department of Physics, University of Nevada, Reno, NV, 89557, USA
| | - P Mabey
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | | | - A F A Bott
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - L N K Döhl
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A R Bell
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - R Bingham
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, UK
| | - R Clarke
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Foster
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - G Giacinti
- Max-Planck-Institut für Kernphysik, Postfach 103980, 69029, Heidelberg, Germany
| | - P Graham
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - R Heathcote
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - M Koenig
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - D Q Lamb
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - J Meinecke
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Th Michel
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | - F Miniati
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - M Notley
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - B Reville
- School of Mathematics and Physics, Queens University Belfast, Belfast, BT7 1NN, UK
| | - D Ryu
- Department of Physics, School of Natural Sciences, UNIST, Ulsan, 44919, Korea
| | - S Sarkar
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Y Sakawa
- Institute of Laser Engineering, Osaka, 565-0871, Japan
| | - M P Selwood
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Squire
- Theoretical Astrophysics, 350-17, California Institute of Technology, Pasadena, CA, 91125, USA
- Physics Department, University of Otago, Dunedin, 9016, New Zealand
| | - R H H Scott
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - P Tzeferacos
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - N Woolsey
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A A Schekochihin
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
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31
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Sevigny CM, Sengupta S, Luo Z, Jin L, Pearce D, Clarke R. Abstract P2-06-14: The role of SLC7A5 (LAT1) in endocrine therapy-resistant breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-06-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Endocrine therapies are commonly used to treat estrogen receptor-positive (ER+) breast cancers, which comprise 70% of all new breast cancer cases. Unfortunately, emergence of resistance to these therapies presents a major clinical challenge. Cancer cells can adapt to the dysregulation of cellular metabolism induced by endocrine therapy in order to evade cell death.Central to this adaptation is the scavenging of free-formed amino acids from the tumor microenvironment. For example, we found 109 solute carrier (SLC) mRNAs to be differentially expressed between endocrine-sensitive and resistant cells. We began our mechanistic studies of these genes with SLC family 7 member 5 (SLC7A5 or LAT1). SLC7A5 is a key component of a transmembrane transporter, which can complex with CD98 and increase the uptake of large, neutral amino acids (such as leucine or tyrosine).
We used a panel of endocrine therapy-resistant (LCC9) and sensitive (MCF7; LCC1) breast cancer cells. SLC7A5 expression was upregulated by estrogen in MCF7 and LCC1 cells; this induction was blocked by fulvestrant treatment. Basal expression of the SLC7A5 protein in the absence of estrogen was 2.75-fold higher in LCC9 cells compared with MCF7 cells; SLC7A5 mRNA expression was 71-fold higher. Fulvestrant treatment did not significantly alter SLC7A5 mRNA or protein expression in LCC9 cells. Inhibiting SLC7A5 function using either a pharmacological inhibitor (JPH203), or depleting expression using siRNA, led to significant suppression of LCC9 cell growth. Cell cycle analysis revealed that SLC7A5 depletion caused cells to accumulate in the G1-phase, with a concurrent reduction of cells in S-phase. In four publicly available datasets of ER+, tamoxifen treated breast cancer patients, high expression of SLC7A5 was significantly associated with poor relapse-free survival.
This study uncovers a novel adaptive mechanism in endocrine therapy-resistant breast cancer cells that is facilitated by increased expression of SLC7A5, which enables them to supplement their increased metabolic needs and promoting cell growth. Blocking the functions of SLC7A5, perhaps in conjunction with inhibition of autophagy, may therefore offer a new avenue of potential therapeutic intervention against endocrine therapy-resistant breast cancers.
Citation Format: Sevigny CM, Sengupta S, Luo Z, Jin L, Pearce D, Clarke R. The role of SLC7A5 (LAT1) in endocrine therapy-resistant breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-14.
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Affiliation(s)
- CM Sevigny
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
| | - S Sengupta
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
| | - Z Luo
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
| | - L Jin
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
| | - D Pearce
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
| | - R Clarke
- Georgetown University, Washington, DC; The University of Edinburgh, Edinburgh, United Kingdom
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Timbrell S, Aglan H, Cramer A, Foden P, Weaver D, Pachter J, Farnie G, Clarke R, Bundred N. Abstract P2-06-07: Investigating the role of focal adhesion kinase in regulating CSC activity in invasive ductal carcinoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Breast Cancer Stem-like Cells (BCSCs) have been associated with tumour development, metastasis and recurrence1. Focal Adhesion Kinase (FAK) is a non-receptor tyrosine kinase classically known for its role in metastasis, proliferation and survival. We have previously shown FAK plays a role in regulating CSC activity in DCIS2. We aimed to investigate FAK and CSC marker expression in a retrospective patient cohort. We aimed to evaluate the effects of FAK inhibition on CSC activity in Invasive Ductal Carcinoma.
Methods
Using a retrospective case-control cohort of 244 patients across a range of molecular phenotypes we evaluated FAK Immunohistochemical expression alongside CSC markers; Aldehyde Dehydrogenase 1 (ALDH1) and Integrin Alpha 6 (ITGa6). FAK expression was measured in IDC cell lines and ALDEFLUOR high expressing cells. FAK was inhibited using 0.5μM VS4718 or SiRNA and CSC activity evaluated in 5 cell lines and 25 patient samples. We determined the effects of 50mg/kg VS4718 for 4 weeks as single agent or in combination with Paclitaxel 7.5mg/kg in a ER-/PR-/HER- Patient Derived Xenograft model (PDX).
Results
Total FAK expression was associated with reduced breast cancer survival. Co-expression of FAK and either BCSC marker was associated with the poorest survival.
FAK and CSC marker expression pFAKtFAKALDH1ITGα6tFAK and ALDH1tFAK and ITGα6Recurrence Risk0.58 (0.31-1.08) p = 0.0842.05 (1.23-3.43) p = 0.0062.21 (1.20-4.05) p=0.0111.54 (0.92-2.23) p=0.107 Breast Cancer Death0.41 (0.12-1.51) p=0.1824.84 (2.33 -10.04) p = <0.0016.58 (1.87-23.10) p=0.0032.23 (1.08-4.58) p=0.03016.7 (3.7-73.9) p=<0.00112.8 (1.37-13.2,) p=0.012Hazard ratios calculated using cox-proportional hazard regression analysis.
pFAK was higher in ALDEFLUOR expressing cells and triple negative cell lines. SiRNA knockout of FAK reduced mammosphere formation, self-renewal and ALDEFLUOR expression from 1.2% to 0.2% (p=<0.01, unpaired t-test) in MDA-MB-231 cells. VS4718 reduced primary mammosphere forming efficiency in all cell lines and reduced self-renewal in ER negative cell lines. FAK inhibition led to a reduction in mammosphere forming efficiency and self-renewal in 25 primary breast cancer specimens as outlined below:
FAK inhibition reduces MFE Primary Breast Cancer samples ER negative cell lines ER+/PR+/ Her2-ER-/PR-/Her2+ER-/PR-/Her2-SKBr3MDA-MB-231SUM159Primary mammosphere formation51.1% (n=17)53.2% (n=4)49.6% (n=5)74.1%84.8%67.6%Secondary mammosphere formation45.8% (n=8) 43.9% (n=3)42.1%57.9%47.5%Percentage of mammospheres formed given relative to control. Cell line work, minimum n=6. All above significant p=<0.05, One way Anova used with post hoc Tukeys test.
VS4718 reduced tumour growth, Ki67 staining and CSC activity in our triple negative PDX model. VS4718 administration reduced ex-vivo mammosphere formation, tumour initiating capacity and prevented ALDEFLUOR enrichment when used in combination with Paclitaxel.
Conclusions
FAK, ALDH1 and ITGa6 are associated with increased breast cancer mortality in early breast cancer. Inhibition of FAK reduces CSC activity in vitro and in vivo in cell lines and patient samples. This data suggest that FAK inhibition may be used to reduce CSC activity in triple negative carcinoma.
1. Williams et al, Stem cells 2015.
Citation Format: Timbrell S, Aglan H, Cramer A, Foden P, Weaver D, Pachter J, Farnie G, Clarke R, Bundred N. Investigating the role of focal adhesion kinase in regulating CSC activity in invasive ductal carcinoma [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-07.
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Affiliation(s)
- S Timbrell
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - H Aglan
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - A Cramer
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - P Foden
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - D Weaver
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - J Pachter
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - G Farnie
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - R Clarke
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
| | - N Bundred
- Breast Biology Group, The University of Manchester, Manchester, United Kingdom; Academic Surgery, Manchester University Foundation Trust, Manchester, United Kingdom; The Christie, Manchester, United Kingdom; Verastem, Boston; Cellular Assays Group, The University of Oxford, Oxford, United Kingdom
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Clarke R, Dixon M, Jin L, Pearce D, Turnbull A, Selli C, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Sims A, Liu MC. Abstract P5-04-17: Local network topology differences between early and late recurrence in ER+ breast cancers. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-04-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Late recurrence is characteristic of ER+ breast cancers. Despite an apparently effective adjuvant endocrine therapy, many breast cancers recur years after their initial endocrine treatment. Why some tumors recur early (<3 years) and some recur later (>5 years) is poorly understood. If systemic endocrine therapies killed all cells, recurrence would reflect only the appearance of new disease. Thus, we hypothesized that cells that survive and lie dormant may be driven, in part, by altered wiring of their cell death signaling. We, therefore, studied how cell death signaling is differentially wired in primary tumors that will recur early versus those that will recur later.
Method: Genes involved in apoptosis, autophagy, ferroptosis, necrosis, and pyroptosis were identified from KEGG to initiate network feature analysis of gene expression data from public and our first in-house gene expression dataset. Data were collected from ER+ breast cancer pre-endocrine treatment samples with up to 20 years follow-up. Publicly available datasets used were GSE6532, GSE2034, GSE7390, GSE17705, GSE12093, and TCGA. We applied our Knowledge-fused Differential Dependency Network (KDDN) analysis tool to the public datasets; KDDN has provided powerful new insights into signaling in breast and other cancers. Common gene-gene interactions (edges) predicted in at least two different datasets were extracted from all KDDN analyses results. To strengthen the relevance of these features, predicted network edges that represent known protein-protein interactions (PPI) were identified from the STRING database, and these edges were noted in the signaling graphs. Final network graphs were constructed using the common edges from all overlaid networks. We conducted IPA analysis on all nodes in the final network and selected those incorporating network hubs. We took a similar approach to our second in-house dataset, which we used for independent testing. Here, patients were included if their tumor exhibited an initial reduction in volume of at least 40% by four months in response to neo-adjuvant Letrozole. Patients were then classified into two groups during follow-up of up to 3.7 years: i) initial tumor size reduction followed by continued response (expected to recur late); ii) initial reduction followed by tumor regrowth (expected to recur early). KDDN analysis was performed on pretreatment samples from these two groups and a network created annotated with PPI information.
Results: MAPK8 and CYCS (Molecular Mechanisms of Cancer, p=1.58E-52), TNFRSF1A Neuroinflammation Signaling Pathway, p=1.26E-54), RELA, and NFKB1 (Colorectal Cancer Metastasis Signaling, p=7.94E-35), were identified as hubs. Hubs may be critical signaling components driving the differences between tumors that will become dormant and recur late. Connections between SLC25A6 and SQSTM1 (p = 0.008), BIRC2 and GABARAP (p = 0.021) in the early group, and AKT3 and IRS2 (p = 0.014) in the late group, were shared between the two final networks. With longer follow-up time on the second in-house dataset, we will better define the two groups and identify additional common phenotype specific gene-gene interactions.
Citation Format: Clarke R, Dixon M, Jin L, Pearce D, Turnbull A, Selli C, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Sims A, Liu MC. Local network topology differences between early and late recurrence in ER+ breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-04-17.
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Affiliation(s)
- R Clarke
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - M Dixon
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Jin
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - D Pearce
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Turnbull
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - C Selli
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - R Hu
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Zwart
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - Y Wang
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - J Xuan
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - S Sengupta
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Sims
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MC Liu
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
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Turnbull AK, Webber V, McStay D, Arthur L, Martinez-Perez C, Fernando A, Renshaw L, Keys J, Clarke R, Sims AH, Dixon JM. Abstract P3-10-26: Predicting benefit from HER2-targeted therapies in patients with ER+/HER2+ breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-10-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ER+/HER2+ accounts for up to 10% of all breast cancers (BCs) and most are treated with endocrine therapy (ET) after surgery to reduce the recurrence risk. We developed and validated an immunohistochemistry (IHC) based test (EA2Clin) that incorporates baseline IL6ST, clinical variables and on-treatment measurement of MCM4. Responders (Rs) and non-responders (NRs) to ET are identified and it accurately estimates recurrence-free survival (RFS) and BC-specific overall survival (BCSS). The aim was to determine if EA2Clin could accurately predict ER+/HER2+ patients likely to benefit from ET and to determine if it can identify those for whom HER2-targeted therapies are required.
Methods: 3 cohorts were studied:
A: 32 post-menopausal women (PMW) with large ER+/HER2+ BC treated with neoadjuvant (3-6 months) then adjuvant letrozole. 5 also received adjuvant chemotherapy plus Herceptin. Neoadjuvant clinical response was assessed by changes in tumour volume. Tumour core biopsies were taken at 0, 14 days and 3 months. Gene expression analysis using Illumina HT12 whole-genome beadarrays was performed on a subset (n=17) where fresh tissue was available.
B: 13 PMW with ER+/HER2+ BC who were treated by surgery without neoadjuvant therapy. RNA was extracted from excision tissues and analysed using whole-genome Affymetrix U133A microarrays.
C: 15 PMW with ER+/HER2+ BC treated with 2-weeks of pre-operative letrozole (n=7) or anastrozole (n=8). All received adjuvant letrozole. Tissues were collected at pre-treatment and at surgery. None received Herceptin or chemotherapy.
All patients were followed-up after surgery (median follow-up = 6.4 years).
Results: In cohort A, half (16/32) of the patients responded to ET with tumour volume reductions of >70% with neoadjuvant treatment. Innate resistance was apparent in 3 patients with continued tumour growth on ET, whereas 13 patients developed resistance after a period of response. EAClin2 predicted neoadjuvant response with a 92% accuracy. There was increased expression of phospho-AKT and phospho-ERK in NRs, not seen in Rs. Half (8/16) of the NR cancers expressed phospho-ER; but was not seen in any responsive cancer. Gene expression analysis in 17 patients showed increased MAPK and PI3K pathway activity in the 9 NR compared with the 8 R tumours. These results were recapitulated in cohort B where MAPK and PI3K activity were associated with low levels of IL6ST.
In the 16/32 patients who responded well to neoadjuvant ET the actuarial recurrence rate was 0% at 5 and 10 years. The rate of recurrence in the NR was 30% at both 5 and 10 years. Of the 5 patients who received chemotherapy plus Herceptin, none recurred despite a poor response to neoadjuvant letrozole (median length to last follow-up was 6.1 years). Initial data suggest that in cohort B EA2Clin identifies a group of ER+/HER2+ cancers that can be managed by ET alone.
Conclusions:
· The EA2Clin test identifies ER+/HER2+ BCs who respond well to ET alone and those with a poor clinical response who have higher risk of recurrence.
· NR to ET have increased expression of PI3K and MAPK pathways, consistent with active HER2 signalling.
· There is potential role for EA2Clin in selecting ER+/HER2+ patients that require and benefit from HER2-targeted therapies.
Citation Format: Turnbull AK, Webber V, McStay D, Arthur L, Martinez-Perez C, Fernando A, Renshaw L, Keys J, Clarke R, Sims AH, Dixon JM. Predicting benefit from HER2-targeted therapies in patients with ER+/HER2+ breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-26.
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Affiliation(s)
- AK Turnbull
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - V Webber
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - D McStay
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - L Arthur
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - C Martinez-Perez
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - A Fernando
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - L Renshaw
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - J Keys
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - R Clarke
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - AH Sims
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
| | - JM Dixon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Clarke Labs, Breast Cancer Research Laboratories, Georgetown University, Washington DC
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Sadleir P, Platt P, Clarke R, Bozic B. Should surgery proceed or be abandoned after intra-operative anaphylaxis? A reply. Anaesthesia 2019; 74:256. [PMID: 30656652 DOI: 10.1111/anae.14560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Sadleir
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - P Platt
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - R Clarke
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - B Bozic
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Pitt J, Boesch C, Whitaker T, Clarke R. A systematic approach to monitoring high preharvest aflatoxin levels in maize and peanuts in Africa and Asia. WORLD MYCOTOXIN J 2018. [DOI: 10.3920/wmj2018.2317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aflatoxin in maize and peanuts remains a critical problem in much of Africa and Asia. Many countries in these regions lack a systematic preharvest approach for providing government agencies with warnings of a potential threat to human and animal health resulting from excessive levels of aflatoxin in crops at harvest. This paper sets out an approach to such a system. It is based on the establishment of a surveillance system in each community to monitor aflatoxin contamination resulting from drought stress before harvest and advise on remedial actions. The system should be under the control of a central government coordinator. If severe drought stress occurs, the coordinator would arrange for samples of the affected crop to be provided to a central aflatoxin laboratory established and controlled by the relevant government department. Assays from the central laboratory would be sent via the central coordinator to a government scientific advisory body, which would recommend appropriate remedial action to be taken at government level.
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Affiliation(s)
- J.I. Pitt
- CSIRO Agriculture and Food, North Ryde, NSW 2113, Australia
| | - C. Boesch
- Food and Agriculture Organization of the United Nations, Viale delle Terme die Caracalla, 00153 Rome, Italy
| | - T.B. Whitaker
- Biological and Agricultural Engineering Department, North Carolina State University, Raleigh, NC 27695-7625, USA
| | - R. Clarke
- Food and Agriculture Organization of the United Nations, Viale delle Terme die Caracalla, 00153 Rome, Italy
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Bennett D, Du H, Guo Y, Bian Z, Chen J, Collins R, Peto R, Li L, Clarke R, Chen Z. P661Associations of sedentary behaviour with myocardial infarction and stroke: findings from a 10-year prospective study of 0.5 million chinese adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p661] [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: 11/13/2022] Open
Affiliation(s)
- D Bennett
- University of Oxford, Oxford, United Kingdom
| | - H Du
- University of Oxford, Oxford, United Kingdom
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing, China People's Republic of
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing, China People's Republic of
| | - J Chen
- China National Center for Food Safety Risk Assessment, Beijing, China People's Republic of
| | - R Collins
- University of Oxford, Oxford, United Kingdom
| | - R Peto
- University of Oxford, Oxford, United Kingdom
| | - L Li
- Peking University, Chinese Academy of Medical Sciences, Beijing, China People's Republic of
| | - R Clarke
- University of Oxford, Oxford, United Kingdom
| | - Z Chen
- University of Oxford, Oxford, United Kingdom
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Gnatiuc L, Alegre-Diaz J, Wade R, Ramirez R, Herrington WG, Solano M, Clarke R, Lewington SL, Collins R, Peto R, Tapia-Conyer R, Emberson J, Kuri-Morales P. P6282Adiposity and vascular-metabolic mortality among 150,000 Mexican adults followed for 15 years. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Gnatiuc
- University of Oxford, CTSU, Oxford, United Kingdom
| | - J Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | | | - M Solano
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Clarke
- University of Oxford, CTSU, Oxford, United Kingdom
| | - S L Lewington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, CTSU, Oxford, United Kingdom
| | - R Peto
- University of Oxford, CTSU, Oxford, United Kingdom
| | - R Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - P Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Booth TN, Wick C, Clarke R, Kutz JW, Medina M, Gorsage D, Xi Y, Isaacson B. Evaluation of the Normal Cochlear Second Interscalar Ridge Angle and Depth on 3D T2-Weighted Images: A Tool for the Diagnosis of Scala Communis and Incomplete Partition Type II. AJNR Am J Neuroradiol 2018; 39:923-927. [PMID: 29545247 DOI: 10.3174/ajnr.a5585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Cochlear malformations may be be subtle on imaging studies. The purpose of this study was to evaluate the angle and depth of the lateral second interscalar ridge or notch in ears without sensorineural hearing loss (normal ears) and compare them with ears that have a documented incomplete type II partition malformation. MATERIALS AND METHODS The second interscalar ridge notch angle and depth were measured on MR imaging in normal ears by a single experienced neuroradiologist. The images of normal and incomplete partition II malformation ears were then randomly mixed for 2 novice evaluators to measure both the second interscalar ridge notch angle and depth in a blinded manner. For the mixed group, interobserver agreement was calculated, normal and abnormal ear measurements were compared, and receiver operating characteristic curves were generated. RESULTS The 94 normal ears had a mean second interscalar ridge angle of 80.86° ± 11.4° and depth of 0.54 ± 0.14 mm with the 98th percentile for an angle of 101° and a depth of 0.3 mm. In the mixed group, agreement between the 2 readers was excellent, with significant differences for angle and depth found between normal and incomplete partition type II ears for angle and depth on average (P < .001). Receiver operating characteristic cutoffs for delineating normal from abnormal ears were similar for both readers (depth, 0.31/0.34 mm; angle, 114°/104°). CONCLUSIONS A measured angle of >114° and a depth of the second interscalar ridge notch of ≤0.31 mm suggest the diagnosis of incomplete partition type II malformation and scala communis. These measurements can be accurately made by novice readers.
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Affiliation(s)
- T N Booth
- From the Departments of Radiology (T.N.B., R.C., D.G.)
| | - C Wick
- Otolaryngology (C.W., J.W.K., M.M., B.I.), Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - R Clarke
- From the Departments of Radiology (T.N.B., R.C., D.G.)
| | - J W Kutz
- Otolaryngology (C.W., J.W.K., M.M., B.I.), Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M Medina
- Otolaryngology (C.W., J.W.K., M.M., B.I.), Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - D Gorsage
- From the Departments of Radiology (T.N.B., R.C., D.G.)
| | - Y Xi
- Department of Radiology (Y.X.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - B Isaacson
- Otolaryngology (C.W., J.W.K., M.M., B.I.), Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
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Castle J, Harvey J, Clarke R, Holcombe C, Volleamere A, Bramley M, Kokan J, Bundred N, Kirwan C. Update for: Thrombin Inhibition Preoperatively (TIP) in Early Breast Cancer, the first clinical trial of DOACs as an anti-cancer agent. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.097] [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: 10/17/2022]
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Orr KE, Hamilton SC, Clarke R, Adi MY, Gutteridge C, Suresh P, Freeman SJ. The integration of transabdominal ultrasound simulators into an ultrasound curriculum. Ultrasound 2018; 27:20-30. [PMID: 30774695 DOI: 10.1177/1742271x18762251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Introduction Simulation is increasingly used throughout medicine. Within ultrasound, simulators are more established for learning transvaginal and interventional procedures. The use of modern high-fidelity transabdominal simulators is increasing, particularly in centres with large trainee numbers. There is no current literature on the value of these simulators in gaining competence in abdominal ultrasound. The aim was to investigate the impact of a new ultrasound curriculum, incorporating transabdominal simulators into the first year of training in a UK radiology academy. Methods The simulator group included 13 trainees. The preceding cohort of 15 trainees was the control group. After 10 months, a clinical assessment was performed to assess whether the new curriculum resulted in improved ultrasound skills. Questionnaires were designed to explore the acceptability of simulation training and whether it had any impact on confidence levels. Results Trainees who had received simulator-enriched training scored higher in an objective clinical ultrasound assessment, which was statistically significant (p = 0.0463). End confidence scores for obtaining diagnostic images and demonstrating pathology were also higher in the simulation group. All trainees stated that transabdominal simulator training was useful in early training. Conclusions This initial study shows that embedded into a curriculum, transabdominal ultrasound simulators are an acceptable training method that can result in improved ultrasound skills and higher confidence levels. Using simulators early in training could allow trainees to master the basics, improve their confidence, enabling them to get more educational value from clinical ultrasound experience while reducing the impact of training on service provision.
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Affiliation(s)
- K E Orr
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
| | - S C Hamilton
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
| | | | - M Y Adi
- Peninsula Radiology Academy, UK
| | | | - P Suresh
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
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Clarke R, Dixon MJ, Jin L, Turnbull A, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Renshaw L, Sims A, Liu MC. Abstract P4-04-10: Molecular features of dormancy in ER+ breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-04-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Late recurrence (emergence from dormancy) is characteristic of ER+ breast cancers. Despite adjuvant endocrine therapy, many breast cancers recur decades after their initial diagnosis and treatment. Why this occurs is poorly understood.
Methods: We studied 2 independent datasets of endocrine treated, ER+ breast cancers with up to 20 years follow-up. The 1st comprised matched samples from the primary tumor pretreatment at diagnosis and the first recurrence after or during adjuvant endocrine therapy (all FFPE). The 2nd dataset comprised pretreatment biopsies only (all snap frozen). For both datasets, high quality RNA was amplified, labelled, and subjected to transcriptome analysis using the Affymetrix technology (U133 Plus 2.0). Low quality data were identified using 'simpleaffy' and 'ffpe', and removed; all tools were from the R package unless otherwise noted. Remaining data were normalized using 'frma'. Genes differentially expressed between early (≤3 years) and late (≥ 5 years) were selected using limma. Unsupervised hierarchical clustering and PCA explored the structure of the data.
A similar molecular analysis was done on the 2nd dataset. A classification scheme that robustly separated early from late recurrences was validated in an independent public dataset of comparable patients, array platform, and frozen tissues. We also explored features in pretreatment samples that predetermined response duration.
Results: Genes that separated pretreatment specimens by recurrence time did not separate posttreatment specimens. Specimens did not cluster in patient pairs or by site of recurrence.
8245 genes were differentially expressed between early and late recurrences in the FFPE samples, while 2400 genes were significantly different in the same comparison in the frozen samples. Initial pathway analysis was done on each dataset independently using IPA (Ingenuity® Systems, www.ingenuity.com). 70 canonical pathways were identified in common between the two datasets (pretreatment). We then looked for genes regulated in both datasets (ignores FFPE and frozen tissue as source). There were 279 genes in common that differentially regulated in the same direction (upregulated; downregulated). IPA analysis of these genes identified 49 canonical pathways. We also explored the differentially expressed gene sets using 'GSEA' (www.software.broadinstitute.org/gsea/index.jsp). Pathways consistently associated with early vs. late recurrence include integrin signaling, the unfolded protein response, endoplasmic reticulum stress, actin-based motility, and estrogen biosynthesis.
Conclusion: Analysis of pretreatment tumors can predict early recurrences from those that will remain dormant and recur much later. Recurrent tumors exhibit a remodeled molecular landscape that likely reflects the effects of treatments and/or a recreation of a niche with potentially common features at the site of recurrence. Changes in molecular signaling associated with duration of recurrence are consistent with our experimental model studies in vitro implicating UPR signaling as a major integrator of response to endocrine therapy and duration of survival. Additional data sets are being arrayed and more detailed molecular signaling studies are in progress.
Citation Format: Clarke R, Dixon MJ, Jin L, Turnbull A, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Renshaw L, Sims A, Liu MC. Molecular features of dormancy in ER+ breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-10.
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Affiliation(s)
- R Clarke
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MJ Dixon
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Jin
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Turnbull
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - R Hu
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Zwart
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - Y Wang
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - J Xuan
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - S Sengupta
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Renshaw
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Sims
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MC Liu
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
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Stephenson CL, Harris CA, Clarke R. An assessment of the acute dietary exposure to glyphosate using deterministic and probabilistic methods. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2018; 35:258-272. [PMID: 29052491 DOI: 10.1080/19440049.2017.1376120] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022]
Abstract
Use of glyphosate in crop production can lead to residues of the active substance and related metabolites in food. Glyphosate has never been considered acutely toxic; however, in 2015 the European Food Safety Authority (EFSA) proposed an acute reference dose (ARfD). This differs from the Joint FAO/WHO Meeting on Pesticide Residues (JMPR) who in 2016, in line with their existing position, concluded that an ARfD was not necessary for glyphosate. This paper makes a comprehensive assessment of short-term dietary exposure to glyphosate from potentially treated crops grown in the EU and imported third-country food sources. European Union and global deterministic models were used to make estimates of short-term dietary exposure (generally defined as up to 24 h). Estimates were refined using food-processing information, residues monitoring data, national dietary exposure models, and basic probabilistic approaches to estimating dietary exposure. Calculated exposures levels were compared to the ARfD, considered to be the amount of a substance that can be consumed in a single meal, or 24-h period, without appreciable health risk. Acute dietary intakes were <100% of the ARfD for all foodstuffs, except wild fungi, when calculated using the EFSA model. The model assumptions differ from those of the source model (German national model), resulting in the use of a higher variability factor. Intakes estimated with the German model represented only 18% of the ARfD. The impact of differing assumptions regarding variability and other input parameters is discussed. Probabilistic exposure estimates showed that the acute intake on no person-days exceeded 10% of the ARfD, even for the pessimistic scenario.
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Affiliation(s)
| | - C A Harris
- a Exponent International Ltd , Harrogate , UK
| | - R Clarke
- a Exponent International Ltd , Harrogate , UK
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Horgan L, Knezevic B, Klinken E, Clarke R, Sadleir P, Platt P, Bundell C, Lucas M. P19: JUST A SPOONFUL OF COUGH SYRUP: A CASE OF PHOLCODINE HYPERSENSITIVITY. Intern Med J 2017. [DOI: 10.1111/imj.19_13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Affiliation(s)
- L Horgan
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| | - B Knezevic
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| | - E Klinken
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| | - R Clarke
- Department of Anaesthetics, Sir Charles Gairdner Hospital; Perth Australia
| | - P Sadleir
- Department of Anaesthetics, Sir Charles Gairdner Hospital; Perth Australia
| | - P Platt
- Department of Anaesthetics, Sir Charles Gairdner Hospital; Perth Australia
| | - C Bundell
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| | - M Lucas
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
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Sood S, Clarke R, Bowhay A, De S. Manoeuvre to aid Endoscopic division of aryepiglottic folds (Aryepiglottoplasty). Clin Otolaryngol 2017; 43:981-982. [PMID: 28803450 DOI: 10.1111/coa.12954] [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] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S Sood
- Alder Hey Children's Hospital, Liverpool, UK
| | - R Clarke
- Alder Hey Children's Hospital, Liverpool, UK
| | - A Bowhay
- Alder Hey Children's Hospital, Liverpool, UK
| | - S De
- Alder Hey Children's Hospital, Liverpool, UK
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Cairns B, Clarke R, Harris P, Canoy D, Floud S, Armstrong M, Wright F, Travis R, Reeves G, Beral V, Green J. P2995Risk factors for aortic stenosis and aortic valve replacement in 1.2 million UK women. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p2995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B.J. Cairns
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R. Clarke
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - P. Harris
- Royal Prince Alfred Hospital, Cardiology Department, Sydney, Australia
| | - D. Canoy
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - S. Floud
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - M.E.G. Armstrong
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - F.L. Wright
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - R.C. Travis
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - G.K. Reeves
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - V. Beral
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J. Green
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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Martyr A, Wu Y, Morris R, Hindle J, Rusted J, Thom J, Clarke R, Clare L. FACTORS ASSOCIATED WITH QUALITY OF LIFE IN DEMENTIA: A CORRELATIONAL META-ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Martyr
- University of Exeter, Exeter, United Kingdom,
| | - Y. Wu
- University of Exeter, Exeter, United Kingdom,
| | - R. Morris
- Kings College Hospital, London, United Kingdom
| | - J. Hindle
- Bangor University, Bangor, United Kingdom,
| | - J. Rusted
- University of Sussex, Brighton, United Kingdom,
| | - J. Thom
- University of New South Wales, Sydney, New South Wales, Australia,
| | - R. Clarke
- University of Sussex, Brighton, United Kingdom,
| | - L. Clare
- University of Exeter, Exeter, United Kingdom,
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O’Shea R, Clarke R, Berkley E, Giffney C, Farrell M, O’Donovan E, Gallagher DJ. Next generation sequencing is informing phenotype: a TP53 example. Fam Cancer 2017; 17:123-128. [DOI: 10.1007/s10689-017-0002-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ritchie S, Edwards R, Clarke R, Williams L, Jones GD. 60ABSORBING SENSORY-INTEGRATION EXERCISES INTO A STRENGTH AND BALANCE INTERVENTION FOR OLDER PEOPLE WHO HAVE FALLEN. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.60] [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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