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Timmerman P, Barfield M, Portabella EB, Calogero S, Cowan K, Faber J, Ferrari L, Golob M, Goodman J, Goodwin L, Gnoth MJ, Hughes R, Ivanova T, Jordan G, Laurén A, Maux D, McDougall S, Milushewa P, Nelson R, Pynaert G, Sklodowski K, Sleigh R, Struwe P, Verhaeghe T, Wheller R, White S, Zeiser K. Recommendations and feedback from the European Bioanalysis Forum Workshop: 1 year into ICH M10 - keeping our finger on the pulse. Bioanalysis 2024; 16:259-270. [PMID: 38315622 DOI: 10.4155/bio-2024-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
The ICH M10 guideline on bioanalytical method validation and sample analysis is being adopted since 2023. However, and inevitably, some paragraphs or requirements remain ambiguous and are open for different interpretations. In support of a harmonized interpretation by the industry and health authorities, the European Bioanalysis Forum organized a workshop on 14 November 2023 in Barcelona, Spain, to discuss unclear and/or ambiguous paragraphs which were identified by the European Bioanalysis Forum community and delegates of the workshop prior to the workshop. This manuscript reports back from the workshop with recommendations and aims at continuing an open scientific discussion within the industry and with regulators in support of a science-driven guideline for the bioanalytical community and in line with the ICH mission - that is, achieve greater harmonization worldwide to ensure that safe, effective and high-quality medicines are developed and registered in the most resource-efficient manner.
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Affiliation(s)
- Philip Timmerman
- European Bioanalysis Forum, Havenlaan 86c b204, Brussels, 1000, Belgium
| | - Matthew Barfield
- Roche Innovation Center Welwyn, Roche Pharma Research & Early Development, Welwyn Garden City, Hertfordshire, AL7 1TW, United Kingdom
| | - Enric Bertran Portabella
- Moderna Innovation & Technology Center, Harwell Science & Innovation Campus. Oxford, OX11 0DF, United Kingdom
| | | | - Kyra Cowan
- Merck KGaA, Research & Development, Drug Metabolism & Pharmacokinetics New Biological Entities, Darmstadt, 64293, Germany
| | - Jörg Faber
- A&M Labor für Analytik und Metabolismusforschung Service GmbH, Bergheim, 50126, Germany
| | - Luca Ferrari
- Roche Pharma Research & Early Development (pRED), F. Hoffmann-La Roche Ltd, Basel, 4070, Switzerland
| | | | - Jo Goodman
- AstraZeneca, Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, Cambridge, CB21 6GH, United Kingdom
| | - Lee Goodwin
- Labcorp, Bioanalytical Services, Otley Road, Harrogate, HG3 1PY, United Kingdom
| | - Mark Jean Gnoth
- Bayer, DMPK, in vivo PK & bioanalytics, Bayer AG, Wuppertal, 42096, Germany
| | - Richard Hughes
- Resolian Bioanalytics, Newmarket Road, Fordham, CB7 5WW, United Kingdom
| | | | - Gregor Jordan
- Roche Pharma Research & Early Development (pRED), Pharmaceutical Sciences, Bioanalytics & Biomarkers, Roche Innovation Center Munich, Roche Diagnostics GmbH, Penzberg, 82377, Germany
| | - Anna Laurén
- MinervaX, Lund, 223 63, Sweden (employed by at the time of writing of this manuscript: Novo Nordisk A/S, Non-clinical & Clinical Assay Sciences, Global Discovery & Development Sciences, Global Drug Discovery, Maaløv, DK-2760, Denmark)
| | - Delphine Maux
- Syneos Health, Clinical Pharmacology & Bioanalysis, Bioanalysis, Biot, 06410, France
| | - Stuart McDougall
- Quotient Sciences, Bioanalytical Services, Taylor Drive, Alnwick, Northumberland, NE66 2DH, United Kingdom
| | | | | | | | - Kamil Sklodowski
- Roche Pharma Research & Early Development (pRED), F. Hoffmann-La Roche Ltd, Basel, 4070, Switzerland
| | - Rebecca Sleigh
- Resolian Bioanalytics, Newmarket Road, Fordham, CB7 5WW, United Kingdom
| | - Petra Struwe
- Celerion Switzerland AG, Bioanalytical Services, Allmendstrasse, Fehraltorf, 8320, Switzerland
| | - Tom Verhaeghe
- J&J Innovative Medicine, BDDS, Beerse, 2340, Belgium
| | - Robert Wheller
- Resolian Bioanalytics, Newmarket Road, Fordham, CB7 5WW, United Kingdom
| | - Steve White
- GSK, IVIVT-BIB, Gunnells Wood Road, Stevenage, SG1 2NY, United Kingdom
| | - Katja Zeiser
- Nuvisan GmbH, Bioanalysis, Neu-Ulm, 89231, Germany
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Loomis SJ, Miller R, Castrillo-Viguera C, Umans K, Cheng W, O'Gorman J, Hughes R, Budd Haeberlein S, Whelan CD. Genome-Wide Association Studies of ARIA From the Aducanumab Phase 3 ENGAGE and EMERGE Studies. Neurology 2024; 102:e207919. [PMID: 38165296 DOI: 10.1212/wnl.0000000000207919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyloid-related imaging abnormalities (ARIA) were the most common adverse events reported in the phase 3 ENGAGE and EMERGE trials of aducanumab, an anti-amyloid monoclonal antibody. APOE ε4 carrier status has been shown to increase risk of ARIA in prior trials of aducanumab and other anti-amyloid therapies; however, the remainder of the human genome has not been evaluated for ARIA risk factors. Therefore, we sought to determine in a hypothesis-free manner whether genetic variants beyond APOE influence risk of ARIA in aducanumab-treated patients. METHODS We performed genome-wide association studies (GWAS) of ARIA in participants in the ENGAGE and EMERGE trials. Participants had mild cognitive impairment due to Alzheimer disease or mild Alzheimer disease dementia and were amyloid-positive on PET scans. All participants underwent regular MRI monitoring to detect and diagnose ARIA. RESULTS Of the 3,285 participants in the intent-to-treat population, this analysis included 1,691 with genotyping array data who received at least one dose of aducanumab with at least one post-baseline MRI. All participants in the study cohort were of European ancestry; 51% were female. The mean age was 70.3 years. 31% had ARIA-E, 19% had ARIA-H microhemorrhage, and 14% had ARIA-H superficial siderosis. We identified one genome-wide significant (p < 5.0 × 10-8) association at the chromosome 19 locus encompassing APOE. The APOE association with ARIA was stronger in ε4/ε4 homozygotes (OR = 4.28, 4.58, 7.84; p < 2.9 × 10-14 for ARIA-E, ARIA-H microhemorrhage, and ARIA-H superficial siderosis, respectively) than in ε3/ε4 heterozygotes (OR = 1.74, 1.46, 3.14; p ≤ 0.03). We found greater odds of radiographically severe ARIA (OR = 7.04-24.64, p ≤ 2.72 × 10-5) than radiographically mild ARIA (OR = 3.19-5.00, p ≤ 1.37 × 10-5) among ε4/ε4 homozygotes. APOE ε4 was also significantly associated with both symptomatic (ε4/ε4 OR = 3.64-9.52; p < 0.004) and asymptomatic (ε4/ε4 OR = 4.20-7.94, p < 1.7 × 10-11) cases, although among ARIA cases, APOE did not appear to modulate symptomatic status. No other genome-wide significant associations were found. DISCUSSION We identified a strong, genome-wide significant association between APOE and risk of ARIA. Future, larger studies may be better powered to detect associations beyond APOE. These findings indicate that APOE is the strongest genetic risk factor of ARIA incidence, with implications for patient management and risk-benefit treatment decisions. TRIAL REGISTRATION INFORMATION Both trials (ENGAGE [221AD301]: NCT02477800 and EMERGE [221AD302]: NCT02484547) were registered in June 2015 at clinicaltrials.gov and enrolled patients from August 2015 to July 2018.
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Sima DM, Phan TV, Van Eyndhoven S, Vercruyssen S, Magalhães R, Liseune A, Brys A, Frenyo P, Terzopoulos V, Maes C, Guo J, Hughes R, Gabr RE, Huijbers W, Saha-Chaudhuri P, Curiale GG, Becker A, Belachew S, Van Hecke W, Ribbens A, Smeets D. Artificial Intelligence Assistive Software Tool for Automated Detection and Quantification of Amyloid-Related Imaging Abnormalities. JAMA Netw Open 2024; 7:e2355800. [PMID: 38345816 PMCID: PMC10862143 DOI: 10.1001/jamanetworkopen.2023.55800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Amyloid-related imaging abnormalities (ARIA) are brain magnetic resonance imaging (MRI) findings associated with the use of amyloid-β-directed monoclonal antibody therapies in Alzheimer disease (AD). ARIA monitoring is important to inform treatment dosing decisions and might be improved through assistive software. Objective To assess the clinical performance of an artificial intelligence (AI)-based software tool for assisting radiological interpretation of brain MRI scans in patients monitored for ARIA. Design, Setting, and Participants This diagnostic study used a multiple-reader multiple-case design to evaluate the diagnostic performance of radiologists assisted by the software vs unassisted. The study enrolled 16 US Board of Radiology-certified radiologists to perform radiological reading with (assisted) and without the software (unassisted). The study encompassed 199 retrospective cases, where each case consisted of a predosing baseline and a postdosing follow-up MRI of patients from aducanumab clinical trials PRIME, EMERGE, and ENGAGE. Statistical analysis was performed from April to July 2023. Exposures Use of icobrain aria, an AI-based assistive software for ARIA detection and quantification. Main Outcomes and Measures Coprimary end points were the difference in diagnostic accuracy between assisted and unassisted detection of ARIA-E (edema and/or sulcal effusion) and ARIA-H (microhemorrhage and/or superficial siderosis) independently, assessed with the area under the receiver operating characteristic curve (AUC). Results Among the 199 participants included in this study of radiological reading performance, mean (SD) age was 70.4 (7.2) years; 105 (52.8%) were female; 23 (11.6%) were Asian, 1 (0.5%) was Black, 157 (78.9%) were White, and 18 (9.0%) were other or unreported race and ethnicity. Among the 16 radiological readers included, 2 were specialized neuroradiologists (12.5%), 11 were male individuals (68.8%), 7 were individuals working in academic hospitals (43.8%), and they had a mean (SD) of 9.5 (5.1) years of experience. Radiologists assisted by the software were significantly superior in detecting ARIA than unassisted radiologists, with a mean assisted AUC of 0.87 (95% CI, 0.84-0.91) for ARIA-E detection (AUC improvement of 0.05 [95% CI, 0.02-0.08]; P = .001]) and 0.83 (95% CI, 0.78-0.87) for ARIA-H detection (AUC improvement of 0.04 [95% CI, 0.02-0.07]; P = .001). Sensitivity was significantly higher in assisted reading compared with unassisted reading (87% vs 71% for ARIA-E detection; 79% vs 69% for ARIA-H detection), while specificity remained above 80% for the detection of both ARIA types. Conclusions and Relevance This diagnostic study found that radiological reading performance for ARIA detection and diagnosis was significantly better when using the AI-based assistive software. Hence, the software has the potential to be a clinically important tool to improve safety monitoring and management of patients with AD treated with amyloid-β-directed monoclonal antibody therapies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joshua Guo
- Biogen Digital Health, Biogen, Cambridge, Massachusetts
| | | | | | | | | | | | - Andrew Becker
- Biogen Digital Health, Biogen, Cambridge, Massachusetts
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Pang M, Gabelle A, Saha‐Chaudhuri P, Huijbers W, Gafson A, Matthews PM, Tian L, Rubino I, Hughes R, de Moor C, Belachew S, Shen C. Precision medicine analysis of heterogeneity in individual-level treatment response to amyloid beta removal in early Alzheimer's disease. Alzheimers Dement 2024; 20:1102-1111. [PMID: 37882364 PMCID: PMC10917030 DOI: 10.1002/alz.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Alzheimer's disease (AD) is a neurological disorder with variability in pathology and clinical progression. AD patients may differ in individual-level benefit from amyloid beta removal therapy. METHODS Random forest models were applied to the EMERGE trial to create an individual-level treatment response (ITR) score which represents individual-level benefit of high-dose aducanumab relative to the placebo. This ITR score was used to test the existence of heterogeneity in treatment effect (HTE). RESULTS We found statistical evidence of HTE in the Clinical Dementia Rating-Sum of Boxes (CDR-SB;P = 0.034). The observed CDR-SB benefit was 0.79 points greater in the group with the top 25% of ITR score compared to the remaining 75% (P = 0.020). Of note, the highest treatment responders had lower hippocampal volume, higher plasma phosphorylated tau 181 and a shorter duration of clinical AD at baseline. DISCUSSION This ITR analysis provides a proof of concept for precision medicine in future AD research and drug development. HIGHLIGHTS Emerging trials have shown a population-level benefit from amyloid beta (Aβ) removal in slowing cognitive decline in early Alzheimer's disease (AD). This work demonstrates significant heterogeneity of individual-level treatment effect of aducanumab in early AD. The greatest clinical responders to Aβ removal therapy have a pattern of more severe neurodegenerative process.
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Affiliation(s)
- Menglan Pang
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Audrey Gabelle
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | | | - Willem Huijbers
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Arie Gafson
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Paul M. Matthews
- Department of Brain SciencesFaculty of MedicineImperial College LondonLondonUK
- UK Dementia Research Institute at Imperial College LondonLondonUK
| | - Lu Tian
- Biomedical Data Science and StatisticsStanford University School of MedicineStanfordCaliforniaUSA
| | | | - Richard Hughes
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Carl de Moor
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Shibeshih Belachew
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Changyu Shen
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
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Jyamubandi I, Aamir A, Kaur J, Sylvester A, Hughes R, Li S. A singlicate immunogenicity method to detect anti-polyethylene glycol antibodies: pre- and post-dose of PEGylated therapies. Bioanalysis 2024; 16:5-17. [PMID: 37991214 DOI: 10.4155/bio-2023-0196] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Aim: Preexisting anti-polyethylene glycol (PEG) antibodies (APAs) may affect the efficacy and safety of PEGylated compounds. Omontys® and Krystexxa® withdrawal and SARS-CoV-2 RNA vaccine anaphylaxis have all been linked to APAs. This project aimed to develop and validate a method to detect total antibodies against PEG, pre- and post-dose. Materials & methods: The repetitive, linear PEG structure prevented the use of a bridging homogenous format, hence the requirement to use a solid-phase extraction and acid dissociation assay coupled with the Meso Scale Discovery® platform. Results & conclusion: Using singlicate analysis, the method was validated to successfully detect APA pre- and post-dose, with a crucial aspect of the method being the preparation of an appropriate negative control.
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Affiliation(s)
| | - Aanya Aamir
- Resolian, Newmarket Road, Fordham, Ely, CB7 5WW, UK
| | - Jyotsna Kaur
- Resolian, Newmarket Road, Fordham, Ely, CB7 5WW, UK
| | | | | | - Sophia Li
- Resolian, Newmarket Road, Fordham, Ely, CB7 5WW, UK
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Smith N, Hughes R, Cushley C, Brain L, Galbreath J, Russell R, Jenkins M, Kelly FE. 'Who are you and what do you do?' Using name and role stickers to improve communication and teamwork in intensive care during the COVID-19 pandemic. J Intensive Care Soc 2023; 24:30-31. [PMID: 37928095 PMCID: PMC10621504 DOI: 10.1177/1751143720959620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- N Smith
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - R Hughes
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Cushley
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Brain
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Galbreath
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - R Russell
- Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - M Jenkins
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - FE Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Rojas AM, Ostler P, Hughes R, Alonzi R, Lowe G, Hoskin P. Single Dose vs. Fractionated High-Dose Rate Brachytherapy in Localized Prostate Cancer: Long Term Results. Int J Radiat Oncol Biol Phys 2023; 117:S110. [PMID: 37784290 DOI: 10.1016/j.ijrobp.2023.06.436] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate long-term freedom from biochemical relapse (FFbR) and overall survival (OS) after single-dose high-dose-rate brachytherapy (HDR-BT) compared with 2 or 3 fraction schedules. MATERIALS/METHODS HDR-BT, delivering 1 × 19 Gy or 1 × 20 Gy (A = 49), 2 × 13 Gy (B = 138) or 3 × 10.5 Gy (C = 106), was given to patients with intermediate or high-risk prostate cancer as their sole treatment. Patients were staged with pelvic MRI and isotope bone scan. Transperineal transrectal ultrasound guided implantation was followed by MRI based CTV definition based on GEC ESTRO guidelines. Biochemical relapse was assessed using the Phœnix definition (PSA nadir plus 2 µg/L). Patients were evaluated prospectively from 6 months after implant and bi-annually thereafter. Estimates of freedom from biochemical relapse, and overall survival (OS) were calculated using the Kaplan-Meier (K-M) method and the log-rank test to test for significance. Univariate and multivariate hazard ratios (HR) were obtained using Cox's proportional hazard model. For multivariate modelling a stepwise reduction method was used. RESULTS Median follow-up was 123, 116 and 120 months (p = 0.4), (A, B, C, respectively). Neo-adjuvant and adjuvant androgen deprivation treatment was given to 80% of all patients, median duration was 9 months for A and 6 months for B and C. K-M estimates of FFbR, at 8 and 10 years, were 67% and 64% (Group A), 78% and 72% (Group B), and 80% and 76% (Group C). Differences in FFbR between dose groups was not significant (p = 0.2). Similarly, no significant difference was seen in OS. Eight and 10-year estimates were 81% and 75% (A), 85% and 74% (B), and 90% and 83% (C); p = 0.5. Hazard Ratios for risk of biochemical recurrence were significant for ADT administration (yes/no) and overall risk category, in multivariate analyses. Only the latter was significant in univariate analysis for risk of death, Gleason risk (low, intermediate, high), MRI tumor stage risk and overall risk category were significant in univariate analyses. Only tumor stage and Gleason risk were significant in multivariate analyses. CONCLUSION Concerns around the efficacy of 19-20 Gy single dose HDR BT as monotherapy, based on early data, may have been unfounded. Long-term outcome data up to 10 years show no significant difference in PSA control and overall survival compared to 2 and 3 fractions of HDR-BT.
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Affiliation(s)
- A M Rojas
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R Hughes
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R Alonzi
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - G Lowe
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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Hughes R, Gandhi V, Snook A, Waldman S, Mueller A. Gamma Secretase Inhibition Sensitizes Pancreatic Adenocarcinoma Tumors to RT In Vivo. Int J Radiat Oncol Biol Phys 2023; 117:S103-S104. [PMID: 37784274 DOI: 10.1016/j.ijrobp.2023.06.060] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Pancreatic adenocarcinoma (PDAC) is an extremely aggressive cancer that lacks curative treatment options. Almost half of patients present with unresectable disease limiting treatment to non-curative options. Patients treated with neoadjuvant radiation therapy (RT) exhibit increases in fibrosis and epithelial-to-mesenchymal transition (EMT). ADAM10, an extracellular sheddase, can stimulate stromal fibrosis, EMT, and radioresistance. ADAM10 also mediates EMT through Notch signaling by cleaving its extracellular domain. Further cleavage by gamma secretase produces the Notch intracellular domain (NICD), which translocates to the nucleus and activates downstream transcriptional targets. Here, we explore whether inhibition of Notch cleavage by gamma secretase radiosensitizes PDAC tumors. MATERIALS/METHODS Bilateral flank subcutaneous PDAC isografts were produced in 40 mice using PK5L1940 KPC cells. Intraperitoneal injections of the gamma secretase inhibitor, DAPT (5 mg/kg), were delivered daily for 7 days, starting 3 days prior to RT. A single dose of 20 Gy was administered to each flank tumor, and volumes were measured twice weekly. Colony formation assays of KPC cells were performed after RT, in the presence or absence of DAPT. Since stromal fibrosis can mediate radio-resistance in the tumor microenvironment (TME), the effect of tumor cells on Notch pathway activation in mouse fibroblasts (3T3 cells) was investigated using a luciferase reporter assay. Thus, 3T3 cells transfected with a Notch pathway luciferase reporter were incubated with PDAC cells for 48 h, followed by measurement of luciferase activity. RESULTS In vivo, the combination of DAPT and RT significantly delayed tumor growth, and some tumors were completely eradicated. Mean tumor size for the combination at 21 days was 21 mm3 (range = 0-53, p = 0.005), while tumor size was 577 mm3 (range = 217-955, p = 0.69) for DAPT alone, 435 mm3 for RT alone (range = 51-932, p = 0.79), and 367 mm3 for untreated vehicle (range = 97-1144). Surprisingly, DAPT did not reduce clonogenic survival in vitro. Both ADAM10 knockout and DAPT decreased NICD cleavage and transcription of the downstream target Hes1 in vivo and in vitro. Co-culture with PDAC cells increased Notch luciferase reporter activity in fibroblasts. This effect was not mimicked by PDAC-conditioned media, suggesting a requirement for intercellular contact. CONCLUSION Notch pathway inhibition sensitizes PDAC tumors to RT in vivo, but not in vitro, suggesting involvement of the TME. Indeed, co-culture with PDAC cells stimulates notch signaling in fibroblasts, suggesting non-cell autonomous mechanisms mediating fibrosis in the TME driving radioresistance. Future studies will determine if ADAM10 inhibition targeting PDAC cells and/or gamma secretase inhibition targeting the TME enhances radiation sensitivity in vivo by blocking fibroblast Notch signaling.
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Affiliation(s)
- R Hughes
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - V Gandhi
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - A Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - S Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Powell D, Markel D, Chubb H, Muscatelli S, Hughes R, Hallstrom B, Frisch N. The Differential Effect of COVID on Total Joint Arthroplasty Between Hospital and Ambulatory Surgery Centers/Hospital Outpatient Departments: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis. Arthroplast Today 2023; 23:101189. [PMID: 37731594 PMCID: PMC10507191 DOI: 10.1016/j.artd.2023.101189] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Coronavirus disease (COVID) created unprecedented challenges, especially for high-volume elective subspecialties like total joint arthroplasty. Limited inpatient capacity and resource conservation led to new outpatient selection criteria and site of service changes. As a Michigan Arthroplasty Registry Quality Collaborative Initiative quality project, demographic changes, complications, and differential effects on inpatient vs outpatient centers pre- and post-COVID were analyzed. Methods The registry identified all total joint arthroplasty at hospitals and ASCs/HOPDs between 07/2019-12/2019 and 07/2020-12/2020. These intervals represented pre-COVID and post-COVID elective surgery shutdowns. Case volumes, demographics, and 90-day complications were compared. Results Comparing 2020 to 2019, hospital volumes decreased (-9% total hip arthroplasty [THA], -17% total knee arthroplasty [TKA]), and ambulatory surgery center (ASC)/hospital outpatient department (HOPD) increased (+84% THA, +125% TKA). Entering 2020, ASC/HOPD patients were older (P = .0031, P < .0001: THA, TKA), had more American Society of Anesthesiologists score 3-4 (P = .0105, P = .0021), fewer attended joint class (P < .0001, P < .0001), and more hips were women (P = .023). Hospital patients had higher preoperative pain scores (P = .0117, P < .0001; THA, TKA), less joint education attendance (P < .0001, P < .0001), younger TKAs (P = .0169), and more American Society of Anesthesiologists score 3-4 (0.0009). After propensity matching, there were no significant differences between site of service for 90-day fractures, deep vein thromboses or pulmonary embolisms, infection, or hip dislocations. Hospital THAs had higher readmissions (P = .0003) and TKAs had higher 30-day emergency department visits (P = .005). ASC/HOPD patients were prescribed higher oral morphine equivalents (P < .0001, P < .0001; THA, TKA). Conclusions COVID's elective surgery shutdown caused a dramatic site of service shift. Traditional preoperative education was negatively impacted, and older and sicker patients became outpatients. But short-term complications were not increased in ASCs/HOPDs. These site of service and associated patient demographic changes may be safely sustained.
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Affiliation(s)
- Dexter Powell
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
| | - David Markel
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
- The Core Institute, Novi, MI, USA
| | | | - Stefano Muscatelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard Hughes
- MARCQI Coordinating Center, Ann Arbor, MI, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hallstrom
- MARCQI Coordinating Center, Ann Arbor, MI, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Frisch
- Department of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, MI, USA
- Department of Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI, USA
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Powell D, Comer B, Hallstrom B, Zheng H, Hughes R, Markel D. Early Survivorship of Uncemented Total Knee Arthroplasty Varies by Age and Sex based on Data from the Michigan Arthroplasty Registry Collaborative Quality Initiative. J Arthroplasty 2023:S0883-5403(23)00204-8. [PMID: 36889526 DOI: 10.1016/j.arth.2023.02.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Outcome data for newer uncemented total knee arthroplasty designs has been mixed. Registry studies showed worse survivorship, but clinical trials have not demonstrated differences compared to cemented designs. There has been renewed interest in uncemented TKA with modern designs and improved technology. The utilizations of uncemented knees in Michigan, 2-year outcomes, and the effects of age and sex were evaluated. METHODS A statewide database from 2017 through 2019 was analyzed for incidence, distribution, and early survivorship of cemented vs. uncemented TKAs. There was 2-year minimum follow-up. Kaplan-Meier survival analysis was used to generate time to first revision cumulative percent revision (CPR) curves. The impacts of age and sex were examined. RESULTS Use of uncemented TKAs increased from 7.0 to 11.3%. Uncemented TKAs were more commonly men, younger, heavier, American Society of Anesthesiologists (ASA) Score>2, and opioid users (p<0.05). At 2 years, overall CPR was higher in uncemented (2.44% [2.00, 2.99] versus cemented (1.76% [1.64, 1.89]), particularly in women (uncemented (2.41 [1.87, 3.12]) vs cemented (1.64 [1.50, 1.80]). Revision rates were greater with uncemented women >70 years (1.2% 1 year, 1.02% 2 years) vs <70 years (0.56%, 0.53%), notably uncemented were inferior in both groups (p<0.05). Men, regardless of age, had similar survivorships with both cemented and uncemented designs. CONCLUSION The use of an uncemented TKA had an increased risk of early revision compared to cemented. This finding, however, was only apparent in women, especially those >70 years old. Surgeons should consider cement fixation in women >70 years.
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Affiliation(s)
- Dexter Powell
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America.
| | - Brendan Comer
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America
| | - Brian Hallstrom
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Huiyong Zheng
- MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Richard Hughes
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - David Markel
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America; The Core Institute, 26750 Providence Pkwy, Novi, MI 48374
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11
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Wenzlick T, Kutzner A, Markel D, Hughes R, Chubb H, Roberts K. A reduction in opioid prescription size after total joint arthroplasty can be safely performed without an increase in complications. J Arthroplasty 2023:S0883-5403(23)00013-X. [PMID: 36828049 DOI: 10.1016/j.arth.2023.01.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Excessive opioid prescriptions after total joint arthroplasty increase risks for adverse opioid related events, chronic opioid use, and unlawful opioid diversion. Decreasing postoperative prescriptions may improve quality after TJA. Concerns exist that a decrease in opioids prescribed may increase complications such as readmissions, emergency department (ED) visits, or worsened patient reported outcomes (PROs). The purpose of this study was to explore whether a reduction in opioids prescribed after TJA resulted in increased complications. METHODS Data originated from a statewide database prospectively abstracted including oral morphine equivalents prescribed at discharge, readmissions, ED visits, and PROs. Data was collected from 84,998 TJA occurring one year before and after the creation of an opioid-prescribing protocol that had decreased prescriptions by approximately 50%. Trends were monitored using Shewhart control charts. Regression models were used to determine statistically significant changes over time. RESULTS All groups showed a reduction in opioids prescribed by almost 50% without an increase in ER visits or readmissions, and without a detrimental effect on PROs. Compared to baseline data before opioid reduction, opioid-naïve TKA had significant improvements in all outcomes (p=0.03, p=0.02, p<0.001, p<0.001). Opioid tolerant TKAs and THAs had no worsened outcomes and significant improvement in KOOSJR(p=0.03) and HOOSJR (p=0.03). Opioid-naïve THA had significant improvements in HOOSJR (p=0.003) and PROMIS (p=0.001). CONCLUSIONS Postoperative opioid prescription recommendations from a statewide registry decreased prescribing by approximately 50% without decreasing PROs or increasing ED visits or readmissions. A reduction in opioids prescribed after TJA can be accomplished safely and without increased complications.
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Affiliation(s)
- Thomas Wenzlick
- Department of Orthopaedic Surgery, BHSH- Spectrum Health/Michigan State University, Grand Rapids, MI, 49503
| | - Andrew Kutzner
- Department of Orthopaedic Surgery, BHSH- Spectrum Health/Michigan State University, Grand Rapids, MI, 49503
| | | | - Richard Hughes
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, MI, 48109
| | - Heather Chubb
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, MI, 48109
| | - Karl Roberts
- Department of Orthopaedic Surgery, BHSH- Spectrum Health/Michigan State University, Grand Rapids, MI, 49503.
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McCoy CA, Hughes R. Will you review this patient with an open ankle injury? J Accid Emerg Med 2023; 40:100-156. [PMID: 36693663 DOI: 10.1136/emermed-2022-212660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Christopher Andrew McCoy
- Emergency Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Richard Hughes
- Emergency Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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13
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Parsons D, Taylor R, Hughes R, Middleton C, Gublin Y, Levell D. Predators and habitat association of post-settlement snapper (Chrysophrys auratus). J Fish Biol 2022; 101:1509-1521. [PMID: 36131511 PMCID: PMC10092373 DOI: 10.1111/jfb.15222] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/15/2022] [Indexed: 06/15/2023]
Abstract
Structured habitats play an important nursery role during the crucial early juvenile or post-settlement stages of many fish species. Predominantly, the utility of structured habitats to juvenile fish is thought to be associated with the provisioning of food or as a refuge from predation. Although snapper (Chrysophrys auratus) in New Zealand also have a strong affinity for structured habitats during their post-settlement phase, their predators are unknown as is the role of predation in determining habitat association. Here the authors investigated potential predators of post-settlement snapper by remotely observing interactions of restrained post-settlement snapper with potential predators and investigating the diet of potential predators. They also conducted tank experiments with a potential predator, both with and without the presence of structure. Restrained snapper were infrequently approached by predators, but two new nocturnal predators were identified. No snapper were observed in the diet of potential predators, although two piscivores were identified as potential candidates. No predation occurred during tank experiments, but there was a non-significant indication that under threat of predation post-settlement snapper may use habitat when it is present and aggregate together when it is not. The findings suggest that the pulsed nature of predation may have made it difficult to observe given the methods employed and that the threat of predation may be sufficient to drive the habitat selection of post-settlement snapper. Investigating the significance of predation via methods that do not require direct observations may therefore be more appropriate given this context.
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Affiliation(s)
- Darren Parsons
- National Institute of Water and Atmospheric ResearchAucklandNew Zealand
- Institute of Marine Science, University of AucklandAucklandNew Zealand
| | - Rikki Taylor
- National Institute of Water and Atmospheric ResearchAucklandNew Zealand
| | - Richard Hughes
- Northland Marine Research CentreNational Institute of Water and Atmospheric ResearchRuakakaNew Zealand
| | - Crispin Middleton
- Northland Marine Research CentreNational Institute of Water and Atmospheric ResearchRuakakaNew Zealand
| | - Yann Gublin
- Northland Marine Research CentreNational Institute of Water and Atmospheric ResearchRuakakaNew Zealand
| | - Demi Levell
- Northland Marine Research CentreNational Institute of Water and Atmospheric ResearchRuakakaNew Zealand
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Lyons J, Hughes R, McCarthy K, Everage N, Kapadia S, Miller C, Singhal P, Smirnakis K. Progressive multifocal leukoencephalopathy outcomes in patients with multiple sclerosis treated with dimethyl fumarate. Mult Scler J Exp Transl Clin 2022; 8:20552173221132469. [PMID: 36387034 PMCID: PMC9661630 DOI: 10.1177/20552173221132469] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Dimethyl fumarate (DMF), an oral disease-modifying therapy with an established benefit and well-described safety profile, is among the most commonly used therapies for relapsing forms of multiple sclerosis. As of 31 December 2021, >560,000 patients have been treated with DMF, representing >1,190,000 person-years of exposure. Of these, 6413 patients (14,292 person-years) were from clinical trials. Methods and results Progressive multifocal leukoencephalopathy (PML) has occurred in the setting of lymphopenia (<0.91 × 109/L) in patients treated with DMF. We present detailed clinical characteristics and outcomes of the 12 confirmed PML cases occurring in MS patients on DMF as of 21 July 2021. The PML incidence in DMF-treated patients is 1.07 per 100,000 person-years of DMF exposure. Lymphopenia is the common risk for PML in DMF treatment. Discussion DMF-related PML is rare but has occurred in the setting of lymphopenia, supporting the current recommendations for absolute lymphocyte count monitoring in all patients, regardless of age and time on therapy.
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Affiliation(s)
- Jennifer Lyons
- Jennifer Lyons, Biogen, 225 Binney Street, Cambridge, MA 02142, USA.
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15
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All S, Rashdan S, Gerber D, Hughes R, Lohrey J, Dowell J, Westover K, Vo D, Iyengar P. 1st Line Pembrolizumab in Treatment of Stage IV NSCLC Patients – A Pattern of Failure Analysis with Associated Survival Outcomes. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1477] [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: 10/31/2022]
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16
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Papatheodorou E, Kissel C, Merghani A, Hughes R, Torlasco C, Bakalakos A, Downs E, Parry-Williams G, Finocchiaro G, Malhotra A, Moon JC, Papadakis M, Al Fakih K, Dey D, Sharma S. Exercise induced coronary inflammation in masters athletes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1288] [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
Chronic endurance exercise has been linked to increased prevalence of coronary artery disease (CAD) in male master athletes. Data are limited regarding the presence of exercise-induced coronary inflammation and its association with atherosclerosis in master endurance athletes. Human coronary inflammation can be detected non-invasively by imaging pericoronary adipose tissue (PCAT). We tested the hypothesis that chronic endurance exercise leads to increased prevalence of atherosclerosis via coronary inflammation.
Methods
Computed tomography coronary angiogram CTCA scans from 2 cohorts of master athletes and age-matched controls, without known risk factors for CAD, were analysed post-hoc and the PCAT attenuation index was calculated around the proximal right coronary artery (FAIRCA). The athletes and the healthy controls also underwent an electrocardiogram, an echocardiogram, a cardiopulmonary exercise test (CPET), a 24-hour Holter tape and a Cardiac Magnetic Resonance (CMR) scan.
Results
Scans from 243 masters endurance athletes (62% females) and 58 age and Framingham CAD risk score matched healthy controls were analysed. FAIRCA was significantly higher (less negative) in male masters athletes vs female masters athletes [−61.3 Hounsfield Units (HU) vs −62.8 HU, p=0.01], in male athletes vs male controls (−61.3 HU vs −68.6 HU, p<0.001) and in female athletes vs female controls (−62,8 HU vs −67.5 HU, p=0.005). In female masters athletes, peak oxygen consumption during CPET (peak VO2) statistically significantly predicted the FAIRCA, F(1,146) = 22.62, p<0.0001. There was no correlation between the FAIRCA and presence of atherosclerosis in male masters athletes.
Conclusions
Masters athletes show increased markers of coronary inflammation. This effect appears to be greater in male masters athletes and is associated with a higher peak VO2 in female masters athletes. However, we did not identify a link between coronary inflammation and coronary atherosclerosis in this cohort.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiac Risk in the Young, UK
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Affiliation(s)
| | - C Kissel
- University Hospital Zurich , Zurich , Switzerland
| | - A Merghani
- University of British Columbia , Vancouver , Canada
| | - R Hughes
- Barts Health NHS Trust , London , United Kingdom
| | - C Torlasco
- University of Milan Bicocca , Milan , Italy
| | - A Bakalakos
- Barts Health NHS Trust , London , United Kingdom
| | - E Downs
- University of Sheffield , Sheffield , United Kingdom
| | | | - G Finocchiaro
- Guy's and St Thomas' NHS Trust Hospitals , London , United Kingdom
| | - A Malhotra
- University of Manchester , Manchester , United Kingdom
| | - J C Moon
- Barts Health NHS Trust , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - K Al Fakih
- Lewisham and Greenwich NHS Trust , London , United Kingdom
| | - D Dey
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - S Sharma
- St George's University of London , London , United Kingdom
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17
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Bencina G, Chami N, Hughes R, Weston G, Baxter C, Salomonsson S, Demedts I. 1351P Indirect costs due to lung cancer-related premature mortality in four European countries. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1483] [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: 11/01/2022] Open
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18
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Theiveehathasan M, Hughes R, Brockelsby C. EP01.06-005 Assessment of Cardiovascular Risk in the Non Screening Radically Treated Lung Cancer Cohort. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.317] [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: 11/28/2022]
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Kearney N, McCourt C, Hughes R, Alsharqi A, O'Kane D, Kirby B. Systemic immune inflammation index is a marker of cardiovascular risk and not just disease severity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:e928-e929. [PMID: 35694838 DOI: 10.1111/jdv.18322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- N Kearney
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Department of Dermatology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - C McCourt
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - R Hughes
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - A Alsharqi
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - D O'Kane
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - B Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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Kadambi A, Pustulka I, Hughes R, Prabhu V, Zhao Q. 23P Systematic literature review of real-world outcomes of chemotherapies for advanced or recurrent endometrial cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.041] [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: 11/28/2022] Open
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22
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Khan B, Mariathas M, Jarvis P, Hughes R, Purohit N. SPECT-CT to Investigate Pain Post Total Hip Arthroplasty: Unexpected Findings That Affect Patient Management. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750675] [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: 10/17/2022]
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Schmierer K, Hauser SL, Kappos L, Montalban X, Craveiro L, Hughes R, Prajapati K, Koendgen H, Pradhan A, Wolinsky JS. 034 Updated safety analysis of ocrelizumab in multiple sclerosis. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOngoing safety reporting is crucial to understanding the long-term benefit-risk profile of ocrelizumab in multiple sclerosis (MS). Safety/efficacy of ocrelizumab have been characterised in Phase II (NCT00676715) and III (NCT01247324/NCT01412333/NCT01194570) trials in relapsing-remitting MS, relapsing MS (RMS) and primary progressive MS (PPMS). Here, we report safety evaluations from ocrelizumab clinical trials and open-label extensions up to January 2019, and selected post-marketing data.MethodsSafety outcomes are reported for the ocrelizumab all-exposure population in Phase II/III and ongoing Phase IIIb trials. To account for different exposure lengths, rates per 100 patient years (PY) are presented.ResultsIn clinical trials, 4,611 patients with MS received ocrelizumab (14,329 PY exposure). Reported rates per 100 PY (95% confidence interval) were: adverse events (AEs), 252 (249–254); serious AEs, 7.33(6.89–7.79); infections, 76.7 (75.3–78.2); serious infections, 1.99 (1.77–2.23); malignancies, 0.46 (0.35–0.58); and AEs leading to discontinuation, 1.08 (0.92–1.27). Updated ocrelizumab all-exposure population data and selected post-marketing data will be presented.ConclusionsReported event rates in the ocrelizumab all-exposure clinical trial population and post-mar- keting settings remain generally consistent with the controlled treatment period in RMS/PPMS populations. Regular reporting of long-term safety data will continue.k.schmierer@qmul.ac.uk
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Schmierer K, Bar-Or A, Bermel R, Weber MS, Hughes R, Lin CJ, Wang JM, Craviero L, Hauser SL, Derfuss T. 033 Ocrelizumab: serum Ig levels and serious infections. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAn apparent association between decreased Ig levels and serious infections (SIs) was pre- viously reported. Here, we characterised the temporal evolution of Ig levels and risk of SIs by baseline Ig quartile over 6 years in OPERA I/II (NCT01247324/NCT01412333), ORATORIO (NCT01194570), and their open-label extensions.MethodsSerum Ig levels were measured ≥24 weeks. Baseline IgG/IgM/IgA quartiles (g/L) were determined; Q1 represents the lowest quartile. Changes in Ig levels and SI rates by baseline quartiles were assessed.ResultsOver 6 years, mean change in IgG levels, g/L (% change) per year by quartile were: Q1, -0.24 (-2.9%); Q2, -0.32 (-3.2%); Q3, -0.40 (-3.6%); Q4, -0.40 (-3.0%) in OPERA, and Q1, -0.23 (-2.9%); Q2, -0.28 (-2.9%);Q3 -0.35 (-3.1%); Q4, -0.51 (-3.8%) in ORATORIO. SI rates/100PY (95% CI) were: Q1, 1.63 (0.95–2.61); Q2, 1.55(0.90–2.48); Q3, 1.51 (0.86–2.45); Q4, 1.11 (0.57–1.94) in OPERA, and Q1, 4.04 (2.66–5.87); Q2, 3.81 (2.46–5.62); Q3, 5.39 (3.76–7.50); Q4, 2.17 (1.22–3.59) in ORATORIO. Changes in IgM/IgA will also be presented.ConclusionsPatients with lower baseline IgG demonstrated less absolute IgG decline, but similar per- centage decline, versus patients with higher baseline IgG. SI rates were low, and similar across quartiles.k.schmierer@qmul.ac.uk
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Li X, Muston D, Ramakrishnan K, Black C, Hughes R, Weston G, Lucherini S. Budget Impact of Keytruda for the Treatment of Patients with Recurrent or Metastatic (R/M) and Locally Advanced (LA) Cutaneous Squamous Cell Carcinoma (cSCC) in the United States. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.126] [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: 10/18/2022]
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Han P, Fu S, Kolis J, Hughes R, Hallstrom BR, Carvour M, Maradit-Kremers H, Sohn S, Vydiswaran VGV. Multi-Center Validation of Natural Language Processing Algorithms for Detection of Common Data Elements in Operative Notes for Total Hip Arthroplasty (Preprint). JMIR Med Inform 2022; 10:e38155. [PMID: 36044253 PMCID: PMC9475406 DOI: 10.2196/38155] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Natural language processing (NLP) methods are powerful tools for extracting and analyzing critical information from free-text data. MedTaggerIE, an open-source NLP pipeline for information extraction based on text patterns, has been widely used in the annotation of clinical notes. A rule-based system, MedTagger-total hip arthroplasty (THA), developed based on MedTaggerIE, was previously shown to correctly identify the surgical approach, fixation, and bearing surface from the THA operative notes at Mayo Clinic. Objective This study aimed to assess the implementability, usability, and portability of MedTagger-THA at two external institutions, Michigan Medicine and the University of Iowa, and provide lessons learned for best practices. Methods We conducted iterative test-apply-refinement processes with three involved sites—the development site (Mayo Clinic) and two deployment sites (Michigan Medicine and the University of Iowa). Mayo Clinic was the primary NLP development site, with the THA registry as the gold standard. The activities at the two deployment sites included the extraction of the operative notes, gold standard development (Michigan: registry data; Iowa: manual chart review), the refinement of NLP algorithms on training data, and the evaluation of test data. Error analyses were conducted to understand language variations across sites. To further assess the model specificity for approach and fixation, we applied the refined MedTagger-THA to arthroscopic hip procedures and periacetabular osteotomy cases, as neither of these operative notes should contain any approach or fixation keywords. Results MedTagger-THA algorithms were implemented and refined independently for both sites. At Michigan, the study comprised THA-related notes for 2569 patient-date pairs. Before model refinement, MedTagger-THA algorithms demonstrated excellent accuracy for approach (96.6%, 95% CI 94.6%-97.9%) and fixation (95.7%, 95% CI 92.4%-97.6%). These results were comparable with internal accuracy at the development site (99.2% for approach and 90.7% for fixation). Model refinement improved accuracies slightly for both approach (99%, 95% CI 97.6%-99.6%) and fixation (98%, 95% CI 95.3%-99.3%). The specificity of approach identification was 88.9% for arthroscopy cases, and the specificity of fixation identification was 100% for both periacetabular osteotomy and arthroscopy cases. At the Iowa site, the study comprised an overall data set of 100 operative notes (50 training notes and 50 test notes). MedTagger-THA algorithms achieved moderate-high performance on the training data. After model refinement, the model achieved high performance for approach (100%, 95% CI 91.3%-100%), fixation (98%, 95% CI 88.3%-100%), and bearing surface (92%, 95% CI 80.5%-97.3%). Conclusions High performance across centers was achieved for the MedTagger-THA algorithms, demonstrating that they were sufficiently implementable, usable, and portable to different deployment sites. This study provided important lessons learned during the model deployment and validation processes, and it can serve as a reference for transferring rule-based electronic health record models.
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Affiliation(s)
- Peijin Han
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Sunyang Fu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Julie Kolis
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Richard Hughes
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Brian R Hallstrom
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Martha Carvour
- Department of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA, United States
| | - Hilal Maradit-Kremers
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
- Departments of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, United States
- School of Information, University of Michigan, Ann Arbor, MI, United States
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Hughes R, Massie E, Saldanha J, Komolafe S, Chapman R, Kirk A, Vella M, Moug S, MacArthur C, Mackie H. 294 Implementation of Colorectal Robotic Assisted Surgical Programme During a Global Pandemic: Collaboration Between Territorial and National Waiting Times Centre. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.194] [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: 11/12/2022]
Abstract
Abstract
Introduction
Golden Jubilee National Hospital (GJNH) established a thoracic Robotic Assisted Surgical (RAS) programme in 2018. In March 2021, GJNH invested in a new elective colorectal service and in response to the Scottish Government robotic investment established a collaboration with a territorial health board to host their robot and start a RAS colorectal programme. We provide an overview of barriers and facilitators leading to establishing this new collaboration.
Method
An observational review of RAS training timeline. Demographics, surgical operations, and hospital length of stay were documented. Surgeons, perioperative team, management, and industry (Intuitive) were interviewed to provide insights into implementation and training.
Results
Boards approved RAS business case in April 2021, robot on-site with GJNH governance approval in May. First cohort of colorectal surgeons completed proctored training July 2021. To date, 17 RAS resections performed (mean age 64, 9 males: 8 female). Mean length of stay 4.65 days. No anastomotic leaks and no mortality reported. Interviews revealed key facilitators: advantage of having an established RAS perioperative team and building on pre-existing industry links; developing and strengthening collaborative working between different health boards and surgeons. Barriers included: education of all team members to ensure patient safety for new specialty; multisite collaborative working.
Conclusions
This work provides a template model for future RAS collaborations between different sites and health boards. Collaborative working in a green-hospital setting may improve equity of access for patients whilst future-proofing surgery against further waves of the pandemic.
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Affiliation(s)
- R. Hughes
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - E. Massie
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | | | - R. Chapman
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A. Kirk
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M. Vella
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S. Moug
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - C. MacArthur
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - H. Mackie
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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Chinn V, Neely E, Shultz S, Kruger R, Hughes R, Page R, Coad J, Thunders M. Next Level Health: a holistic health and wellbeing program to empower New Zealand women. Health Promot Int 2022:6505283. [PMID: 35024852 DOI: 10.1093/heapro/daab205] [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: 11/14/2022] Open
Abstract
Improving equity in women's health requires gender-specific and empowering approaches. However, health programs often disempower women by adopting a 'one-size-fits-all' approach that emphasizes diet, exercise and weight loss over other important aspects like sleep and mental wellbeing. This article reports on the design of Next Level Health (NLH), a program that aims to empower women through developing a wide range of health behaviors to support their holistic wellbeing. NLH is grounded by ethics, theory and evidence to support women to make achievable, sustainable changes that are relevant to their everyday lives. Women utilized the NLH framework to develop an integrative health routine across six domains: physical activity, sleep, nutrition, eating behavior, self-care and stress management. The framework guided them to set small, incremental goals that were adaptive to their needs and built from their existing circumstances. Participants reflected on their progress with a facilitator during monthly meetings, accessed a social media support page and received monthly text messages. Health programs remain an essential approach to improving women's health alongside community- and policy-level strategies. The development of NLH exemplifies how evidence may partner with modern health promotion values to inform relevant and ethical program design for women.
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Affiliation(s)
- V Chinn
- School of Health, Victoria University of Wellington, Easterfield Building, Kelburn Parade, Wellington 6012, New Zealand.,School of Health Sciences, Massey University, Wallace St, Mount Cook, Wellington 6021, New Zealand
| | - E Neely
- School of Health, Victoria University of Wellington, Easterfield Building, Kelburn Parade, Wellington 6012, New Zealand
| | - S Shultz
- Kinesiology Department, Seattle University, 12th Ave, Seattle, WA 98122, USA
| | - R Kruger
- School of Sport, Exercise & Nutrition, Massey University, SH17, Albany, Auckland 0632, New Zealand
| | - R Hughes
- Tasmanian School of Medicine, University of Tasmania, Liverpool St, Hobart, TAS 7000, Australia
| | - R Page
- School of Health Sciences, Massey University, Wallace St, Mount Cook, Wellington 6021, New Zealand
| | - J Coad
- School of Food & Advanced Technology, Massey University, Riddet Road, Palmerston North 4410, New Zealand
| | - M Thunders
- Department of Pathophysiology & Molecular Medicine, University of Otago, Mein St, Newtown, Wellington 6021, New Zealand
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Costa L, Alexandre M, Mansinho A, Teixeira Sousa A, Pereira Vieira C, Bell E, Swales O, Hughes R, Nagda N, Lucherini S, Roediger A, Araújo A. 113P Health outcomes and budget impact projection of the anti-PD-(L)1 class in cancer care in Portugal. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.131] [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: 11/16/2022] Open
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Hughes R, Fitzpatrick C, Nichols K, Devlin J, Richardson D. A pilot study exploring sexual health clinician confidence and barriers to anal examination and proctoscopy in men who have sex with men. Sex Health 2021; 18:515-516. [PMID: 34838154 DOI: 10.1071/sh21196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/28/2021] [Indexed: 01/25/2023]
Abstract
Anal examination and proctoscopy are important skills needed to facilitate the diagnoses of STIs and cancer. Clinician (25 doctors/15 nurses) confidence was higher for anal examination versus proctoscopy (median Likert scores 4/5 vs 5/5, P≤0.05) and higher in doctors compared with nurses (median Likert scores 5/5 vs 4/5, P<0.008, 4/5 vs 2/5, P<0.005), and related to years of experience (5/5 vs 4/5, P<0.001, 3/5 vs 5/5, P=0.007). Barriers included lack of opportunities for training, concerns about patient reluctance, and lack of available equipment. We need to be innovative when up-skilling the specialist sexual health workforce using online training and optimising opportunities for clinical assessment of MSM.
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Affiliation(s)
- Richard Hughes
- University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Colin Fitzpatrick
- University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Kayleigh Nichols
- University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK
| | - John Devlin
- University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK; and Brighton & Sussex Medical School, Brighton BN1 9PX, UK
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Richardson D, Nichols K, Hughes R, Smith H, Fitzpatrick C, Cresswell F. The characteristics of men who have sex with men (MSM) using post-exposure prophylaxis for sexual exposure (PEPSE) in the pre-exposure prophylaxis (PrEP) era. HIV Med 2021; 23:553-557. [PMID: 34725897 DOI: 10.1111/hiv.13201] [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] [Received: 09/04/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is now available in the UK. However, some men who have sex with men (MSM) continue to use HIV post-exposure prophylaxis following sexual exposure (PEPSE) and are not using PrEP. It is important to characterize MSM having condomless anal sex who are not using PrEP. METHODS In a cross-sectional analysis, we compared the characteristics of MSM who used PEPSE in 2021 with MSM using PEPSE in 2017. RESULTS Overall, 126 MSM used PEPSE in January to June 2017 and 28 MSM used PEPSE in January to June 2021, a 78% decline in PEPSE use. Those MSM using PEPSE in 2021 were significantly younger (27 vs. 35 years, p < 0.01), more likely to identify as black or from another minority ethnic group [29% (8/28) vs. 8% (10/126); p < 0.01], more likely to attend as a result of a group sex encounter [35% (10/28) vs. 16% (10/126); p = 0.03], more likely to attend following sex involving recreational drug use [32% (9/28) vs. 13% (16/126); p = 0.02], and more likely to initiate PEPSE in the emergency department [35% (10/28) vs. 19% (24/126); p = 0.04] compared with MSM attending in 2017. Those MSM using PEPSE in 2021 were significantly less likely to attend follow-up appointments compared with the 2017 cohort [71% (20/28) vs. 87% (110/126); p < 0.05]. Ninety-five per cent of MSM using PEPSE in 2021 were initiated on PrEP at follow-up. CONCLUSIONS Despite PrEP being readily available, some MSM continue using PEPSE and these MSM are significantly more likely to be younger, from black or minority ethnic groups, to engage in group sex involving recreational drugs and to attend the emergency department for PEPSE compared with MSM attending in 2017. Increasing the accessibility of PrEP for this group of MSM is important in order to optimize HIV prevention strategies.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | | - Richard Hughes
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Hannah Smith
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Fiona Cresswell
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
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Stires H, LaMori J, Chow W, Zalewski Z, Vidulich A, Avina M, Sloan C, Hughes R, Hardy H. Weight Gain and Related Comorbidities Following Antiretroviral Initiation in the 2000s: A Systematic Literature Review. AIDS Res Hum Retroviruses 2021; 37:834-841. [PMID: 34541891 DOI: 10.1089/aid.2020.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/04/2023] Open
Abstract
Antiretroviral therapies (ARTs) benefit millions with human immunodeficiency virus. However, concerns about subsequent weight gain and related metabolic complications have emerged. Early ARTs are associated with adipose tissue changes. While newer ARTs may have fewer adipose alterations, it is unclear whether they lead to increased weight gain. A systematic literature review was performed to describe current published literature describing the use of newer ARTs, weight gain, and related comorbidities. Titles and abstracts were screened, focusing on studies that examined ART initiation and subsequent weight gain; publications were then ranked based on publication type, methodology, and comorbidities, emphasizing US studies with large patient cohorts. This yielded a comprehensive review of the 50 publications on weight gain and a range of related comorbidities, including diabetes and hypertension. Most of the studies describing weight gain found the most significant gains during the first year after initiating ART. Overall, patients gained ∼5 kg 18-96 months after initiating ART. Many of the studies reported altered weight-related comorbidities, including increased risk of diabetes and hypertension. Despite an expectation that newer ARTs may be safer, a review of the literature suggests that contemporary ART use is associated with pronounced weight gain and related comorbidities. Future studies should define and quantify the direct role of newer ARTs in weight gain and related comorbidities, as well as clarify the role of specific drug classes in metabolic disturbance, to improve intervention strategies.
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Affiliation(s)
- Hillary Stires
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Joyce LaMori
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Wing Chow
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Zachary Zalewski
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Alisa Vidulich
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Manuel Avina
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Chris Sloan
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Richard Hughes
- Avalere Health—An Inovalon Company, Washington, District of Columbia, USA
| | - Hélène Hardy
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
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Sher D, Avkshtol V, Moon D, Wang J, Chen L, Dohopolski M, Hughes R, Vo D. Recurrence and Quality-of-Life Following Involved Node Radiotherapy for Head and Neck Squamous Cell Carcinoma: Initial Results From the Phase II INRT-Air Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Burningham K, Moore W, Moon D, Avkshtol V, Day A, Sumer B, Vo D, Bishop J, Hughes R, Sher D. Prognostic Impact of Matted Lymphadenopathy in Oropharynx Cancer Treated With Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cassidy J, McNamara S, Gorry S, Hughes R, Vajda J, Hill L, Akers M, Greene L, Ong T. 144: Quality improvement process to improve home spirometer use in a pediatric CF care center. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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All S, Iyengar P, Westover K, Choy H, Rashdan S, Lohrey J, Hughes R, Dowell J, Gerber D, Vo D. Patterns of Failure in Metastatic Non-Small Cell Lung Cancer Patients After Initiation of Pembrolizumab. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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O'Brien AC, Teh Z, Rinaldi M, Lee E, Hughes R, Aktselis I, McKean D. Intraosseous Type 2 Median Nerve Entrapment After Posterior Elbow Dislocation Diagnosed on Ultrasound With MRI and Surgical Correlation. Cureus 2021; 13:e18606. [PMID: 34659922 PMCID: PMC8500458 DOI: 10.7759/cureus.18606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Median nerve entrapment is a rare complication of posterior elbow dislocation and medial epicondyle fracture. In the event of delayed diagnosis, this injury pattern may result in significant and sometimes irreversible nerve damage. As such, a high degree of clinical suspicion and early imaging is indicated in patients with persistent nerve deficits following reduction of elbow dislocation. Here, a case of intraosseous type 2 median nerve entrapment that was diagnosed on ultrasound in an eight-year-old patient following ulnohumeral dislocation is discussed. This article reviews the key imaging findings of median nerve entrapment and discusses the subsequent MRI and surgical findings of this rare condition.
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Affiliation(s)
- Amy C O'Brien
- Radiology Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR
| | - Zoe Teh
- School of Medicine, Cardiff University, Cardiff, GBR
| | - Marta Rinaldi
- National Spinal Injuries Centre, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR
| | - Elsa Lee
- Radiology, King's College London, London, GBR
| | - Richard Hughes
- Radiology Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR
| | - Ioannis Aktselis
- Orthopaedic Surgery Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR
| | - David McKean
- Radiology Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR
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Hauser SL, Kappos L, Montalban X, Craveiro L, Chognot C, Hughes R, Koendgen H, Pasquarelli N, Pradhan A, Prajapati K, Wolinsky JS. Safety of Ocrelizumab in Patients With Relapsing and Primary Progressive Multiple Sclerosis. Neurology 2021; 97:e1546-e1559. [PMID: 34475123 PMCID: PMC8548959 DOI: 10.1212/wnl.0000000000012700] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [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: 01/15/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives To report safety of ocrelizumab (OCR) up to 7 years in patients with relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS) enrolled in clinical trials or treated in real-world postmarketing settings. Methods Safety analyses are based on integrated clinical and laboratory data for all patients who received OCR in 11 clinical trials, including the controlled treatment and open-label extension (OLE) periods of the phase 2 and 3 trials, plus the phase 3b trials VELOCE, CHORDS, CASTING, OBOE, ENSEMBLE, CONSONANCE, and LIBERTO. For selected adverse events (AEs), additional postmarketing data were used. Incidence rates of serious infections (SIs) and malignancies were contextualized using multiple epidemiologic sources. Results At data cutoff (January 2020), 5,680 patients with multiple sclerosis (MS) received OCR (18,218 patient-years [PY] of exposure) in clinical trials. Rates per 100 PY (95% confidence interval) of AEs (248; 246–251), serious AEs (7.3; 7.0–7.7), infusion-related reactions (25.9; 25.1–26.6), and infections (76.2; 74.9–77.4) were similar to those within the controlled treatment period of the phase 3 trials. Rates of the most common serious AEs, including SIs (2.01; 1.81–2.23) and malignancies (0.46; 0.37–0.57), were consistent with the ranges reported in epidemiologic data. Discussion Continuous administration of OCR for up to 7 years in clinical trials, as well as its broader use for more than 3 years in the real-world setting, are associated with a favorable and manageable safety profile, without emerging safety concerns, in a heterogeneous MS population. Classification of Evidence This analysis provides Class III evidence that long-term, continuous treatment with OCR has a consistent and favorable safety profile in patients with RMS and PPMS. This study is rated Class III because of the use of OLE data and historical controls.
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Affiliation(s)
- Stephen L Hauser
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth).
| | - Ludwig Kappos
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Xavier Montalban
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Licinio Craveiro
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Cathy Chognot
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Richard Hughes
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Harold Koendgen
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Noemi Pasquarelli
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Ashish Pradhan
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Kalpesh Prajapati
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Jerry S Wolinsky
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
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O'Dowd DP, Romer H, Hughes R, Harding N, Ball S, Migliorini F, Maffulli N. Forearm compartment pressures and grip strength in elite motorbike racers with chronic exertional compartment syndrome. J Orthop Surg Res 2021; 16:603. [PMID: 34654457 PMCID: PMC8518181 DOI: 10.1186/s13018-021-02765-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remarkably little research has been published on chronic exertional compartment syndrome (CECS) of the forearm. This study investigated forearm flexor compartment pressure pre- and post-exercise in elite motorbike racers clinically diagnosed with CECS and assessed their grip strength before and after arm pump exercise. METHODS Elite motorbike riders with a clinical diagnosis of CECS of the right forearm when racing were recruited during the opening rounds of a British Superbike season. Their grip strength and forearm flexor compartment pressures were measured before and after a set exercise programme. RESULTS Of the 11 riders recruited to the study, 10 completed the full testing regime. The mean pre-exercise forearm compartment pressures [11.7 mmHg (range 7-17 mmHg)] significantly increased post-exercise [30.5 mmHg (range 15-45 mmHg)], with a mean increase of 18.80 mmHg (P < 0.0001). The mean pre-exercise grip strength [50.61 mmHg (range 37-66.7 mmHg)] decreased post-exercise to [35.62 mmHg (range 17.1-52.5 mmHg)], a mean decrease of 14.99 mmHg (P < 0.0001). CONCLUSION There is a statistically significant increase in the forearm flexor compartment pressures in elite motorbike racers with CECS, but with marked variability of these values. Grip strength decreases statistically significantly following onset of symptoms of CECS of the forearm.
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Affiliation(s)
- Dominic P O'Dowd
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,Medical Team, British Superbike Series, MSVR Brands Hatch, West Kingsdown, Longfield, DA3 8NG, UK
| | - Heike Romer
- Medical Team, British Superbike Series, MSVR Brands Hatch, West Kingsdown, Longfield, DA3 8NG, UK.,Department of Anaesthesia, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - Richard Hughes
- Medical Team, British Superbike Series, MSVR Brands Hatch, West Kingsdown, Longfield, DA3 8NG, UK
| | - Noel Harding
- Medical Team, British Superbike Series, MSVR Brands Hatch, West Kingsdown, Longfield, DA3 8NG, UK
| | - Samantha Ball
- Medical Team, British Superbike Series, MSVR Brands Hatch, West Kingsdown, Longfield, DA3 8NG, UK
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081, Baronissi, Salerno, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
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40
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Dalili D, Fairhead R, Mermekli A, Papanikitas J, Teh J, Hughes R, Fascia D, McKean D. Impact of the COVID-19 pandemic on corticosteroid injection services: A National Survey of Members of the British Society of Skeletal Radiologists (BSSR). Br J Radiol 2021; 94:20210327. [PMID: 34520669 PMCID: PMC9328042 DOI: 10.1259/bjr.20210327] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective To describe the restructuring of services by British radiologists in response to evolving national guidelines and highlight the impact of the COVID-19 pandemic on the treatment of musculoskeletal (MSK) conditions. Methods An online anonymised survey was distributed via the British Society of Skeletal Radiology (BSSR) members forum in November 2020. Responses were collated using a standardised Google form including 21 questions. Results 135 members of the BSSR completed the survey. 85% of respondents stopped performing corticosteroid injections (CSI) during the initial lockdown of the pandemic. This was primarily influenced by national guidelines. The majority of respondents initially abstained from offered CSI procedures, then by November 2020, 69% of respondents were providing CSI for high and low risk patients, 23% were only providing CSI for low-risk patients with 8% still not performing any CSI. 40% of respondents reported routinely obtaining specific written consent regarding the risk of COVID-19. Approximately, 11,000 CSI were performed by respondents between March and November 2020 with no reported significant COVID-19-related complications. Over 80% of BSSR members reported that the number of CSI procedures that they performed dropped by more than 80% compared to usual. 73% of respondents reported an increased backlog of patients awaiting treatment. The average waiting time for routine outpatient CSI treatment was > 12 weeks in 53% of responses, compared to 34% the previous year. Conclusion The COVID-19 pandemic has had a significant impact on the clinical practices of MSK radiologists in the UK. Our survey highlights the rapid response of BSSR members as national guidelines evolved. Currently, the majority of respondents are performing CSI for musculoskeletal conditions when clinically indicated, with enhanced consent. However, the pandemic has resulted in increased waiting times – delaying the treatment of patients who may be suffering with significant pain and disability. Further research is warranted to provide guidance around both service recovery and provision of CSI around COVID-19 vaccination schedules. Advances in knowledge BSSR members responded rapidly to changing guidelines during the COVID-19 pandemic. The majority of respondents are currently performing CSI when clinically indicated. The pandemic has resulted in a significant increase in waiting times which will have a significant impact on UK musculoskeletal services.
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Affiliation(s)
- Danoob Dalili
- South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, United Kingdom.,Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, London, United Kingdom
| | - Rory Fairhead
- Pembroke College, Oxford University Medical School, Oxford, UK
| | - Asimenia Mermekli
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Richard Hughes
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
| | - Daniel Fascia
- Radiology Department, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - David McKean
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
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Fairhead R, Vickers P, Kuek DK, Lee E, Mermekli A, Gandhi A, Hughes R, McKean D. Contrast Dispersal Patterns in CT-Guided Indirect Posterolateral Cervical Nerve Root Injections. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731554] [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: 10/21/2022]
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Fairhead R, Dalili D, Mermekli A, Papanikitas J, Kuek DK, Hughes R, Fascia DT, McKean D. Corticosteroid Injections During the COVID-19 Pandemic: A Survey of BSSR Members. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731561] [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: 10/21/2022]
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Mermekli A, Fairhead R, Hare N, Kuek DK, Lee E, Hughes R, Dalili D, Papanikitas J, McKean D. Conscious Sedation during Percutaneous Image-guided Palliative Radiofrequency Ablation of Painful Bone Metastases: A Case Series. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731569] [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: 10/21/2022]
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Mermekli A, Hare N, Fairhead R, Kuek DK, Gandhi A, Dalili D, Hughes R, Papanikitas J, McKean D. Radiofrequency Ablation Combined with Augmentation for Local Tumor Control of Skeletal Metastases. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731526] [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: 10/21/2022]
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Tsang Y, Tharmalingam H, Belessiotis-Richards K, Armstrong S, Ostler P, Hughes R, Alonzi R, Hoskin P. OC-0040 Ultrafractionated radiotherapy(RT) in localised prostate cancer:HDR brachytherapy vs stereotactic RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hughes R, Whitley L, Schneble HM, Muros-Le-Rouzic E, Sauter A, Pedotti R, Köndgen H. Cas d’infection à la COVID-19 chez des personnes atteintes de sclérose en plaques (SEP) traitées par ocrelizumab (OCR) : actualisation des données de pharmacovigilance. Rev Neurol (Paris) 2021. [PMCID: PMC8036144 DOI: 10.1016/j.neurol.2021.02.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Les risques potentiels d’infection à la COVID-19 chez les patients (pts) atteints de SEP traités par immunothérapie restent méconnus. Plus de 170 000 pts SEP sont traités par OCR avec un profil bénéfice/risque favorable. Objectifs Présenter une synthèse des données disponibles pour les pts atteints de SEP, traités par OCR et ayant une infection à la COVID-19 suspectée ou confirmée (au 31 juillet 2020). Patients et méthodes Les cas d’infection COVID-19 ont été recherchés dans la Base mondiale de pharmacovigilance de Roche (données post-commercialisation/essais cliniques) et définis comme confirmés (test SARS-CoV-2 et/ou radiographie évocatrice d’une pneumonie COVID-19) ou rapportés comme confirmés (post-commercialisation) ou suspectés (symptômes seuls). L’issue des cas (rétablis, en cours de rétablissement, non rétablis, fatals ou statut non rapporté) et les facteurs de risque potentiels (si disponibles) ont été analysés. Résultats Parmi les 4000 pts issus des essais cliniques, 51 cas (1,3 %) COVID-19 (26 confirmés) ont été identifiés. La sévérité de la COVID-19 était légère à modérée chez la plupart des pts (68,6 %), sévère pour dix pts (19,6 %) et fatale pour 3 cas (5,9 %) cas. Dans les rapports post-commercialisation, 307 cas COVID-19 ont été identifiés (263 confirmés). La sévérité du COVID-19 était asymptomatique à modérée chez 143 pts (46,6 %), sévère chez 52 pts (16,9 %) et critique chez 15 pts (4,9 %). Il y a eu 17 cas mortels (5,5 %). Discussion À partir des données de Pharmacovigilance, la COVID-19 chez des pts SEP traités par OCR était généralement légère/modérée, ne nécessitant pas d’hospitalisation. L’âge > 50 ans, le sexe masculin et la présence de comorbidités (hypertension, obésité, diabète, maladie respiratoire, cardiaque, et/ou rénale, cancer) étaient identifiés dans les cas graves ; 134 (43,6 %) des cas post-commercialisation avaient ≥ 1 de ces facteurs de risque. Conclusion Malgré les limites des données de Pharmacovigilance, l’expérience de la COVID-19 chez des pts atteints de SEP et traités par OCR semble cohérente avec celle rapportée dans la population générale et des pts atteints de SEP.
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Papatheodorou E, Merghani A, Bakalakos A, Hughes R, Torlasco C, Downs E, D"silva A, Finocchiaro G, Malhotra A, Tome M, Moon JC, Al Fakih K, Papadakis M, Sharma S. Left ventricular remodelling in masters athletes. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.017] [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
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): I have received a research fellowship grant from the UK based charity Cardiac Risk in the Young
Objectives
We investigated the effect of long-term exercise and sex on left ventricular (LV) geometry in a large group of female and male masters athletes.
Background
Studies assessing LV geometry in masters athletes are scarce.
Methods
Different types of LV geometry were identified according to echocardiography-derived relative wall thickness (RWT) and left ventricular mass (LVM) values as per international guidelines. 4 groups were formed: normal (normal LVM/normal RWT), concentric hypertrophy (increased LVM/increased RWT), eccentric hypertrophy (increased LVM/normal RWT), and concentric remodeling (normal LVM/increased RWT).
Results
A total of 277 healthy, elite, caucasian endurance masters athletes (65% female; mean age54.8 ± 7.7 years) were assessed. The athletes were exercising for a mean 32 ± 11.7 years and have completed a median 70 competitions including a median 13 marathon-type competitions. Females exhibited lower absolute LVM (127.7 ± 30.31g vs 196.57 ± 45.0g, p < 0.001), indexed LVM (76.8 ± 18.0 g/m2 vs. 103.6 ± 22.7 g/m2; p < 0.001), RWT (0.36 ± 0.07 vs. 0.42 ± 0.08; p < 0.001) and absolute LV end-diastolic dimension (LVEDD) (46.3 ± 4.1 mm vs 50.1 ± 5.11 mm, p < 0.001) but greater indexed LVEDD (27.7 ± 2.7mm/m2 vs 26.5 ± 2.7 mm/m2, p < 0.001) compared with male athletes. Most female athletes showed normal LV geometry (72% vs 38% in male athletes, P < 0.001) and significantly less concentric remodeling (12% vs 35%, p < 0.001) and concentric hypertrophy (5% vs 13%, p = 0.01) (table & figure).
Conclusions
A sex-specific response to chronic exercise is observed. Male masters athletes exhibit significantly more frequently abnormal LV geometry with concentric LV remodeling and/or concentric hypertrophy.
Cohort characteristics Male masters athletes N = 97 Female masters athletes N = 180 P value Age (years) 55.0 ± 9.0 54.7 ± 6.9 0.68 Years of exercise 32.0 ± 12.8 33.3 ± 11.1 0.14 LV Mass (g) 127.7 ± 30.31 196.57 ± 45.0 <0.001 LV Mass Indexed (g/m2) 76.8 ± 18.0 103.6 ± 22.7 <0.001 LVEDD (mm) 46.3 ± 4.1 50.1 ± 5.11 <0.001 LVEDD Indexed (mm/m2) 27.7 ± 2.7 26.5 ± 2.7 <0.001 Normal Remodeling 36 (37) 130 (72) <0.001 Eccentric Hypertrophy 14 (14) 18 (10) 0.27 Concentric Remodeling 34 (35) 23 (13) <0.001 Concentric Hypertrophy 13 (13) 9 (5) 0.01 LV Left Ventricular, LVEDD: Left Ventricular End Diastolic Dimension Abstract Figure. Patterns of left ventricular remodeling
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Affiliation(s)
| | - A Merghani
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom of Great Britain & Northern Ireland
| | - A Bakalakos
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hughes
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Torlasco
- University of Milan-Bicocca, Milan, Italy
| | - E Downs
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A D"silva
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - G Finocchiaro
- St Thomas" Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Malhotra
- Manchester University Hospitals, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - M Tome
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - K Al Fakih
- Lewisham Healthcare NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Papadakis
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
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McKean D, Chung SL, Naudé RTW, McElroy B, Baxter J, Pendse A, Papanikitas J, Teh J, Hughes R. Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series. J Ultrason 2021; 20:e300-e306. [PMID: 33500798 PMCID: PMC7830058 DOI: 10.15557/jou.2020.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/05/2020] [Indexed: 11/22/2022] Open
Abstract
Aim of the study: To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Methods: Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. Results: In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks post-injection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. Conclusion: In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament.
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Affiliation(s)
- David McKean
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - Siok Li Chung
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - Rebecca Te Water Naudé
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
| | - Bernard McElroy
- Orthopaedic Department, Chiltern Hospital, Great Missenden, UK
| | - Jonathan Baxter
- Orthopaedic Department, Buckinghamshire Healthcare NHS Trust, UK
| | - Aniruddha Pendse
- Orthopaedic Department, Buckinghamshire Healthcare NHS Trust, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
| | - Richard Hughes
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
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Kelly A, Meurling J, Kirthi Jeyarajah S, Ryan C, Hughes R, Garvey J, Kirby B. Obstructive sleep apnoea in psoriasis and hidradenitis suppurativa. Br J Dermatol 2021; 184:1183-1185. [PMID: 33404093 DOI: 10.1111/bjd.19802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- A Kelly
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - J Meurling
- Department of, Respiratory, St. Vincent's University Hospital, Dublin, Ireland
| | - S Kirthi Jeyarajah
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - C Ryan
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - R Hughes
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - J Garvey
- Department of, Respiratory, St. Vincent's University Hospital, Dublin, Ireland
| | - B Kirby
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
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Hughes R, Whitley L, Fitovski K, Schneble HM, Muros E, Sauter A, Craveiro L, Dillon P, Bonati U, Jessop N, Pedotti R, Koendgen H. COVID-19 in ocrelizumab-treated people with multiple sclerosis. Mult Scler Relat Disord 2020; 49:102725. [PMID: 33482590 PMCID: PMC7772086 DOI: 10.1016/j.msard.2020.102725] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022]
Abstract
Background There are limited data on the impact of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on people with multiple sclerosis (MS). Objective To better understand SARS-CoV-2 infection in ocrelizumab-treated people with MS. Methods Internal Roche/Genentech data sources: Cases of COVID-19 from ongoing Roche/Genentech clinical trials and from post-marketing use of ocrelizumab until July 31, 2020 were identified and assessed using descriptive statistics. External real-world data (RWD) source: An MS COVID-19 cohort and an ocrelizumab-treated MS COVID-19 cohort were identified and assessed from the OPTUMⓇ de-identified COVID-19 electronic health record (EHR) database. Results Roche/Genentech clinical trial data: There were 51 (1.3%) suspected or confirmed cases of COVID-19 identified from 4,000 patients ongoing in 10 Roche/Genentech clinical trials. Of these, 26 (51%) were confirmed COVID-19 and 25 (49%) were suspected COVID-19. Sixteen (31.4%) patients were hospitalized. COVID-19 severity was mild to moderate in most patients (35, 68.6%). Ten (19.6%) patients had severe disease and there were three (5.9%) fatal cases. Most patients (43, 84.3%) recovered or were recovering. There was no association apparent between duration of exposure to ocrelizumab and COVID-19. Among COVID-19 patients with previous serum immunoglobulin status (27/51, 52.9%), all (27/27, 100%) had IgG levels within the normal range. Roche/Genentech post-marketing safety database data: There were 307 post-marketing cases of COVID-19 in the Roche/Genentech global safety database. Of these, 263 (85.7%) were confirmed and 44 (14.3%) were suspected COVID-19. 100 (32.6%) patients were hospitalized. COVID-19 was asymptomatic, mild or moderate in 143 (46.6%) patients, severe in 52 (16.9%) patients, and critical in 15 (4.9%) patients. There were 17 (5.5%) fatal cases. Information on severity was not reported in 80 (26.1%) cases. Most patients (211, 68.7%) recovered or were recovering at the time of the report. External RWD data source: As of July 13, 2020, the OPTUMⓇ database included EHRs for almost 1.2 million patients with suspected COVID-19, 130,500 of whom met the criteria for confirmed/clinically diagnosed COVID-19. A total of 357 patients with MS with confirmed COVID-19 were identified. Forty-eight (13.4%) were treated with ocrelizumab, of whom 12 (25.0%) were hospitalized and one died (2.1%). Similar rates of hospitalization, invasive ventilation, and death were observed in the ocrelizumab-treated and non-ocrelizumab-treated MS cohorts. Across the Roche/Genentech and RWD sources assessed, age, male sex, and the presence of comorbidities such as hypertension were associated with a more severe disease course of COVID-19. There was a higher number of comorbidities present in hospitalized versus non-hospitalized patients. Conclusions This assessment provides evidence that COVID-19 in ocrelizumab-treated people with MS is predominantly mild to moderate in severity with most patients not requiring hospitalization; in line with data reported from the general population and MS datasets. Risk factors known to be associated with severe COVID-19 outcomes in the general population also appear to influence COVID-19 severity in ocrelizumab-treated people with MS. Case fatality rates for ocrelizumab-treated people with MS were within published ranges for the general population and other MS cohorts.
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Affiliation(s)
| | | | | | | | - Erwan Muros
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Paul Dillon
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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