1
|
Mansour A, Warren R, Lungwitz D, Forster M, Scherf U, Opitz A, Malischewski M, Koch N. Coordination of Tetracyanoquinodimethane-Derivatives with Tris(pentafluorophenyl)borane Provides Stronger p-Dopants with Enhanced Stability. ACS Appl Mater Interfaces 2023; 15:46148-46156. [PMID: 37730205 PMCID: PMC10561139 DOI: 10.1021/acsami.3c10373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Strong molecular dopants for organic semiconductors that are stable against diffusion are in demand, enhancing the performance of organic optoelectronic devices. The conventionally used p-dopants based on 7,7,8,8-tetracyanoquinodimethane (TCNQ) and its derivatives "FxTCN(N)Q", such as 2,3,4,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F4TCNQ) and 1,3,4,5,7,8-hexafluorotetracyano-naphthoquinodimethane (F6TCNNQ), feature limited oxidation strength, especially for modern polymer semiconductors with high ionization energy (IE). These small molecular dopants also exhibit pronounced diffusion in the polymer hosts. Here, we demonstrate a facile approach to increase the oxidation strength of FxTCN(N)Q by coordination with four tris(pentafluorophenyl)borane (BCF) molecules using a single-step solution mixing process, resulting in bulky dopant complexes "FxTCN(N)Q-4(BCF)". Using a series of polymer semiconductors with IE up to 5.9 eV, we show by optical absorption spectroscopy of solutions and thin films that the efficiency of doping using FxTCN(N)Q-4(BCF) is significantly higher compared to that using FxTCN(N)Q or BCF alone. Electrical transport measurements with the prototypical poly(3-hexylthiophene-2,5-diyl) (P3HT) confirm the higher doping efficiency of F4TCNQ-4(BCF) compared to F4TCNQ. Additionally, the bulkier structure of F4TCNQ-4(BCF) is shown to result in higher stability against drift in P3HT under an applied electric field as compared to F4TCNQ. The simple approach of solution-mixing of readily accessible molecules thus offers access to enhanced molecular p-dopants for the community.
Collapse
Affiliation(s)
- Ahmed
E. Mansour
- Helmholtz-Zentrum
Berlin für Materialien und Energie GmbH, 12489 Berlin, Germany
- Institut
für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Ross Warren
- Institut
für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Dominique Lungwitz
- Institut
für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Michael Forster
- Department
of Chemistry and Wuppertal Center for Smart Materials and Systems
(CM@S), Bergische Universität Wuppertal, 42097 Wuppertal, Germany
| | - Ullrich Scherf
- Department
of Chemistry and Wuppertal Center for Smart Materials and Systems
(CM@S), Bergische Universität Wuppertal, 42097 Wuppertal, Germany
| | - Andreas Opitz
- Institut
für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Moritz Malischewski
- Institute
of Chemistry and Biochemistry, Freie Universität
Berlin, 14195 Berlin, Germany
| | - Norbert Koch
- Helmholtz-Zentrum
Berlin für Materialien und Energie GmbH, 12489 Berlin, Germany
- Institut
für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| |
Collapse
|
2
|
Rikhotso MC, Ledwaba SE, Ngandu JPK, Mavumengwana V, Kinnear CJ, Warren R, Potgieter N, Traoré AN. Favourable outcomes in RR-TB patients using BPaL and other WHO-recommended second-line anti-TB drugs. Int J Tuberc Lung Dis 2023; 27:599-605. [PMID: 37491748 PMCID: PMC10365554 DOI: 10.5588/ijtld.22.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/25/2023] [Indexed: 07/27/2023] Open
Abstract
SETTING: According to reports in South Africa, treatment failure rates for rifampicin-resistant TB (RR-TB) are significant and below the WHO target of ≥70%. HIV infection and the use of highly active antiretroviral therapy (HAART) influence how patients receiving anti-TB drugs respond to therapy. In the treatment of RR-TB, more recent medications, including bedaquiline, pretomanid and linezolid (BPaL), have shown promising results.OBJECTIVE: To assess treatment outcomes in RR-TB patients using BPaL and other second-line anti-TB drugs as recommended by the WHO in the South African population.DESIGN: The databases Medline, PubMed, Google Scholar and Embase were searched for studies between 2015 and 2022, which investigated BPaL outcomes in South Africa.RESULTS: Of the 27,259 participants, 21% were on bedaquiline, 1% were taking pretomanid and 9% were taking linezolid as part of their background regimen. About 68% of the patients were HIV-positive, with 59% of them taking HAART.CONCLUSION: Overall, 66% of patients taking BPaL drugs as part of their background regimen had favourable treatment outcomes. Additionally, patients with RR-TB who were HIV-positive and taking HAART while receiving BPaL drugs as part of a background regimen had improved treatment outcomes.
Collapse
Affiliation(s)
- M C Rikhotso
- Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou
| | - S E Ledwaba
- Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou
| | - J-P K Ngandu
- Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou
| | - V Mavumengwana
- Department of Science and Innovation - National Research FoundationCentre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South African Medical Research Council Genomics Centre, Cape Town, South Africa
| | - C J Kinnear
- Department of Science and Innovation - National Research FoundationCentre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South African Medical Research Council Genomics Centre, Cape Town, South Africa
| | - R Warren
- Department of Science and Innovation - National Research FoundationCentre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South African Medical Research Council Genomics Centre, Cape Town, South Africa
| | - N Potgieter
- Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou
| | - A N Traoré
- Department of Biochemistry and Microbiology, Faculty of Sciences, Engineering & Agriculture, University of Venda, Thohoyandou
| |
Collapse
|
3
|
Opperman CJ, Singh S, Davids T, Cox H, Warren R, Goosen W. Identifying non-tuberculosis mycobacteria: Is it time to introduce new molecular assays? S Afr Med J 2023; 113:4-5. [PMID: 37278260 DOI: 10.7196/samj.2022.v113i6.16771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- C J Opperman
- National Health Laboratory Service, Green Point Laboratory, Cape Town, South Africa; DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - S Singh
- National Health Laboratory Service, Green Point Laboratory, Cape Town, South Africa; DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - T Davids
- City Health, Community Services and Health, City of Cape Town, South Africa.
| | - H Cox
- Division of Medical Microbiology, Institute of Infectious Disease and Molecular Medicine; and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, South Africa.
| | - R Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - W Goosen
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| |
Collapse
|
4
|
Chirehwa MT, Resendiz-Galvan JE, Court R, De Kock M, Wiesner L, de Vries N, Harding J, Gumbo T, Warren R, Maartens G, Denti P, McIlleron H. Optimizing Moxifloxacin Dose in MDR-TB Participants with or without Efavirenz Coadministration Using Population Pharmacokinetic Modeling. Antimicrob Agents Chemother 2023; 67:e0142622. [PMID: 36744891 PMCID: PMC10019313 DOI: 10.1128/aac.01426-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Moxifloxacin is included in some treatment regimens for drug-sensitive tuberculosis (TB) and multidrug-resistant TB (MDR-TB). Aiming to optimize dosing, we described moxifloxacin pharmacokinetic and MIC distribution in participants with MDR-TB. Participants enrolled at two TB hospitals in South Africa underwent intensive pharmacokinetic sampling approximately 1 to 6 weeks after treatment initiation. Plasma drug concentrations and clinical data were analyzed using nonlinear mixed-effects modeling with simulations to evaluate doses for different scenarios. We enrolled 131 participants (54 females), with median age of 35.7 (interquartile range, 28.5 to 43.5) years, median weight of 47 (42.0 to 54.0) kg, and median fat-free mass of 40.1 (32.3 to 44.7) kg; 79 were HIV positive, 29 of whom were on efavirenz-based antiretroviral therapy. Moxifloxacin pharmacokinetics were described with a 2-compartment model, transit absorption, and elimination via a liver compartment. We included allometry based on fat-free mass to estimate disposition parameters. We estimated an oral clearance for a typical patient to be 17.6 L/h. Participants treated with efavirenz had increased clearance, resulting in a 44% reduction in moxifloxacin exposure. Simulations predicted that, even at a median MIC of 0.25 (0.06 to 16) mg/L, the standard daily dose of 400 mg has a low probability of attaining the ratio of the area under the unbound concentration-time curve from 0 to 24 h to the MIC (fAUC0-24)/MIC target of >53, particularly in heavier participants. The high-dose WHO regimen (600 to 800 mg) yielded higher, more balanced exposures across the weight ranges, with better target attainment. When coadministered with efavirenz, moxifloxacin doses of up to 1,000 mg are needed to match these exposures. The safety of higher moxifloxacin doses in clinical settings should be confirmed.
Collapse
Affiliation(s)
- M. T. Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - J. E. Resendiz-Galvan
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - R. Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M. De Kock
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - L. Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N. de Vries
- Brooklyn Chest Hospital, Cape Town, South Africa
| | - J. Harding
- DP Marais Hospital, Cape Town, South Africa
| | - T. Gumbo
- Quantitative Preclinical and Clinical Sciences Department, Praedicare Inc., Dallas, Texas, USA
| | - R. Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - G. Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - P. Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H. McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Rutkowski D, Warren R, Griffiths C, Paus R. 861 EGFR/MEK inhibitor therapy induces partial hair follicle immune privilege collapse in vivo and ex vivo. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
6
|
Islam R, Hashmi Z, Aljarad F, Madanur M, Imtiaz N, Warren R. 262 Full Cycle Audit on Definitive Management of Biliary Pancreatitis. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To reaudit the practice of definitive management of gall stones pancreatitis in our trust for the period of 1st May-31st October and compare the result with previous one (1st June 2019–31st Dec 2019).
Method
It was a retrospective collection of data of patients admitted to our trust with biliary pancreatitis. Electronic notes, PACS for US report, Electronic discharge summary and Operative notes analysed.
Results
We identified 4 patients admitted with biliary pancreatitis during the re-audit period. US report was checked for confirmation of diagnosis of gall stones. The EDN was checked for date for Laparoscopic cholecystectomy. Unfortunately, none of them had their procedure time in 2 weeks’ time of their diagnosis. The reason behind this was because of COVID-19 pandemic, we were backlogging with our elective list. All the patients eventually underwent their procedure, but not in 2 weeks’ time as per the guidelines. All suitable patients had their cholecystectomy in a timely manner during first audit. None had it in timely manner during second audit.
Conclusions
Early Laparoscopic cholecystectomy for simple gallstone pancreatitis prevents life threatening Pancreatitis and readmissions.
The UK guidelines on management of pancreatitis issued by British society guidelines (BSG) states that all mild gall stones pancreatitis should have definitive management of lithiasis on the same admission or within 2 weeks (Recommendation B). In our practice, all our suitable patients during first audit had timely Laparoscopic cholecystectomy, however, no one had it in timely manner on the next audit for COVID-19 pandemic.
Collapse
Affiliation(s)
- R. Islam
- Queen Elizabeth Hospital, London, United Kingdom
| | - Z.Z. Hashmi
- Queen Elizabeth Hospital, London, United Kingdom
| | - F. Aljarad
- Queen Elizabeth Hospital, London, United Kingdom
| | - M.A. Madanur
- Queen Elizabeth Hospital, London, United Kingdom
| | - N. Imtiaz
- Queen Elizabeth Hospital, London, United Kingdom
| | - R. Warren
- Queen Elizabeth Hospital, London, United Kingdom
| |
Collapse
|
7
|
Scaccabarozzi AD, Basu A, Aniés F, Liu J, Zapata-Arteaga O, Warren R, Firdaus Y, Nugraha MI, Lin Y, Campoy-Quiles M, Koch N, Müller C, Tsetseris L, Heeney M, Anthopoulos TD. Doping Approaches for Organic Semiconductors. Chem Rev 2021; 122:4420-4492. [PMID: 34793134 DOI: 10.1021/acs.chemrev.1c00581] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Electronic doping in organic materials has remained an elusive concept for several decades. It drew considerable attention in the early days in the quest for organic materials with high electrical conductivity, paving the way for the pioneering work on pristine organic semiconductors (OSCs) and their eventual use in a plethora of applications. Despite this early trend, however, recent strides in the field of organic electronics have been made hand in hand with the development and use of dopants to the point that are now ubiquitous. Here, we give an overview of all important advances in the area of doping of organic semiconductors and their applications. We first review the relevant literature with particular focus on the physical processes involved, discussing established mechanisms but also newly proposed theories. We then continue with a comprehensive summary of the most widely studied dopants to date, placing particular emphasis on the chemical strategies toward the synthesis of molecules with improved functionality. The processing routes toward doped organic films and the important doping-processing-nanostructure relationships, are also discussed. We conclude the review by highlighting how doping can enhance the operating characteristics of various organic devices.
Collapse
Affiliation(s)
- Alberto D Scaccabarozzi
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia
| | - Aniruddha Basu
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia
| | - Filip Aniés
- Department of Chemistry and Centre for Processable Electronics, Imperial College London, London W12 0BZ, U.K
| | - Jian Liu
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg 412 96, Sweden
| | - Osnat Zapata-Arteaga
- Materials Science Institute of Barcelona, ICMAB-CSIC, Campus UAB, 08193 Bellaterra, Spain
| | - Ross Warren
- Institut für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Yuliar Firdaus
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia.,Research Center for Electronics and Telecommunication, Indonesian Institute of Science, Jalan Sangkuriang Komplek LIPI Building 20 level 4, Bandung 40135, Indonesia
| | - Mohamad Insan Nugraha
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia
| | - Yuanbao Lin
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia
| | - Mariano Campoy-Quiles
- Materials Science Institute of Barcelona, ICMAB-CSIC, Campus UAB, 08193 Bellaterra, Spain
| | - Norbert Koch
- Helmholtz-Zentrum Berlin für Materialien und Energie GmbH, Kekulé-Strasse 5, 12489 Berlin, Germany.,Institut für Physik & IRIS Adlershof, Humboldt-Universität zu Berlin, 12489 Berlin, Germany
| | - Christian Müller
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg 412 96, Sweden
| | - Leonidas Tsetseris
- Department of Physics, National Technical University of Athens, Athens GR-15780, Greece
| | - Martin Heeney
- Department of Chemistry and Centre for Processable Electronics, Imperial College London, London W12 0BZ, U.K
| | - Thomas D Anthopoulos
- King Abdullah University of Science and Technology (KAUST), KAUST Solar Center (KSC), Thuwal 23955, Saudi Arabia
| |
Collapse
|
8
|
Warren R, Rich T, Leavesley S, Phan AV. A three-dimensional finite element model of cAMP signals. Forces in Mechanics 2021; 4. [PMID: 35072121 PMCID: PMC8773462 DOI: 10.1016/j.finmec.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R. Warren
- Department of Mechanical, Aerospace and Biomedical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - T.C. Rich
- Center for Lung Biology & Department of Pharmacology, University of South Alabama, Mobile, AL 36688, USA
| | - S.J. Leavesley
- Center for Lung Biology & Department of Pharmacology, University of South Alabama, Mobile, AL 36688, USA
- Department of Chemical and Biomolecular Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - A.-V. Phan
- Department of Mechanical, Aerospace and Biomedical Engineering, University of South Alabama, Mobile, AL 36688, USA
- Corresponding author. (A.-V. Phan)
| |
Collapse
|
9
|
Sakai N, Warren R, Zhang F, Nayak S, Liu J, Kesava SV, Lin YH, Biswal HS, Lin X, Grovenor C, Malinauskas T, Basu A, Anthopoulos TD, Getautis V, Kahn A, Riede M, Nayak PK, Snaith HJ. Adduct-based p-doping of organic semiconductors. Nat Mater 2021; 20:1248-1254. [PMID: 33888905 DOI: 10.1038/s41563-021-00980-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Electronic doping of organic semiconductors is essential for their usage in highly efficient optoelectronic devices. Although molecular and metal complex-based dopants have already enabled significant progress of devices based on organic semiconductors, there remains a need for clean, efficient and low-cost dopants if a widespread transition towards larger-area organic electronic devices is to occur. Here we report dimethyl sulfoxide adducts as p-dopants that fulfil these conditions for a range of organic semiconductors. These adduct-based dopants are compatible with both solution and vapour-phase processing. We explore the doping mechanism and use the knowledge we gain to 'decouple' the dopants from the choice of counterion. We demonstrate that asymmetric p-doping is possible using solution processing routes, and demonstrate its use in metal halide perovskite solar cells, organic thin-film transistors and organic light-emitting diodes, which showcases the versatility of this doping approach.
Collapse
Affiliation(s)
- Nobuya Sakai
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK
| | - Ross Warren
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK
| | - Fengyu Zhang
- Department of Electrical and Computer Engineering, Princeton University, Princeton, NJ, USA
| | - Simantini Nayak
- Department of Chemistry, University of Oxford, Inorganic Chemistry Laboratory, Oxford, UK
- Materials Chemistry Department, CSIR-Institute of Mineral and Materials Technology, Bhubaneswar, India
| | - Junliang Liu
- Department of Materials, University of Oxford, Oxford, UK
| | - Sameer V Kesava
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK
| | - Yen-Hung Lin
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK
| | - Himansu S Biswal
- School of Chemical Sciences, National Institute of Science Education and Research, Bhubaneswar, India
| | - Xin Lin
- Department of Electrical and Computer Engineering, Princeton University, Princeton, NJ, USA
| | - Chris Grovenor
- Department of Materials, University of Oxford, Oxford, UK
| | - Tadas Malinauskas
- Department of Organic Chemistry, Kaunas University of Technology, Kaunas, Lithuania
| | - Aniruddha Basu
- KAUST Solar Center (KSC), King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Thomas D Anthopoulos
- KAUST Solar Center (KSC), King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Vytautas Getautis
- Department of Organic Chemistry, Kaunas University of Technology, Kaunas, Lithuania
| | - Antoine Kahn
- Department of Electrical and Computer Engineering, Princeton University, Princeton, NJ, USA
| | - Moritz Riede
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK
| | - Pabitra K Nayak
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK.
- TIFR Centre for Interdisciplinary Sciences, Tata Institute of Fundamental Research, Hyderabad, India.
| | - Henry J Snaith
- Clarendon Laboratory, Department of Physics, University of Oxford, Oxford, UK.
| |
Collapse
|
10
|
Cambazard F, Lebwohl M, Lacour JP, Liljedahl M, Lynde C, Holst Moerch M, Thaci D, Warren R. Traitement d’entretien du psoriasis en plaques par une association fixe de calcipotriol (Cal) à 0,005 % et de dipropionate de bétaméthasone (DB) à 0,064 % sous forme de mousse : résultats d’un essai contrôlé randomisé de phase III. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.530] [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: 10/22/2022]
|
11
|
Yiu Z, Parisi R, Lunt M, Warren R, Griffiths C, Langan S, Ashcroft D. 399 Risk of hospitalization due to infection in patients with psoriasis: A population-based cohort study using the UK Clinical Practice Research Datalink. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.407] [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: 10/24/2022]
|
12
|
Hoegh-Guldberg O, Jacob D, Taylor M, Guillén Bolaños T, Bindi M, Brown S, Camilloni IA, Diedhiou A, Djalante R, Ebi K, Engelbrecht F, Guiot J, Hijioka Y, Mehrotra S, Hope CW, Payne AJ, Pörtner HO, Seneviratne SI, Thomas A, Warren R, Zhou G. The human imperative of stabilizing global climate change at 1.5°C. Science 2019. [PMID: 31604209 DOI: 10.1016/b978-1-78548-051-5.50007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Increased concentrations of atmospheric greenhouse gases have led to a global mean surface temperature 1.0°C higher than during the pre-industrial period. We expand on the recent IPCC Special Report on global warming of 1.5°C and review the additional risks associated with higher levels of warming, each having major implications for multiple geographies, climates, and ecosystems. Limiting warming to 1.5°C rather than 2.0°C would be required to maintain substantial proportions of ecosystems and would have clear benefits for human health and economies. These conclusions are relevant for people everywhere, particularly in low- and middle-income countries, where the escalation of climate-related risks may prevent the achievement of the United Nations Sustainable Development Goals.
Collapse
Affiliation(s)
- O Hoegh-Guldberg
- Global Change Institute, University of Queensland, St. Lucia, QLD 4072, Australia.
- School of Biological Sciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - D Jacob
- Climate Service Center Germany (GERICS), Helmholtz-Zentrum Geesthacht, Hamburg, Germany
| | - M Taylor
- Department of Physics, University of the West Indies, Kingston, Jamaica
| | - T Guillén Bolaños
- Climate Service Center Germany (GERICS), Helmholtz-Zentrum Geesthacht, Hamburg, Germany
| | - M Bindi
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, 50144 Firenze, Italy
| | - S Brown
- Faculty of Engineering and Physical Sciences, University of Southampton, Boldrewood Innovation Campus, Southampton SO16 7QF, UK
- Department of Life and Environmental Sciences, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Poole, Dorset BH12 5BB, UK
| | - I A Camilloni
- Centro de Investigaciones del Mar y la Atmósfera (UBA-CONICET), UMI-IFAECI/CNRS, and Departamento de Ciencias de la Atmósfera y los Océanos (FCEN), University of Buenos Aires, Buenos Aires, Argentina
| | - A Diedhiou
- Université Grenoble Alpes, French National Research Institute for Sustainable Development (IRD), CNRS, Grenoble INP, IGE, F-38000 Grenoble, France
| | - R Djalante
- United Nations University-Institute for the Advanced Study of Sustainability (UNU-IAS), Tokyo, Japan
- Halu Oleo University, Kendari, South East Sulawesi, Indonesia
| | - K Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA
| | - F Engelbrecht
- Global Change Institute, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - J Guiot
- Aix Marseille University, CNRS, IRD, INRA, Collège de France, CEREGE, Aix-en-Provence, France
| | - Y Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | | | - C W Hope
- Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | | | - H-O Pörtner
- Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | - S I Seneviratne
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - A Thomas
- Climate Analytics, 10961 Berlin, Germany
- Environmental and Life Sciences, University of the Bahamas, Nassau 76905, Bahamas
| | - R Warren
- Tyndall Centre for Climate Change Research and School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - G Zhou
- State Key Laboratory of Severe Weather, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| |
Collapse
|
13
|
Hoegh-Guldberg O, Jacob D, Taylor M, Guillén Bolaños T, Bindi M, Brown S, Camilloni IA, Diedhiou A, Djalante R, Ebi K, Engelbrecht F, Guiot J, Hijioka Y, Mehrotra S, Hope CW, Payne AJ, Pörtner HO, Seneviratne SI, Thomas A, Warren R, Zhou G. The human imperative of stabilizing global climate change at 1.5°C. Science 2019; 365:365/6459/eaaw6974. [DOI: 10.1126/science.aaw6974] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022]
Abstract
Increased concentrations of atmospheric greenhouse gases have led to a global mean surface temperature 1.0°C higher than during the pre-industrial period. We expand on the recent IPCC Special Report on global warming of 1.5°C and review the additional risks associated with higher levels of warming, each having major implications for multiple geographies, climates, and ecosystems. Limiting warming to 1.5°C rather than 2.0°C would be required to maintain substantial proportions of ecosystems and would have clear benefits for human health and economies. These conclusions are relevant for people everywhere, particularly in low- and middle-income countries, where the escalation of climate-related risks may prevent the achievement of the United Nations Sustainable Development Goals.
Collapse
|
14
|
Rutkowski D, Hardman J, Warren R, Griffiths C, Paus R. 422 Human hair follicles express PD-L1, whose expression is down-regulated by EGFR and MEK inhibitors ex vivo. A potential mechanism for EGFR inhibitor induced sterile folliculitis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Benzian-Olsson N, Dand N, Chaloner C, Meynell F, Warren R, Reynolds N, Barker J, Smith C, Capon F. 150 Sex and Smoke-Related Differences in the Severity of Palmoplantar Pustulosis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
van der Heijden YF, Hughes J, Dowdy DW, Streicher E, Chihota V, Jacobson KR, Warren R, Theron G. Overcoming limitations of tuberculosis information systems: researcher and clinician perspectives. Public Health Action 2019; 9:120-127. [PMID: 31803584 DOI: 10.5588/pha.19.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Tuberculosis (TB) diagnosis and treatment requires patients to have multiple encounters with health care systems and the different stakeholders who play a role in curing them to coordinate their efforts. To optimize this process, high-quality, readily available data are required. Data systems to facilitate these linkages are a neglected priority which, if weak, fundamentally undermine TB control interventions. Objective To describe lessons learnt from the use of programmatic data for TB patient care and research. Design We did a survey of researcher and clinical provider experiences with information systems and developed a tiered approach to addressing frequently reported barriers to high-quality care. Results Unreliable linkages, incomplete data, lack of a reliable unique patient identifier, and lack of data management expertise were the most important data-related barriers to high-quality patient care and research. We propose the creation of health service delivery environments that facilitate, prioritize, and evaluate high-quality data entry during patient or specimen registration. Conclusion An integrated approach, focused on high-quality data, and centered on unique patient identification will form the foundation for linkages across health systems that reduce patient management errors, bolster surveillance, and enhance the quality of research based on programmatic data.
Collapse
Affiliation(s)
- Y F van der Heijden
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Tuberculosis Center, Nashville, TN, USA
| | - J Hughes
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Streicher
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - V Chihota
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - R Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Theron
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
17
|
Reeve BWP, McFall SM, Song R, Warren R, Steingart KR, Theron G. Commercial products to preserve specimens for tuberculosis diagnosis: a systematic review. Int J Tuberc Lung Dis 2019; 22:741-753. [PMID: 29914599 DOI: 10.5588/ijtld.17.0816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Eliminating tuberculosis in high-burden settings requires improved diagnostic capacity. Important tests such as Xpert® MTB/RIF and culture are often performed at centralised laboratories that are geographically distant from the point of specimen collection. Preserving specimen integrity during transportation, which could affect test performance, is challenging. OBJECTIVE To conduct a systematic review of commercial products for specimen preservation for a World Health Organization technical consultation. DESIGN Databases were searched up to January 2018. Methodological quality was assessed using Quality Assessment of Technical Studies, a new technical study quality-appraisal tool, and Quality Assessment of Diagnostic Accuracy Studies-2. Studies were analysed descriptively in terms of the different products, study designs and diagnostic strategies used. RESULTS Four products were identified from 16 studies: PrimeStore-Molecular-Transport-Medium (PS-MTM), FTA card, GENO•CARD (all for nucleic acid amplification tests [NAATs]) and OMNIgene•SPUTUM (OMS; culture, NAATs). PS-MTM, but not FTA card or GENO•CARD, rendered Mycobacterium tuberculosis non-culturable. OMS reduced Löwenstein-Jensen but not MGIT™ 960™ contamination, led to delayed MGIT time-to-positivity, resulted in Xpert performance similar to cold chain-transported untreated specimens, and obviated the need for N-acetyl-L-cysteine-sodium hydroxide decontamination. Data from paucibacillary specimens were limited. Evidence that a cold chain improves culture was mixed and absent for Xpert. The effect of the product alone could be discerned in only four studies. CONCLUSION Limited evidence suggests that transport products result in test performance comparable to that seen in cold chain-transported specimens.
Collapse
Affiliation(s)
- B W P Reeve
- NRF/DST Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S M McFall
- Center for Innovation in Global Health Technologies, Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - R Song
- Foundation for Innovative New Diagnostics, Geneva, Switzerland, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA, Department of Paediatrics, University of Oxford, Oxford
| | - R Warren
- NRF/DST Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K R Steingart
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Theron
- NRF/DST Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
18
|
Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
|
19
|
Lynce F, Barac A, Geng X, Dang C, Yu AF, Smith KL, Gallagher C, Pohlmann PR, Nunes R, Herbolsheimer P, Warren R, Srichai MB, Hofmeyer M, Cunningham A, Timothee P, Asch FM, Shajahan-Haq A, Tan MT, Isaacs C, Swain SM. Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study. Breast Cancer Res Treat 2019; 175:595-603. [PMID: 30852761 PMCID: PMC6534513 DOI: 10.1007/s10549-019-05191-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 01/03/2023]
Abstract
Purpose HER2-targeted therapies have substantially improved the outcome of patients with breast cancer, however, they can be associated with cardiac toxicity. Guidelines recommend holding HER2-targeted therapies until resolution of cardiac dysfunction. SAFE-HEaRt is the first trial that prospectively tests whether these therapies can be safely administered without interruptions in patients with cardiac dysfunction. Methods Patients with stage I–IV HER2-positive breast cancer candidates for trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with left ventricular ejection fraction (LVEF) 40–49% and no symptoms of heart failure (HF) were enrolled. All patients underwent cardiology visits, serial echocardiograms and received beta blockers and ACE inhibitors unless contraindicated. The primary endpoint was completion of the planned HER2-targeted therapies without developing either a cardiac event (CE) defined as HF, myocardial infarction, arrhythmia or cardiac death or significant asymptomatic worsening of LVEF. The study was considered successful if planned oncology therapy completion rate was at least 30%. Results Of 31 enrolled patients, 30 were evaluable. Fifteen patients were treated with trastuzumab, 14 with trastuzumab and pertuzumab, and 2 with TDM-1. Mean LVEF was 45% at baseline and 46% at the end of treatment. Twenty-seven patients (90%) completed the planned HER2-targeted therapies. Two patients experienced a CE and 1 had an asymptomatic worsening of LVEF to ≤ 35%. Conclusion This study provides safety data of HER2-targeted therapies in patients with breast cancer and reduced LVEF while receiving cardioprotective medications and close cardiac monitoring. Our results demonstrate the importance of collaboration between cardiology and oncology providers to allow for delivery of optimal oncologic care to this unique population. Electronic supplementary material The online version of this article (10.1007/s10549-019-05191-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- F Lynce
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - A Barac
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
- MedStar Heart & Vascular Institute, Washington, DC, USA
| | - X Geng
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - C Dang
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A F Yu
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K L Smith
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - C Gallagher
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - P R Pohlmann
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - R Nunes
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - R Warren
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - M B Srichai
- MedStar Heart & Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - M Hofmeyer
- MedStar Heart & Vascular Institute, Washington, DC, USA
| | - A Cunningham
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - P Timothee
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - F M Asch
- MedStar Heart & Vascular Institute, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - A Shajahan-Haq
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - M T Tan
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - C Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - S M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA.
| |
Collapse
|
20
|
Khoury K, Isaacs C, Gatti-Mays ME, Donahue RN, Schlom J, Wang H, Gallagher C, Graham D, Warren R, Dilawari A, Swain SM, Pohlmann PR, Lynce F. Abstract OT3-04-01: Nivolumab or capecitabine or combination therapy as adjuvant therapy for triple negative breast cancer (TNBC) with residual disease following neoadjuvant chemotherapy: The OXEL study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-04-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Long-term follow-up of neoadjuvant studies demonstrates poor clinical outcomes in patients with TNBC who do not achieve pathologic complete response, with only 35% remaining free of recurrence at 10 years. The addition of adjuvant capecitabine in the CREATE-X study prolonged disease free survival and overall survival (OS) in patients with HER2 negative breast cancer with residual invasive disease, with more striking benefit in patients with TNBC. Checkpoint inhibitors have not been approved in breast cancer yet, but recent studies suggest a benefit in combination with chemotherapy and low burden of disease. In the current study, we will evaluate the role of chemoimmunotherapy in the adjuvant setting for patients with TNBC with residual disease after neoadjuvant therapy. We will also investigate the role of the peripheral immunoscore (PIS) in predicting the benefit of immune checkpoint inhibition with or without chemotherapy.
Trial design: OXEL is a pilot open-label three arm randomized study of nivolumab, capecitabine or the combination as adjuvant therapy for 45 patients with residual TNBC after adequate neoadjuvant chemotherapy. Patients enrolled will be randomly assigned to 1 of 3 treatment arms: nivolumab 360 mg iv q3weeks for x 6 cycles; capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles; nivolumab 360mg iv q3weeks + capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles.
Main eligibility criteria: Patients ≥18 years of age with TNBC and ≥1cm of residual disease in the breast and/or node positive disease; receipt of neoadjuvant taxane +/- anthracycline, or platinum, and having completed definitive resection of primary tumor, with no prior use of capecitabine, fluorouracil or immunotherapy, and with no active autoimmune disease or chronic use of systemic steroids.
Specific aims: The primary endpoint is assessing the immunologic effects of capecitabine, nivolumab or the combination in the adjuvant setting by PIS. Additional endpoints include toxicity assessment, distant recurrence free survival (DRFS) and OS at 3-years, association between changes in PIS and circulating tumor DNA at different timepoints with clinical outcome variables and characterization of the immune contexture in residual tumors.
Statistical methods: The study is designed to assess the change in PIS at 6 weeks from baseline in each arm. The sample size of 15 per arm (45 total for 3 arms) will provide preliminary results. A sample size of 15 per arm will have 85% power to detect an effect size of 1 (the difference of the change in PIS from baseline to week 6 between two arms divided by the standard deviation) at 5% significance level.
Present accrual and target accrual: The Institutional Review Board at Georgetown University Medical Center has approved the study. Clinicaltrials.gov NCT03487666. Enrollment of the first patient is expected in July 2018 with a total of 45 patients planned to be recruited. Recruitment sites are MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Hackensack University Medical Center. This trial is supported by Bristol-Meyers Squibb, P30CA051008-25 from NCI, Inivata and the Nina Hyde Center for Breast Cancer Research.
Citation Format: Khoury K, Isaacs C, Gatti-Mays ME, Donahue RN, Schlom J, Wang H, Gallagher C, Graham D, Warren R, Dilawari A, Swain SM, Pohlmann PR, Lynce F. Nivolumab or capecitabine or combination therapy as adjuvant therapy for triple negative breast cancer (TNBC) with residual disease following neoadjuvant chemotherapy: The OXEL study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-04-01.
Collapse
Affiliation(s)
- K Khoury
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - C Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - ME Gatti-Mays
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - RN Donahue
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - J Schlom
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - H Wang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - C Gallagher
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - D Graham
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - R Warren
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - A Dilawari
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - SM Swain
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - PR Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| | - F Lynce
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; National Cancer Institute, National Institute of Health, Bethesda, MD; Georgetown University Medical Center, Washington, DC; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC; Hackensack University Medical Center, Hackensack, NJ
| |
Collapse
|
21
|
De Vos M, Ley S, Derendinger B, Dippenaar A, Grobbelaar M, Reuter A, Daniels J, Burns S, Theron G, Posey J, Warren R, Cox H. EMERGENCE OF BEDAQUILINE RESISTANCE AFTER COMPLETION OF BEDAQUILINE-BASED DRUGRESISTANT TB TREATMENT: A CASE STUDY FROM SOUTH AFRICA. ACTA ACUST UNITED AC 2019. [DOI: 10.15789/2220-7619-2018-4-6.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. De Vos
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - S. Ley
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - B. Derendinger
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - A. Dippenaar
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - M. Grobbelaar
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - A. Reuter
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town
| | - J. Daniels
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town
| | - S. Burns
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - G. Theron
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - J. Posey
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R. Warren
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - H. Cox
- Institute of Infectious Disease and Molecular Medicine and Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town
| |
Collapse
|
22
|
Warren R, Lambert S, Razee H. The Dietary Behaviours of Cancer Caregivers: Preliminary Findings on How Becoming a Cancer Caregiver Might Influence Food Choices and Dietary Behaviours in the Carer Compared With Pre-Caring. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.33000] [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: 11/20/2022] Open
Abstract
Background: Cancer is often called a “we-disease” as the effects of the diagnosis can go beyond the patient to others, including the caregiver. In Australia, it is estimated that approximately 138,000 new cancer diagnoses will be made in 2018, with the 5 year survival rate currently at 68%. This has shifted the way that cancer care is delivered, with many patients now being cared for at home by a loved one. As a result, cancer caregivers report higher levels of fatigue, stress, mood disturbances and mental illness (depression and anxiety), insomnia and digestive complaints than noncaring counterparts. While it is known that these characteristics can influence diet, very little has been published with relation to cancer caregivers as a stand-alone population. Aim: To explore how being a cancer caregiver might influence dietary behaviors, food choices and eating patterns in the caregiver to see if these have changed/not changed from precaring. Methods: Participants were recruited from a number of avenues, including not-for-profit cancer support services and support groups. Our study is a descriptive qualitative study where participants complete an online questionnaire to determine their Burden of Care score (through Given and Given's Caregiver Reaction Assessment) and current dietary patterns and behaviors. Some of these participants were further interviewed using a semistructured interview to explore their role as a carer, dietary patterns and food choices and this interview data were thematically analyzed. Results: Preliminary results (as part of an ongoing study) from six completed semistructured interviews with cancer caregivers from New South Wales, Australia suggests that the food intake and dietary behaviors of cancer caregivers were influenced by five main aspects: food access and availability, caregiver health, food preferences, the impact of cancer or the patient and caregivers needing more support. This study is ongoing, with an additional 6-8 interviews proposed (or until data saturation is achieved). In the case of some caregivers their dietary behaviors and food choices improved when they became a caregiver (e.g., eating more fruit and vegetables, reducing sugar consumption and an increase in their perception of the importance of healthy eating). Others reported a decline (e.g., increased “grazing” on “junk food”, losing motivation for healthy eating and preparing healthy food and skipping meals). Conclusion: This preliminary data clearly suggests that dietary behaviors and food choices of cancer caregivers do change from precaring. There is however, still a gap in our understanding as to why some carers report improvements and others report a decline. This is an ongoing area of research and is an important aspect of public health given the role cancer caregivers play in Australia.
Collapse
Affiliation(s)
- R. Warren
- University of New South Wales, School of Public Health and Community Medicine, Sydney, Australia
| | - S. Lambert
- University of New South Wales, School of Public Health and Community Medicine, Sydney, Australia
| | - H. Razee
- University of New South Wales, School of Public Health and Community Medicine, Sydney, Australia
| |
Collapse
|
23
|
Warren R, Price J, Graham E, Forstenhaeusler N, VanDerWal J. The projected effect on insects, vertebrates, and plants of limiting global warming to 1.5°C rather than 2°C. Science 2018; 360:791-795. [PMID: 29773751 DOI: 10.1126/science.aar3646] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/12/2018] [Indexed: 01/09/2023]
Abstract
In the Paris Agreement on Climate Change, the United Nations is pursuing efforts to limit global warming to 1.5°C, whereas earlier aspirations focused on a 2°C limit. With current pledges, corresponding to ~3.2°C warming, climatically determined geographic range losses of >50% are projected in ~49% of insects, 44% of plants, and 26% of vertebrates. At 2°C, this falls to 18% of insects, 16% of plants, and 8% of vertebrates and at 1.5°C, to 6% of insects, 8% of plants, and 4% of vertebrates. When warming is limited to 1.5°C as compared with 2°C, numbers of species projected to lose >50% of their range are reduced by ~66% in insects and by ~50% in plants and vertebrates.
Collapse
Affiliation(s)
- R Warren
- Tyndall Centre for Climate Change Research, School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - J Price
- Tyndall Centre for Climate Change Research, School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - E Graham
- College of Science and Engineering, James Cook University, Townsville, Australia
| | - N Forstenhaeusler
- Tyndall Centre for Climate Change Research, School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - J VanDerWal
- College of Science and Engineering, James Cook University, Townsville, Australia
| |
Collapse
|
24
|
Loveday M, Ramjee A, Osburn G, Master I, Kabera G, Brust JCM, Padayatchi N, Warren R, Theron G. Drug-resistant tuberculosis in patients with minimal symptoms: favourable outcomes in the absence of treatment. Int J Tuberc Lung Dis 2018; 21:556-563. [PMID: 28399971 DOI: 10.5588/ijtld.16.0779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Referral hospital for drug-resistant tuberculosis (DR-TB) in KwaZulu-Natal Province, South Africa. OBJECTIVE To review the clinical outcomes of patients (age 14 years) with a laboratory-confirmed diagnosis of DR-TB who had minimal symptoms and/or did not have chest radiographic evidence of active disease at referral. These patients were not started on treatment, but were enrolled in an observation programme with follow-up at 2, 6 and 12 months. RESULTS Of 3345 referred patients diagnosed with DR-TB, 192 (6%) were enrolled in the observation programme. The median duration from initial sputum collection in primary care to examination at our hospital was 92 days (IQR 64-124). After 12 months, 120 (62%) patients were well, 36 (19%) were lost to follow-up, 30 (16%) had deteriorated and were started on second-line anti-tuberculosis treatment and 6 (3%) had died. Bilateral disease (OR 4.25, 95%CI 1.14-15.77, P = 0.030) and previous TB (OR 2.14, 95%CI 1.10-4.19, P = 0.026) were independent predictors of an unfavourable end result in a multivariate model. CONCLUSION In our high-burden setting, most patients diagnosed with DR-TB who had minimal symptoms at referral remained well without treatment. Longitudinal observation, coupled with symptom checking and chest radiograph, is a viable strategy.
Collapse
Affiliation(s)
- M Loveday
- South African Medical Research Council (SAMRC), Cape Town
| | - A Ramjee
- King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban
| | - G Osburn
- King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban
| | - I Master
- King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban
| | - G Kabera
- South African Medical Research Council (SAMRC), Cape Town, Department of Statistics, University of South Africa, Pretoria, South Africa
| | - J C M Brust
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA
| | - N Padayatchi
- Centre for the AIDS Programme of Research in South Africa, SAMRC Extramural TB-HIV Pathogenesis Unit, Durban
| | - R Warren
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Theron
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
25
|
Yamauchi P, Crowley J, Kaur P, Spelman L, Warren R. Biosimilars: what the dermatologist should know. J Eur Acad Dermatol Venereol 2018; 32:1066-1074. [PMID: 29360210 DOI: 10.1111/jdv.14812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/17/2017] [Indexed: 11/27/2022]
Abstract
Biosimilars are highly similar versions of approved branded biologics. In contrast to generics, which are identical copies of the originator medicines, biosimilars are considered unique but related molecules that differ from the originator reference product as well as from each other. Owing to the complexity of biologic medicines, such as therapeutic monoclonal antibodies, minor differences between biosimilars and the reference products are acceptable provided these differences do not result in any clinically meaningful differences in safety or efficacy. In addition, minor changes in structure and function may occur over time in originator biologic products as a result of alterations in production materials (e.g. cell lines), processes or conditions. The developmental process for biosimilars focuses on a 'totality of evidence' approach that emphasizes a stepwise investigational process, including comprehensive structural, functional, pharmacologic and clinical assessment for similarity. The goal of the phase 3 clinical development programme for a biosimilar is not to establish efficacy, per se, but to demonstrate that there are no clinically meaningful differences between the proposed biosimilar and the reference product. The requirement to show clinical similarity informs biosimilar study design, including the selection of the patient population, disease state (indication), study endpoints and statistical methods. Based on the clinical trial results in a representative patient population, results may be extrapolated to other indications provided scientific justification is demonstrated based on, among other things, similar mechanism of action in the extrapolated indications. This review presents the current state of knowledge with respect to biosimilars. We aim to provide the practising clinician with a working knowledge of biosimilars as well as provide some practical guidance on their use and potential benefits in treating dermatologic diseases.
Collapse
Affiliation(s)
- P Yamauchi
- UCLA School of Medicine, Santa Monica, CA, USA
| | - J Crowley
- Bakersfield Dermatology, Bakersfield, CA, USA
| | - P Kaur
- Amgen Inc., Thousand Oaks, CA, USA
| | - L Spelman
- Veracity Clinical Research and Probity, Brisbane, Qld, Australia
| | - R Warren
- The Dermatology Centre, University of Manchester, Salford Royal Foundation Hospital, Salford, Manchester, UK
| |
Collapse
|
26
|
Howell A, Harkness E, Fox J, Astley S, Wiseman J, Eriksson M, Wilson M, Warren R, Hall P, Cuzick J, Evans G. Abstract P4-08-01: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-08-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
Collapse
Affiliation(s)
- A Howell
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - E Harkness
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Fox
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - S Astley
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Wiseman
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Eriksson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Wilson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - R Warren
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - P Hall
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Cuzick
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - G Evans
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| |
Collapse
|
27
|
Patel KA, Warren R, Brooke A, Aziz A, Avades T, Poyner R, Vaidya B. Interpretation of thyroid scintigraphy is inconsistent among endocrinologists. J Endocrinol Invest 2017; 40:1155-1157. [PMID: 28836164 DOI: 10.1007/s40618-017-0750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/19/2017] [Indexed: 10/19/2022]
Affiliation(s)
- K A Patel
- University of Exeter Medical School, Exeter, UK.
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK.
| | - R Warren
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - A Brooke
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - A Aziz
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - T Avades
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - R Poyner
- Department of Nuclear Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - B Vaidya
- University of Exeter Medical School, Exeter, UK
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| |
Collapse
|
28
|
Wu J, Saure D, Schacht A, Mallbris L, Wilhelm S, Dossenbach M, Nast A, Warren R. 336 Matching-adjusted indirect comparisons of Ixekizumab and Secukinumab using Etanercept and Ustekinumab Bridge Comparators. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
29
|
Horton L, Batistoni P, Boyer H, Challis C, Ćirić D, Donné A, Eriksson LG, Garcia J, Garzotti L, Gee S, Hobirk J, Joffrin E, Jones T, King D, Knipe S, Litaudon X, Matthews G, Monakhov I, Murari A, Nunes I, Riccardo V, Sips A, Warren R, Weisen H, Zastrow KD. JET experiments with tritium and deuterium–tritium mixtures. Fusion Engineering and Design 2016. [DOI: 10.1016/j.fusengdes.2016.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
30
|
Biswas S, Andrianopoulos N, Brennan A, Ajani A, Lefkovits J, Warren R, Duffy S, Clark D, Freeman M, Sebastian M, Reid C, Eccleston D. Long-Term Outcomes After PCI in Patients With Insulin-Treated vs. Non-Insulin Treated Diabetes Mellitus. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.426] [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: 10/21/2022]
|
31
|
Brennan A, Dinh D, Lefkovits J, Stub D, Brien R, Carruthers H, Andrianopoulos N, Duffy S, Dick R, Clark D, Hiew C, New G, Warren R, McNeil J, Reid C. Ensuring the Quality in Clinical Quality Registries – Design and Implementation of Rigorous Audit Activities in the Victorian Cardiac Outcomes Registry (VCOR). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Abstract
Objectives: A case audit was undertaken to determine the extent to which the early diagnosis of cancer could be improved by better adherence to screening guidelines, and to estimate the effect that this might have on breast cancer survival. Although affecting only a small proportion of the cancers of the screening programme, this exercise had an educational function for screening radiologists. Setting: The East Anglian breast screening programme, a group of seven centres offering screening to a total population of 2.2 million inhabitants. Women were screened every three years between the ages of 50 and 64. Methods: Adherence to the guidelines of the UK National Breast Screening Programme (as published in 2001) was tested in women assessed between the start of screening on 1 April 1989 and 31 December 1999, in cases where the screen was negative but who were subsequently diagnosed with breast cancer. Results: In this period the programme screened 503,493 women, recalled 25,346 and diagnosed 3689 with cancer. 194 cancers in 193 women were reviewed, comprising those cancers that arose at the site of the lesion previously assessed. 96 women (49.5%) had calcifications, 48 (24.7%) had opacities. 139 of 194 cases were judged to have been inadequately assessed. A recurring theme showed that biopsies not undertaken or with false negative findings led to failure to diagnose lesions which were subsequently shown to be cancer. Microcalcifications and opacities were more likely to have been inadequately assessed than spiculate masses, parenchymal deformities, or asymmetric densities. In the earliest time period (1989–1993), there were a larger proportion of inadequately assessed cases than in the period 1994–1999. Conclusion: Scrupulous adherence to good guidelines will result in a greater proportion of cancers being diagnosed. Failure to perform effective percutaneous biopsy was the usual cause of missed diagnoses. Although an infrequent occurrence this may have an effect on subsequent survival from breast cancer.
Collapse
Affiliation(s)
- R Warren
- Addenbrooke's Hospital, Cambridge, UK.
| | | | | | | | | |
Collapse
|
33
|
Jubulis J, Dionne K, Osterhout G, Ayuk L, Awasom C, Achu P, Noeske J, Warren R, McArthur C, Parrish N. Mycobacterium tuberculosis resistance in pulmonary TB patients in Cameroon: a phenotypic susceptibility assay. Int J Tuberc Lung Dis 2016; 19:823-7. [PMID: 26056109 DOI: 10.5588/ijtld.14.0527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the resistance of Mycobacterium tuberculosis to first- and second-line agents in adult pulmonary tuberculosis (TB) patients in Cameroon using a novel phenotypic assay. SETTING Samples were collected from TB patients at Bamenda Hospital in Bamenda, Cameroon. DESIGN Samples were collected consecutively from adult pulmonary TB patients over a 2-month period. TREK Sensititre(TM) MYCOTB panels were used to perform phenotypic drug susceptibility testing (DST). Susceptibility/resistance was determined by comparing minimum inhibitory concentrations to standard critical concentrations established for first- and second-line anti-tuberculosis drugs. RESULTS Of 103 sputum samples processed, growth on Löwenstein-Jensen media was confirmed in 78 samples, 65 of which were suitable for DST. Thirty-nine strains (60%) were susceptible to all first- and second-line drugs. Five strains (8%) were categorized as multidrug-resistant TB. Two strains (3%) were classified as pre-extensively drug-resistant TB. Of those isolates susceptible to first-line drugs, 20% were resistant to at least one second-line drug. CONCLUSION Antimicrobial resistance may be higher than assumed in TB strains in Cameroon, especially with regard to second-line drugs. There remains a need for rapid, comprehensive DST.
Collapse
Affiliation(s)
- J Jubulis
- The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Maine Medical Center/Tufts University School of Medicine, Portland, Maine, USA
| | - K Dionne
- The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - G Osterhout
- The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - L Ayuk
- Regional Hospital, Bamenda, Cameroon
| | - C Awasom
- Regional Hospital, Bamenda, Cameroon
| | - P Achu
- Mezam Polyclinic HIV/AIDS Treatment Centre, Bamenda
| | - J Noeske
- German International Cooperation, Yaoundé, Cameroon
| | - R Warren
- Stellenbosch University, Cape Town, South Africa
| | - C McArthur
- The University of Missouri-Kansas City School of Dentistry, Kansas City, Missouri, USA
| | - N Parrish
- The Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
34
|
Sherifali D, Bai JW, Kenny M, Warren R, Ali MU. Diabetes self-management programmes in older adults: a systematic review and meta-analysis. Diabet Med 2015; 32:1404-14. [PMID: 25865179 DOI: 10.1111/dme.12780] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [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] [Accepted: 04/08/2015] [Indexed: 01/21/2023]
Abstract
AIM The evidence for self-management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes-specific self-management programme interventions in older adults. METHODS The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta-analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self-management programme and 2156 to usual care. RESULTS The pooled effect on HbA(1c) was a reduction of -2 mmol/mol (-0.2%; 95% CI -0.3 to -0.1); tailored interventions [-3 mmol/mol (-0.2%; 95% CI -0.4 to -0.1)] or programmes with a psychological emphasis [-3 mmol/mol (-0.2; 95% CI -0.4 to -0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI -10.33 to -1.29) and non-significant reductions in systolic and diastolic blood pressure. CONCLUSIONS Diabetes self-management programmes for older adults demonstrate a small reduction in HbA(1c), lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.
Collapse
Affiliation(s)
- D Sherifali
- Faculty of Health Sciences, McMaster University
- Diabetes Care and Research Program, Hamilton Health Sciences
- McMaster Evidence Review and Synthesis Centre, (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - J-W Bai
- Faculty of Health Sciences, McMaster University
| | - M Kenny
- McMaster Evidence Review and Synthesis Centre, (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - R Warren
- McMaster Evidence Review and Synthesis Centre, (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - M U Ali
- McMaster Evidence Review and Synthesis Centre, (MERSC), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
35
|
Tshilombo KV, Mehtar S, Sampson S, Warren R, Steyn NL. Survival and re-aerosolization in dust of Mycobacterium smegmatis, a surrogate marker for Mycobacterium tuberculosis. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474979 DOI: 10.1186/2047-2994-4-s1-p100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
36
|
Jani M, Massey J, Wedderburn L, Vencovský J, Danko K, Lundberg I, Selva-O'Callaghan A, Radstake T, Platt H, Warren R, Griffiths C, Padyukov L, Lee A, Gregersen P, Ollier W, Cooper R, Chinoy H, Lamb J. OP0235 Genetic Risk Factors in Idiopathic Inflammatory Myopathies Are Shared with Other Autoimmune Disorders in European Populations. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2877] [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: 11/03/2022]
|
37
|
Duffy SW, Mackay J, Thomas S, Anderson E, Chen THH, Ellis I, Evans G, Fielder H, Fox R, Gui G, Macmillan D, Moss S, Rogers C, Sibbering M, Wallis M, Warren R, Watson E, Whynes D, Allgood P, Caunt J. Evaluation of mammographic surveillance services in women aged 40-49 years with a moderate family history of breast cancer: a single-arm cohort study. Health Technol Assess 2013; 17:vii-xiv, 1-95. [PMID: 23489892 DOI: 10.3310/hta17110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women with a significant family history of breast cancer are often offered more intensive and earlier surveillance than is offered to the general population in the National Breast Screening Programme. Up to now, this strategy has not been fully evaluated. OBJECTIVE To evaluate the benefit of mammographic surveillance for women aged 40-49 years at moderate risk of breast cancer due to family history. The study is referred to as FH01. DESIGN This was a single-arm cohort study with recruitment taking place between January 2003 and February 2007. Recruits were women aged < 50 years with a family history of breast or ovarian cancer conferring at least a 3% risk of breast cancer between ages 40 and 49 years. The women were offered annual mammography for at least 5 years and observed for the occurrence of breast cancer during the surveillance period. The age group 40-44 years was targeted so that they would still be aged < 50 years after 5 years of surveillance. SETTING Seventy-four surveillance centres in England, Wales, Scotland and Northern Ireland. PARTICIPANTS A total of 6710 women, 94% of whom were aged < 45 years at recruitment, with a family history of breast cancer estimated to imply at least a 3% risk of the disease between the ages of 40 and 50 years. INTERVENTIONS Annual mammography for at least 5 years. MAIN OUTCOME MEASURES The primary study end point was the predicted risk of death from breast cancer as estimated from the size, lymph node status and grade of the tumours diagnosed. This was compared with the control group from the UK Breast Screening Age Trial (Age Trial), adjusting for the different underlying incidence in the two populations. RESULTS As of December 2010, there were 165 breast cancers diagnosed in 37,025 person-years of observation and 30,556 mammographic screening episodes. Of these, 122 (74%) were diagnosed at screening. The cancers included 44 (27%) cases of ductal carcinoma in situ. There were 19 predicted deaths in 37,025 person-years in FH01, with an estimated incidence of 6.3 per 1000 per year. The corresponding figures for the Age Trial control group were 204 predicted deaths in 622,127 person-years and an incidence of 2.4 per 1000 per year. This gave an estimated 40% reduction in breast cancer mortality (relative risk = 0.60; 95% confidence interval 0.37 to 0.98; p = 0.04). CONCLUSIONS Annual mammography in women aged 40-49 years with a significant family history of breast or ovarian cancer is both clinically effective in reducing breast cancer mortality and cost-effective. There is a need to further standardise familial risk assessment, to research the impact of digital mammography and to clarify the role of breast density in this population. TRIAL REGISTRATION National Research Register N0484114809. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 11. See the HTA programme website for further project information.
Collapse
Affiliation(s)
- S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hope R, Blackburn RM, Verlander NQ, Johnson AP, Kearns A, Hill R, Hopkins S, Sheridan E, Livermore DM, Scarborough M, Majumdar S, Cunniffe J, Farrington M, Gouliouris T, Marodi C, Godwin P, Tuck A, Warren R, Coe P, Hassan I, Mannion P, Loudon K, Youngs E, Johnson A, Lee M, Weston V, Guleri A, Howe R, Matthew D, Cotterill S, Todd N, Patel B, Mlangeni D, Stockley JM, Spencer R, Gardner J, Thwaites G, Kirby A, Hopkins S, Crook D, Llewellyn M, Price J, Scarborough M, Morris Jones S, Tilley R. Vancomycin MIC as a predictor of outcome in MRSA bacteraemia in the UK context. J Antimicrob Chemother 2013; 68:2641-7. [DOI: 10.1093/jac/dkt234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
39
|
Gatti-Mays M, Kallakury BVS, Makariou E, Venzon D, Permaul E, Isaacs C, Cohen P, Warren R, Gallagher A, Eng-Wong J. Abstract P1-09-04: Down-regulation of trefoil protein 1(TFF1) in normal breast tissue of postmenopausal women at increased risk for breast cancer on exemestane. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-09-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors (AI) are effective for breast cancer risk reduction in postmenopausal women. TFF1, also known as pS2, is an estrogen response gene present in normal mammary tissue with increased expression in estrogen receptor positive breast cancer. Previous studies have demonstrated down-regulation of TFF1 and Ki-67, a marker of proliferation, in postmenopausal women with locally advanced breast cancer who receive neoadjuvant AIs. TFF1 and proliferating cell nuclear antigen (PCNA) may serve as biomarkers of effect of AIs in women at increased risk for breast cancer.
Methods: We conducted a single-arm phase II trial of exemestane in women at increased risk for breast cancer and examined the impact on TFF1 and PCNA. Postmenopausal women at increased risk for invasive breast cancer by clinical or histological criteria received 25mg of exemestane daily for 2 years. Subjects were required to have stopped any hormonal medication ≥ 3 months prior to enrollment. Image guided breast biopsies targeting dense breast tissue were performed at baseline and at 12 months. Core specimens were obtained under local anesthesia at each time point from the same area of the breast. One core biopsy sample was formalin-fixed, paraffin-embedded and examined for pathologic abnormalities, as well as TFF1 and PCNA. TFF1 was assessed by intensity of stain (0 to 3+) and percent of cells with any staining; PCNA was assessed by percent of cells staining within the tissue section. The pathologist (B.K.) was blinded to the time of biopsy. Change in intensity and % positive cells were evaluated by paired t-test.
Results: Thirty four subjects underwent both baseline & 12 month breast biopsies. Eight biopsies at baseline and 5 biopsies at 12 months did not contain any ductal or lobular tissue and were not analyzed. Twenty-two subjects had evaluable breast tissue at both time points for TFF1 analysis and 23 subjects for PCNA analysis. No high risk lesions or invasive cancers were identified. Of the baseline specimens, 95.5% were positive for TFF1: 59.1% (13 of 22) were scored as 3+(intense), 31.8% (7 of 22) were 2+(moderate) and 4.5% (1 of 22) were 1+(low). Percent of cells staining for TFF1 ranged from 0 to 20% (median = 1%). After 1 year on exemestane TFF1 intensity decreased in 17 subjects (77.3%), 4 had no change and 1 increased. Mean TFF1 change was −1.32 (95% CI −1.87 to −0.76; p < 0.001). The change in % positive cells for PCNA ranged from −15 to +30% (median = 0%).
Discussion: Assessing tissue biomarkers with repeat core needle biopsies in a phase II prevention trial in high risk women is feasible. Since prevention agents are not universally protective, determining biomarkers of effect may allow tailored therapy. TFF1 is a biologically plausible biomarker of AI activity that was down-regulated in 77% of breast tissue following exemestane therapy. This is the first study to evaluate this tissue marker in the prevention setting. Further study is needed to correlate with other biomarkers of interest, e.g. change in mammographic density, serum hormone levels and clinical outcomes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-09-04.
Collapse
Affiliation(s)
- M Gatti-Mays
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - BVS Kallakury
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - E Makariou
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - D Venzon
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - E Permaul
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - C Isaacs
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - P Cohen
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - R Warren
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - A Gallagher
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Eng-Wong
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| |
Collapse
|
40
|
Van Rie A, Mellet K, John MA, Scott L, Page-Shipp L, Dansey H, Victor T, Warren R. False-positive rifampicin resistance on Xpert® MTB/RIF: case report and clinical implications. Int J Tuberc Lung Dis 2012; 16:206-8. [PMID: 22236921 DOI: 10.5588/ijtld.11.0395] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The World Health Organization had endorsed Xpert® MTB/RIF (Xpert) as the initial diagnostic for multidrug-resistant tuberculosis (TB) or TB suspects co-infected with the human immunodeficiency virus. We investigated an unexpected case of rifampicin (RMP) resistance on Xpert using repeat Xpert, smear microscopy, MTBDRplus assay, culture, drug susceptibility testing, spoligotyping and rpoB gene sequencing. A false-positive result was most likely, given the wild type rpoB gene sequence and exclusion of both mixed infection and mixture of drug-susceptible and drug-resistant populations. When decentralising Xpert, test performance characteristics need to be understood by health care workers and methods of confirmation of RMP resistance need to be accessible.
Collapse
Affiliation(s)
- A Van Rie
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Howell A, Astley S, Warwick J, Stavrinos P, Sahin S, Ingham S, McBurney H, Eckersley B, Harvie M, Wilson M, Beetles U, Warren R, Hufton A, Sergeant J, Newman W, Buchan I, Cuzick J, Evans DG. Prevention of breast cancer in the context of a national breast screening programme. J Intern Med 2012; 271:321-30. [PMID: 22292490 DOI: 10.1111/j.1365-2796.2012.02525.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 12/26/2022]
Abstract
Breast cancer is not only increasing in the west but also particularly rapidly in eastern countries where traditionally the incidence has been low. The rise in incidence is mainly related to changes in reproductive patterns and lifestyle. These trends could potentially be reversed by defining women at greatest risk and offering appropriate preventive measures. A model for this approach was the establishment of Family History Clinics (FHCs), which have resulted in improved survival in younger women at high risk. New predictive models of risk that include reproductive and lifestyle factors, mammographic density and measurement of risk-associated single nucleotide polymorphisms (SNPs) may give more precise information concerning risk and enable better targeting for mammographic screening programmes and of preventive measures. Endocrine prevention using anti-oestrogens and aromatase inhibitors is effective, and observational studies suggest lifestyle modification may also be effective. However, referral to FHCs is opportunistic and predominantly includes younger women. A better approach for identifying older women at risk may be to use national breast screening programmes. Here were described pilot studies to assess whether the routine assessment of breast cancer risk is feasible within a population-based screening programme, whether the feedback and advice on risk-reducing interventions would be welcomed and taken up, and to consider whether the screening interval should be modified according to breast cancer risk.
Collapse
Affiliation(s)
- A Howell
- Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Watts M, Joshi S, Wong J, Liu E, Warren R, Larobina M, Goldblatt J, Gurvitch R. Sizing Transcatheter Aortic Valves: Can an Ellipse Formula Obviate the Need to Directly Measure the Aortic Annulus Area Using Computed Tomography? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
Gurvitch R, Willson A, Leipsic J, Watts M, Brooks M, Warren R, Joshi S, Wong J, Webb J. Valve Sizing in Transcatheter Aortic Valve Implantation: By How Much is it Safe to Oversize The Short Axis as Determined by Computed Tomography? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.455] [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: 11/30/2022]
|
44
|
Watts M, Joshi S, Wong J, Liu E, Warren R, Larobina M, Golblatt J, Gurvitch R. Sizing Transcatheter Aortic Valves: Is Sizing According to the Aortic Annular Area Different to Sizing According to the Annular Diameter? Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
45
|
Davis JP, Chaubey VP, Warren R, Parkins M, Louie M, Gregson D, Sabuda D, Kuhn S. Fever, headache, fatigue and chancre in a traveller returning from Tanzania. Can J Infect Dis Med Microbiol 2012; 23:108-9. [PMID: 23997774 PMCID: PMC3476551 DOI: 10.1155/2012/970905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - VP Chaubey
- Department of Medicine
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary
| | - R Warren
- Rural Alberta North Residency Training Program, University of Alberta, Edmonton
| | - M Parkins
- Department of Medicine
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary
| | - M Louie
- Department of Medicine
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary
- Provincial Laboratory for Public Health, Alberta Health Services
| | - D Gregson
- Department of Medicine
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary
- Calgary Laboratory Services, Alberta Health Services
| | - D Sabuda
- Department of Pharmacy Services, Alberta Health Services, Calgary, Alberta
| | - S Kuhn
- Department of Medicine
- Department of Pediatrics, University of Calgary
| |
Collapse
|
46
|
Evans DGR, Astley S, Stavrinos P, Sahin S, Ingham S, McBurney H, Eckersley B, Wilson M, Beetles U, Harvie M, Warren R, Sergeant J, Hufton A, Warwick J, Newman W, Buchan I, Cuzick J, Howell A. P4-11-07: Feasibility and Acceptability of Offering Breast Cancer Risk Estimation in the Context of the UK National Health Service Breast Cancer Screening Programme: A New Paradigm for Cancer Prevention. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Currently there are no real attempts internationally to tailor breast screening programmes to individual risk Methods: We have assessed the feasibility of collecting breast cancer risk information during routine mammographic screening in the National Health Service Breast Screening Programme (NHSBSP) in England, in order to consider, ultimately, adapting the screening interval to risk of breast cancer and introducing preventive strategies in women at high risk. The study Predicting Risk Of Cancer At Screening (PROCAS) aims to recruit 60,000 women over 3 years. Results: 26,000 women (June 8th 2011) have so far given consent to join the study. Thirty six percent of the first 20,000 women in nineteen screening sites in Manchester consented to enter the study and completed a risk factor questionnaire. The median 10 year breast cancer risk was 2.65%, with 926 (9.26%) of the first 10,000 women having a 10 year risk of ≥5% and 92 (0.92%) having a 10 year risk of ≥8% (Tyrer-Cuzick), IQR:1.35. 832 (8.32%) women had a mammographic density of 60% or greater (Visual Analogue Scale). We collected saliva samples from 1019 women for genetic analysis and will extend this to 18% of participants. Of those who agreed to participate in the study, 94% indicated that they wished to know their breast cancer risk. Women with a 10-year risk of ≥8%, and women with a 10-year risk of ≥5% and mammographic density ≥60% were invited to attend or be telephoned to be counselled. To date 138 have accepted with 135, so far, having received risk counselling. Nineteen percent of the high-risk women identified subsequently decided to enter a randomised breast cancer prevention study with either a dietary or drug intervention (IBIS2, anastrazole vs placebo). Results from the first 1,000 women who provided DNA samples suggest that the risk information from the 18 validated SNPS may enhance existing risk models. Conclusion: This study demonstrates that it is feasible to determine individual breast cancer risk and offer women appropriate risk-reducing interventions within the context of a population-based mammographic screening programme.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-07.
Collapse
Affiliation(s)
- DGR Evans
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Astley
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - P Stavrinos
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Sahin
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Ingham
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - H McBurney
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - B Eckersley
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - M Wilson
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - U Beetles
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - M Harvie
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - R Warren
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Sergeant
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - A Hufton
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Warwick
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - W Newman
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - I Buchan
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Cuzick
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - A Howell
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| |
Collapse
|
47
|
Gatti M, Venzon D, Zujewski J, Korde L, Isaacs C, Cohen P, Warren R, Gallagher A, Eng-Wong J. P3-11-01: Effects of Exemestane Therapy on the Lipid Profile of Postmenopausal Women with an Elevated Risk of Developing Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors are effective for breast cancer prevention in postmenopausal women. In the recent MAP.3 study, exemestane significantly reduced invasive breast cancer in postmenopausal women with an elevated risk of developing breast cancer. At 35 months follow up there was no increase risk in cardiovascular events in this study; however, the effects of exemestane use on lipid profiles and cardiovascular health are still unclear.
Methods: We conducted a single-arm phase II trial of exemestane in women at increased risk for breast cancer and examined the impact of exemestane on lipid profiles. Postmenopausal women at high risk for invasive breast cancer (e.g., Gail Model risk ≥ 1.7, a history of lobular neoplasia, atypical ductal hyperplasia, DCIS, or stage I/II breast cancer, or BRCA 1/2 mutation) were given exemestane (25 mg orally daily) for 2 years. Fasting serum total cholesterol, HDL, LDL, triglycerides, and homocysteine were collected at baseline, 3, 12, and 24 months after initiation of exemestane therapy. Apolipoprotein A and B were collected at baseline, 3 and 12 months. Wilcoxon sign ranked test was used to analyze if changes from baseline values differed from zero. The Hochberg p-value adjustment was used to account for multiple hypothesis tests.
Results: Of the 42 women enrolled in the study, 6 dropped out prior to completing 1 year and 1 dropped out prior to completing 2 years of exemestane therapy. Thirty-one women have completed 2 years of exemestane therapy and the remaining 4 are expected to complete 2 years of therapy by January 2012. On average, participants were 58.5 years old, mostly Caucasian (n = 37; 84.1%), and had a BMI of 29.2 kg/m2. A majority (n = 19) of participants were on lipid-lowering medications (14 were taking a statin) or taking fish oil supplements (n =5) prior to starting on the trial and 1 was started on a statin approximately 10 months after starting the trial. There were no significant differences in mean lipid values for each of the 4 assessment points or in the mean change from baseline at 3, 12, and 24 months between patients who were taking lipid-lowering medications and those were not. In unadjusted analyses, change in HDL from baseline was significantly different from zero and decreased from baseline at 3, 12 and 24 months (−8.0 mg/dL, −8.5 mg/dL, and −9.9 mg/dL; All p-values ≤ .001 before and after applying the Hochberg adjustment). Total cholesterol also significantly decreased from baseline at 3 months (−13.6 mg/dL, p = .002) but was no longer significant at 12 and 24 months (−9.6 mg/dL and −11.4 mg/dL, respectively; p-values = .07). The rest of the lipid panel did not significantly change during follow-up.
Discussion: In agreement with previous studies, we found that exemestane causes a significant decrease in HDL and total cholesterol, while leaving the rest of the lipid panel unchanged. Prior studies excluded patients on lipid-lowering medication; half of our participants were taking lipid-lowering medication. It is notable that both women off and on lipid-lowering medication had decreases in HDL. Additional studies are needed to elucidate long-term cardiovascular outcomes in this high risk but otherwise healthy population.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-11-01.
Collapse
Affiliation(s)
- M Gatti
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - D Venzon
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Zujewski
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - L Korde
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - C Isaacs
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - P Cohen
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - R Warren
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - A Gallagher
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Eng-Wong
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| |
Collapse
|
48
|
|
49
|
|
50
|
Warren R, Wertz P, Kirkbride T, Brunner M, Gross M. Comparative Analysis of Skin Surface Lipids of the Labia Majora, Inner Thigh, and Forearm. Skin Pharmacol Physiol 2011; 24:294-9. [DOI: 10.1159/000328731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 03/22/2011] [Indexed: 11/19/2022]
|