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Hussain A, Havelin A, Reynolds N, Ball S, Weatherhead S, Hampton P. 148 Increasing to weekly adalimumab dosing leads to improved psoriasis outcomes-a retrospective single centre review of real-world data. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.158] [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: 11/20/2022]
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Chana M, Muse S, Ball S, Bennett R, McCarthy R. Critical limb ischaemia in the time of COVID-19: establishing ambulatory service provision. Ann R Coll Surg Engl 2022; 104:673-677. [PMID: 34941433 PMCID: PMC9685904 DOI: 10.1308/rcsann.2021.0294] [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] [Accepted: 07/23/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic enforced changes to healthcare services at a pace and extent not seen previously in the NHS. The Royal Devon and Exeter provides regional vascular surgery services. A consultant-led urgent 'hot clinic' was established, providing patients with ambulatory care. We aim to describe the service for critical limb ischaemia (CLI) before and during the COVID-19 pandemic, and evaluate this against recommended best practice. METHODS Retrospective review of electronic databases and records of patients with CLI during a non-COVID vs COVID-19 period. Primary outcome measures were those established by guidance from the Vascular Society of Great Britain and Ireland. RESULTS Non-COVID vs COVID-19: total patients n=97 vs 96, of which CLI patients n=29 vs 21. Median length of stay 15 vs 0 days (p<0.001); median time from referral to specialist review 0 vs 3 days (p<0.001); multidisciplinary team meeting (MDT) recorded 3% vs 29%; median time to intervention 6 vs 8 days; conservative management 52% vs 67%; endovascular 28% vs 10%; open surgery 21% vs 24%; 30-day survival 79% vs 76%. CONCLUSION COVID-19 imposed a major change to the service for patients with CLI with a focus on ambulatory care pathways for diagnosis and intervention. We observe a significant reduction in overall length of stay with no clinically significant change in time to consultant review, time to imaging, overall management strategy or outcomes. The results of this study show that patients with CLI can be managed safely and effectively on an ambulatory basis in accordance with established best practice.
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Affiliation(s)
- M Chana
- The Royal Devon and Exeter Hospital, UK
| | - S Muse
- The Royal Devon and Exeter Hospital, UK
| | - S Ball
- NIHR ARC South West Peninsula (PenARC), The University of Exeter Medical School, UK
| | - R Bennett
- The Royal Devon and Exeter Hospital, UK
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Ball S, Fisher J. Adolescent abdominal pain due to rare mullerian duct anomaly. Am J Emerg Med 2022; 59:218.e1-218.e3. [PMID: 35780004 DOI: 10.1016/j.ajem.2022.06.032] [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: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Abdominal pain is a common presenting complaint to the Emergency Department (ED). Often, rare etiologies can be discovered in the work up of this common complaint. Here we present the case of an adolescent female who presented with abdominal pain and was found to have obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) or Herlyn-Werner-Wunderlich Syndrome. A 12 year old female with known renal agenesis presented with 5 days of left sided abdominal pain that then developed into right lower quadrant pain. She had regular menses for the last 2 years. Ultrasound (US) showed a fluid collection in the lower uterine segment and a complex cystic structure anterior to the uterus. Magnetic resonance imaging (MRI) showed the patient to have didelphys uterus with "severe dilatation of the cervix/vaginal canal… extending from the right uterine horn" and left-sided ovarian and Fallopian tube torsion. She was taken to the operating room where she underwent vaginal septum excision and a left salpingo-oopherectomy. OHVIRA includes the triad of obstructed hemivagina, uterine didelphys, and ipsilateral renal agenesis. This occurs due to embryologic arrest of the mullerian and mesonephric ducts at 8 weeks of gestation. Most abnormalities are right sided which leads to right lower abdominal and pelvic pain approximately 4 months post-menarche. Diagnosis of OHVIRA is made utilizing US and CT scans. MRI can also be useful to further delineate specific anatomy. It is important for the emergency physician to be aware of this entity as most patients don't present to care until acute, severe symptoms develop. This makes it more likely for them to seek care in the ED as opposed to the outpatient setting.
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Affiliation(s)
- Seth Ball
- Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Children's Hospital of Nevada at University Medical Center, 901 Rancho Lane, Suite 135, Las Vegas, NV 89106, USA.
| | - Jay Fisher
- Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Children's Hospital of Nevada at University Medical Center, 901 Rancho Lane, Suite 135, Las Vegas, NV 89106, USA
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Ball S, Morgan A, Simmonds S, Bray J, Bailey P, Finn J. Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences. Resusc Plus 2022; 10:100237. [PMID: 35515011 PMCID: PMC9065707 DOI: 10.1016/j.resplu.2022.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
We ranked businesses for their ability to fill gaps in the AED landscape. 23% of OHCAs in public, and 4% in homes, were within 100 m of an existing AED. Many businesses can simultaneously improve coverage of arrests in public and homes. Rankings were largely robust to the coverage radius used (100 m, 200 m, and 500 m). Even if all 5006 business locations hosted AEDs, large gaps in OHCA coverage remain.
Aim Methods Results Conclusion
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Affiliation(s)
- S. Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
- Corresponding author at: Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - A. Morgan
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
| | - S. Simmonds
- St John Western Australia, Belmont, WA 6104, Australia
| | - J. Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - P. Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
| | - J. Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, Belmont, WA 6104, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia
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Gallier S, Topham A, Nightingale P, Garrick M, Woolhouse I, Berry MA, Pankhurst T, Sapey E, Ball S. Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention. BMC Med Inform Decis Mak 2022; 22:121. [PMID: 35505311 PMCID: PMC9066759 DOI: 10.1186/s12911-022-01865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. Risk factors for VTE are well known and there are validated risk assessment tools to support the use of prophylactic therapies. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance, defined as an assessment which led to an appropriate action-here prescribing prophylactic low molecular weight heparin where indicated, is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems (EPS) can mandate guideline-compliant actions. We hypothesised that a systems-based EPS intervention (prescribing rules which mandate approval or rejection of a proposed prescription of prophylactic low molecular weight heparin based on the mandated VTE assessment) would increase full VTE guideline compliance more than interventions which focused on targeting individual prescribers. METHODS All admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011 and 2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included teaching sessions and face-to-face feedback based on measured performance (an approach targeting individual prescribers) and mandatory risk assessment and prescribing rules into an EPS (a systems approach). RESULTS Data from all 235,005 admissions and all 5503 prescribers were included in the analysis. Risk assessments were completed in > 90-95% of all patients at all times, but full guideline compliance was lower (70% at the start of this study). Face-to-face feedback improved full VTE guideline compliance from 70 to 77% (p ≤ 0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p ≤ 0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p < 0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis. DISCUSSION An EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention over time. Non-compliance remained at 8-5% despite this mandated system. Further research is needed to assess the potential reasons for this.
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Affiliation(s)
- S. Gallier
- PIONEER Health Data Research Hub in Acute Care, Department of Health Informatics, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - A. Topham
- PIONEER Health Data Research Hub in Acute Care, Department of Health Informatics, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - P. Nightingale
- NIHR Clinical Research Facility, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - M. Garrick
- Department of Health Informatics, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - I. Woolhouse
- Respiratory Medicine, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - M. A. Berry
- Acute Medicine, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - T. Pankhurst
- Digital Healthcare and Department of Renal Medicine, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
| | - E. Sapey
- grid.6572.60000 0004 1936 7486PIONEER Health Data Research Hub in Acute Care, University of Birmingham, Edgbaston, Birmingham, B15 2TH UK
| | - S. Ball
- HDR-UK Midlands Site and Better Care Programme, Queen Elizabeth Hospitals NHS Foundation Trust, Mindlesohn Way, Edgbaston, Birmingham, B15 2WB UK
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Taylor E, Goodwin V, Clegg A, Frost J, Ball S. 768 PREDICTORS OF INDEPENDENCE IN COMMUNITY-DWELLING OLDER PEOPLE. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.768] [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] Open
Abstract
Abstract
Introduction
Many people wish to retain their independence as they age. Therefore, identifying factors that can predict sustainability of independence for older people over time are essential for preventing functional decline and maintaining quality of life.
Method
Longitudinal, health, social and economic data, from community-dwelling older people aged ≥75 years (collected at baseline (BL), 6, 12, 24 and 48 months), were obtained from the ongoing Community Ageing Research (CARE 75+) cohort study. Linear regression models were used to identify predictors of independence. The Nottingham Extended Activities of Daily Living (NEADL) score (range 0–66) at 12 months from BL was the dependent variable (DV) to indicate independence. Independent variables (IV)s were selected based on interviews with CARE75+ participants and known predictors such as, ethnicity and frailty. Each IV was regressed against the DV in univariable analyses. All IVs with p value <0.1 from univariable analyses, including baseline NEADL score, were included in the multivariable model.
Results
Data from 1,277 participants (mean (SD) age 84.61 (4.95); 49% male) were analysed. The multivariable model (adjusted R2: 0.71) showed that, in addition to higher BL NEADL (estimated effect 0.49, 95% confidence interval (CI) 0.41 to 0.58), white ethnicity, good sight, lower level of frailty, ability to perform basic activities of daily living, lower depression score, lower cognitive impairment, younger age, living circumstances, fewer hours of informal support, greater physical functioning and lower pain scores were predictors of a higher NEADL at 12 months (p < 0.05 for all).
Conclusion
As well as physical health, social and psychological variables are important in predicting independence, based on NEADL score, over time. Further research into the mechanisms behind these relationships will be conducted.
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Affiliation(s)
| | | | - A Clegg
- Bradford Teaching Hospitals NHS Foundation Trust
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Taylor E, Goodwin V, Clegg A, Ball S, Frost J. 696 UNDERSTANDING INDEPENDENCE—OLDER PEOPLE’S PERSPECTIVES. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Independence is an important personal goal for many older people. Achieving this goal in practice requires a shared-understanding of independence between older people and those supporting them, but a consensus of understanding remains elusive. This study aims to provide a basis for a person-centred understanding of independence by identifying which factors are important to the meaning, and experience, of independence for older people.
Method
In-depth interviews were conducted to explore the understandings of community-dwelling older people. Participants were purposively sampled from the Community Ageing Research 75+ cohort study. Analysis was guided by the Framework approach. Themes were identified through deductive and inductive exploration of the transcripts.
Results
Fourteen older people were interviewed ranging from 76–98 years old, six were male. Five themes were identified. The first three themes: participation, autonomy and control, underpinned participants’ understandings of independence. Engaging in meaningful activities, making decisions, and having control over help received were fundamental to participants’ understandings of independence. These three themes provided the common building blocks for unique configurations of independence. The importance of psychological qualities to the facilitation of independence, as they enabled participants to navigate environmental and social set-backs, presented a fourth theme, ‘Mind over Matter’. The final theme, ‘Participation reinforces psychological qualities’ represented the virtuous circle through which participation in meaningful activities reinforced the psychological attributes necessary to maintain independence.
Conclusion
Meanings of independence are as diverse as the people who develop them, whatever the age group. For the older participants of this study, despite differences, the meaning and facilitation of independence comprised several common themes. Achieving independence was a case of ‘Mind over Matter’ requiring personal effort, irrespective of environmental supports. Participation in meaningful activities was both a goal of independence and a means to reinforce the psychological qualities and energy needed to maintain it.
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Affiliation(s)
| | | | - A Clegg
- Bradford Teaching Hospitals NHS Foundation Trust
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8
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Thyssen JP, Lio P, Ball S, Pierce E, Sun L, Chen Y, Tan JKL, Augustin M. Improvement in symptoms of anxiety and depression in patients with atopic dermatitis after treatment with baricitinib. J Eur Acad Dermatol Venereol 2021; 36:e147-e150. [PMID: 34553429 DOI: 10.1111/jdv.17704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - P Lio
- Medical Dermatology Associates of Chicago, Chicago, IL, USA
| | - S Ball
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - E Pierce
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - L Sun
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Y Chen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - J K L Tan
- University of Western Ontario and Windsor Clinical Research Inc., Windsor, ON, Canada
| | - M Augustin
- University Medical Centre Hamburg, Hamburg, Germany
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9
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Kaul S, Rao C, Mane R, Tan KL, Khan AHA, Hussain MS, Shafi MA, Buettner F, Banerjee S, Boulton R, Bhargava A, Huang J, Hanson M, Raouf S, Ball S, Rajendran N. Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital? Clin Oncol (R Coll Radiol) 2021; 34:e25-e34. [PMID: 34454807 DOI: 10.1016/j.clon.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/03/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
AIMS Although there is emerging evidence to suggest equivalent oncological outcomes using a watch and wait approach compared with primary total mesorectal excision surgery, there is a paucity of evidence about the safety and efficacy of this approach in routine clinical practice. Here we report the long-term outcomes and quality of life from patients managed with watch and wait following a clinical complete response (cCR) to neoadjuvant therapy. MATERIALS AND METHODS Patients with adenocarcinoma of the rectum with cCR following neoadjuvant therapy managed using watch and wait were retrospectively identified. Demographic data, performance status, pretreatment staging information, oncological and surgical outcomes were obtained from routinely collected clinical data. Quality of life was measured by trained clinicians during telephone interviews. RESULTS Over a 7-year period, 506 patients were treated for rectal cancer, 276 had neoadjuvant therapy and 72 had a cCR (26.1%). Sixty-three were managed with watch and wait. Thirteen patients had mucosal regrowth. There was no significant difference in the incidence of metastatic disease between the surgical and watch and wait cohorts (P = 0.38). The 13 patients with mucosal regrowth underwent salvage surgery. Eleven of the patients who underwent surgical resection had R0 resections. There was also a statistically and clinically significant improvement in the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) trial outcome index (P = 0.022). CONCLUSION This study shows that watch and wait is safe and effective outside of tertiary referral centres. It suggests that an opportunistic cCR is durable and when mucosal regrowth occurs it can be salvaged. Finally, we have shown that quality of life is probably improved if a watch and wait approach is adopted.
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Affiliation(s)
- S Kaul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - C Rao
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK; Department of Surgery and Cancer, Imperial College London, London, UK; North Cumbria Integrated Care NHS Foundation Trust, UK.
| | - R Mane
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K L Tan
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - A H A Khan
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M S Hussain
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M A Shafi
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - F Buettner
- German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; Department of Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - S Banerjee
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - R Boulton
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - A Bhargava
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK; Institute of Health, Barts and London Medical School, Queen Mary University of London (QMUL), London, UK
| | - J Huang
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M Hanson
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - S Raouf
- Barts Health NHS Trust, London, UK
| | - S Ball
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - N Rajendran
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
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Wollenberg A, Nakahara T, Maari C, Peris K, Lio P, Augustin M, Silverberg JI, Rueda MJ, DeLozier AM, Pierce E, Yang FE, Sun L, Ball S, Tauber M, Paul C. Impact of baricitinib in combination with topical steroids on atopic dermatitis symptoms, quality of life and functioning in adult patients with moderate-to-severe atopic dermatitis from the BREEZE-AD7 Phase 3 randomized trial. J Eur Acad Dermatol Venereol 2021; 35:1543-1552. [PMID: 33834521 PMCID: PMC8251919 DOI: 10.1111/jdv.17278] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/17/2021] [Indexed: 01/05/2023]
Abstract
Background Baricitinib is an oral, selective, reversible Janus kinase 1/2 inhibitor approved in the European Union and Japan and under investigation in the United States for treatment of atopic dermatitis (AD). Objectives To evaluate the impact of baricitinib plus background topical corticosteroids (TCS) on health‐related quality of life (HRQoL), how AD symptoms impact work productivity and life functioning, and treatment benefit using patient‐reported outcome (PRO) assessments in patients with moderate‐to‐severe AD previously experiencing inadequate response to TCS. Methods Adult patients with AD in BREEZE‐AD7, a Phase 3, multicentre, double‐blind trial, were randomised 1 : 1 : 1 to daily oral placebo (control) or baricitinib 4‐ or 2‐mg plus TCS. PROs reported Week 1 through Week 16: Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment‐AD (WPAI‐AD); Patient‐Reported Outcomes Measurement Information System (PROMIS) Itch and Sleep measures, and Patient Benefit Index (PBI). Data were analysed using logistic regression (categorical) and mixed model repeated measures (continuous). PBI scores were analysed using analysis of variance. Results A total of 329 patients were randomised. Treatment with baricitinib 4‐mg (N = 111) or 2 mg (N = 109) plus TCS led to rapid, statistically significant improvements [vs. TCS plus placebo (N = 109)] in DLQI ≥4‐point improvement starting at Week 2 (4‐mg plus TCS, P ≤ 0.001; 2‐mg plus TCS P ≤ 0.05), change from baseline in WPAI‐AD presenteeism at Week 1 (4‐mg plus TCS, P ≤ 0.01; 2‐mg plus TCS P ≤ 0.05) and PROMIS itch interference at Week 2 (4‐mg plus TCS P ≤ 0.01). Improvements were sustained through Week 16 for baricitinib 4‐mg. Statistically significant improvements were observed at Week 16 for PBI global score (4‐mg plus TCS, P ≤ 0.001; 2‐mg plus TCS P ≤ 0.05). Conclusions Baricitinib plus TCS vs. placebo plus TCS showed significant improvements in treatment benefit at Week 16 and rapid significant improvements in HRQoL and impact of AD symptoms on work productivity and functioning through 16 weeks.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - T Nakahara
- Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - C Maari
- Division of Dermatology, Innovaderm Research and Montreal University, Montreal, Quebec, Canada
| | - K Peris
- Dermatology, Università Cattolica del Sacro Cuore and Fondazione Policlinico Agostino Gemelli - IRCCS, Rome, Italy
| | - P Lio
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Augustin
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J I Silverberg
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - M J Rueda
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - A M DeLozier
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - E Pierce
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - F E Yang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - L Sun
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - S Ball
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - M Tauber
- Toulouse University and CHU Larrey, Toulouse, France
| | - C Paul
- Toulouse University and CHU Larrey, Toulouse, France
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11
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Marinovich ML, Regan AK, Gissler M, Magnus MC, Håberg SE, Mayo JA, Shaw GM, Bell J, Nassar N, Ball S, Gebremedhin AT, Marston C, de Klerk N, Betrán AP, Padula AM, Pereira G. Associations between interpregnancy interval and preterm birth by previous preterm birth status in four high-income countries: a cohort study. BJOG 2021; 128:1134-1143. [PMID: 33232573 DOI: 10.1111/1471-0528.16606] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term. DESIGN Cohort study. SETTING USA (California), Australia, Finland, Norway (1980-2017). POPULATION Women who gave birth to first and second (n = 3 213 855) singleton livebirths. METHODS Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within-site ORs were pooled by random effects meta-analysis. OUTCOME MEASURE PTB (gestational age <37 weeks). RESULTS Absolute risk of PTB for each IPI was 3-6% after a previous term birth and 17-22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P-for-interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43-1.58); 6-11 months (OR 1.10, 95% CI 1.04-1.16); 24-59 months (OR 1.16, 95% CI 1.13-1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60-1.86), compared with 18-23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18-1.42) and ≥60 months (OR 1.29, 95% CI 1.17-1.42), but were less than ORs among women with a previous term birth (P < 0.05). CONCLUSIONS Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB. TWEETABLE ABSTRACT Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
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Affiliation(s)
- M L Marinovich
- School of Public Health, Curtin University, Perth, WA, Australia
| | - A K Regan
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - M Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - M C Magnus
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - S E Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - J A Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - G M Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - J Bell
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - N Nassar
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - S Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - A T Gebremedhin
- School of Public Health, Curtin University, Perth, WA, Australia
| | - C Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
| | - A P Betrán
- Department of Reproductive Health and Research, UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - G Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
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12
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Wilkinson K, Ball S, Mitchell SB, Ukoumunne OC, O'Mahen HA, Tejerina-Arreal M, Hayes R, Berry V, Petrie I, Ford T. The longitudinal relationship between child emotional disorder and parental mental health in the British Child and Adolescent Mental Health surveys 1999 and 2004. J Affect Disord 2021; 288:58-67. [PMID: 33839559 DOI: 10.1016/j.jad.2021.03.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Research suggests parental psychopathology has an adverse effect on child mental health. However, due to the interactional nature of parent-child relationships and with a high rate of emotional disorders reported in school-age children, it is important to know whether the effect is reciprocal. METHODS We explored the longitudinal relationship between child and parent mental health in the British Child and Adolescent Mental Health Surveys (N=7,100 child-parent dyads) and their three-year follow-ups. The Development and Well-Being Assessment with DSM-IV diagnostic criteria was used to measure child psychiatric diagnoses, while parental mental health was assessed using the General Health Questionnaire. Multivariable logistic regression was used to explore the longitudinal association between child emotional disorder and parent mental health. RESULTS Parents of children who had an emotional disorder at baseline were more likely to have poor mental health three years later compared with parents whose children had no psychiatric diagnosis (33.3% versus 16.7%; crude odds ratio=2.52; adjusted odds ratio=2.19, 95% CI=1.58 to 3.05, p<0.001). Children of parents with poor mental health at baseline were more likely to develop an emotional disorder three years later compared with children whose parents had good mental health (5.2% versus 2.5%; crude odds ratio=2.08; adjusted odds ratio=1.63, 95% CI=1.18 to 2.25, p=0.003). LIMITATIONS The findings of this research are limited by the survey data collected, the measures used and survey dropout. CONCLUSIONS We detected a bi-directional relationship between child and parent mental health, suggesting that effective intervention for one individual may benefit other family members.
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Affiliation(s)
- K Wilkinson
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - S Ball
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - S B Mitchell
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - O C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - H A O'Mahen
- University of Exeter Mood Disorders Centre, Sir Henry Wellcome Building, Streatham Drive, Exeter, EX4 4QG, UK
| | - M Tejerina-Arreal
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - R Hayes
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - V Berry
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - I Petrie
- Child Mental Health Group, University of Exeter College of Medicine and Health, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - T Ford
- Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 2AH, UK
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Pringle H, Donigiewicz U, Bennett M, Fowler GF, Walker E, Ball S, Narang S, Bethune RM. P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis. BJS Open 2021. [PMCID: PMC8030173 DOI: 10.1093/bjsopen/zrab032.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.
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Affiliation(s)
| | | | | | | | | | - S Ball
- Royal Devon & Exeter Hospital
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14
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Atkin C, Kamwa V, Reddy-Kolanu V, Parekh D, Evison F, Nightingale P, Gallier S, Ball S, Sapey E. The changing characteristics of COVID-19 presentations. A regional comparison of SARS-CoV-2 hospitalised patients during the first and second wave. Acute Med 2021; 20:92-100. [PMID: 34190735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study assesses COVID-19 hospitalised patient demography and outcomes during wave 1 and wave 2, prior to new variants of the virus. METHODS All patients with a positive SARS-CoV-2 swab between 10th March 2020 and 5th July 2020 (wave 1) and 1st September 2020 and 16th November 2020 (wave 2) admitted to University Hospitals Birmingham NHS Foundation Trust were included (n=4856), followed for 28 days. RESULTS Wave 2 patients were younger, more ethnically diverse, had less co-morbidities and disease presentation was milder on presentation. After matching for these factors, mortality was reduced, but without differences in intensive care admissions. CONCLUSION Prior to new SARS-CoV-2 variants, outcomes for hospitalised patients with COVID-19 were improving but with similar intensive care needs.
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Affiliation(s)
- C Atkin
- Acute Medicine, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing
| | - V Kamwa
- Acute Medicine, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing
| | - V Reddy-Kolanu
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust
| | - D Parekh
- A. Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust
| | - F Evison
- Research Analytics, Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust
| | - P Nightingale
- NIHR Clinical Research Facility Statistician, University Hospitals Birmingham NHS Foundation Trust
| | - S Gallier
- PIONEER Technical Director, Lead for Research Analytics Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust
| | - S Ball
- A. Chief Medical Officer, University Hospitals Birmingham NHS Foundation Trust
| | - E Sapey
- A. Director of PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care B. Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham
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15
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Gallier S, Atkin C, Reddy-Kolanu V, Parekh D, Zou X, Evison F, Ball S, Sapey E. Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload. Acute Med 2021; 20:266-275. [PMID: 35072383 DOI: 10.52964/amja.0876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A COVID virtual ward (CVW) is recommended by NHS England, but 'usual care' outcomes have not been reported. A retrospective study of all adults with COVID-19 attending Queen Elizabeth Hospital Birmingham between 01/06/2020-31/01/2021, assessed against CVW criteria and followed for 28 days. Of 2301 COVID-19 patients, 571(25%) would have met CVW criteria. Of these, 325(57%) were discharged after review and 246(43%) admitted. Of admitted patients who met CVW criteria, 81% required hospital-supported therapies; 11% died. Of the 325 discharged, 13% re-presented, 9% with COVID-related symptoms, 2% required intensive care admission, and one died (0.3%). In this comparison, discharging patients without a CVW did not lead to more re-presentations, re-admissions, ITU escalations or deaths compared to published outcomes for hospitals with a CVW.
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Affiliation(s)
- S Gallier
- PIONEER Technical Director, Lead for Research Analytics Department of Health Informatics Health Informatics, University Hospitals Birmingham NHS Foundation Trust
| | - C Atkin
- NIHR Lecturer in Acute Medicine Institute of Inflammation and Ageing, University of Birmingham
| | - V Reddy-Kolanu
- Consultant in Acute Medicine University Hospitals Birmingham NHS Foundation Trust
| | - D Parekh
- Senior Lecturer in Acute Care, Birmingham Acute Care Research Group Institute of Inflammation and Ageing, University of Birmingham
| | - X Zou
- Research Analytics, Health Informatics University Hospitals Birmingham NHS Foundation Trust
| | - F Evison
- Senior Research Analysis Health Informatics, University Hospitals Birmingham NHS Foundation Trust
| | - S Ball
- Cheif Medical Officer, Director of Better Care Programme University Hospitals Birmingham NHS Foundation Trust
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16
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Ball S, Ball A, Antoniou G. Prognostic Role of Pre-Operative Symptom Status in Carotid Endarterectomy: A Systematic Review and Meta-Analysis. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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18
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Ball S, Stephen JM, El-Daou H, Williams A, Amis AA. The medial ligaments and the ACL restrain anteromedial laxity of the knee. Knee Surg Sports Traumatol Arthrosc 2020; 28:3700-3708. [PMID: 32504158 PMCID: PMC7669770 DOI: 10.1007/s00167-020-06084-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/28/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to determine the contribution of each of the ACL and medial ligament structures in resisting anteromedial rotatory instability (AMRI) loads applied in vitro. METHODS Twelve knees were tested using a robotic system. It imposed loads simulating clinical laxity tests at 0° to 90° flexion: ±90 N anterior-posterior force, ±8 Nm varus-valgus moment, and ±5 Nm internal-external rotation, and the tibial displacements were measured in the intact knee. The ACL and individual medial structures-retinaculum, superficial and deep medial collateral ligament (sMCL and dMCL), and posteromedial capsule with oblique ligament (POL + PMC)-were sectioned sequentially. The tibial displacements were reapplied after each cut and the reduced loads required allowed the contribution of each structure to be calculated. RESULTS For anterior translation, the ACL was the primary restraint, resisting 63-77% of the drawer force across 0° to 90°, the sMCL contributing 4-7%. For posterior translation, the POL + PMC contributed 10% of the restraint in extension; other structures were not significant. For valgus load, the sMCL was the primary restraint (40-54%) across 0° to 90°, the dMCL 12%, and POL + PMC 16% in extension. For external rotation, the dMCL resisted 23-13% across 0° to 90°, the sMCL 13-22%, and the ACL 6-9%. CONCLUSION The dMCL is the largest medial restraint to tibial external rotation in extension. Therefore, following a combined ACL + MCL injury, AMRI may persist if there is inadequate healing of both the sMCL and dMCL, and MCL deficiency increases the risk of ACL graft failure.
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Affiliation(s)
- S. Ball
- Fortius Clinic, London, UK ,Orthopaedic Surgery Department, Chelsea and Westminster Hospital, London, UK
| | - J. M. Stephen
- Fortius Clinic, London, UK ,Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ UK
| | - H. El-Daou
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ UK
| | - A. Williams
- Fortius Clinic, London, UK ,Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ UK
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ UK ,Musculoskeletal Surgery Group, Imperial College London School of Medicine, London, UK
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19
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Ah-Chuen J, Ball S, Shamash J, Tarver K. Real world outcomes in large cell neuroendocrine carcinoma of the lung according to chemotherapy type. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Thein K, Mogollon-Duffo F, Swarup S, Sultan A, Yendala R, Jahan N, Quirch M, Ball S, Htut TW, D’Cunha N, Rehman S, Hardwicke F, Awasthi S, Tijani L. Combination therapy with checkpoint inhibitors for first-line treatment of advanced renal cell carcinoma: A systematic review and meta-analysis of randomized controlled trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.054] [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: 11/14/2022] Open
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21
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Ball S, Halaki M, Orr R. The influence of in-season workloads and injury definition on injury risk in senior university rugby union players. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Thein K, Jahan N, Sultan A, Swarup S, Tun A, Yendala R, Ball S, Hlaing P, Htut T, Rehman S, D’Cunha N, Hardwicke F, Tijani L, Awasthi S. P1.04-78 Efficacy of Checkpoint Inhibitors in Combination with Chemotherapy for First-Line Treatment of Advanced Non-Squamous NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.981] [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: 10/25/2022]
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Jahan N, Swarup S, Sultan A, Naing T, Mogollon-Duffo F, Ball S, Tun A, Htut T, Dash A, D’Cunha N, Hardwicke F, Awasthi S, Tijani L, Thein K. EP1.01-10 Pembrolizumab in Combination with Chemotherapy as First-Line Treatment of Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Shapey IM, Ball S, Mastan A, Summers A, Griffiths A, Dellen DV, Augustine T, Moinuddin Z. The Transplant Surgeon: An Unlikely, Yet Suitably Qualified, Member of The Complex Neuro Endocrine Multi-Disciplinary Team. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Curative surgery for retro-peritoneal tumours involving vascular structures is challenging and multi-visceral resection is often required to obtain clear resection margins. Abdominal transplant surgeons have considerable experience in all aspects of visceral, vascular and retro-peritoneal surgery. Application of these skills to resect tumours involving vascular structures, and re-implant organs to preserve function is unique. We present the case of a 15- year old girl with a complex retro-peritoneal tumour which was resected en-bloc with the kidneys and vena-cava followed by auto-transplantation of the left kidney. Seven years later, the patient represented with a recurrent tumour which was successfully excised in its entirety. We discuss how innovative surgical strategies can be performed safely on an individualized basis. We highlight the importance of balancing the benefits of the ‘technically possible procedure’ with its risks, along with consideration of the outcomes of treatment and non-treatment alike.
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Frank P, Ball S, Thibodeau L, Perry R, Ditullio K, Wilson K, Trivedi A, Villeneuve A. Evaluation of the next generation I-STAT® point-of-care prothrombin time test (I-STAT PTPLUS) against other commercially available prothrombin time tests. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1361] [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]
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Thein KZ, Ball S, Zaw MH, Quirch M, Hardwicke F, Awasthi S, Oo TH, Jones C. Abstract P1-16-04: Risk of venous thromboembolism with abemaciclib based regimen versus other CDK 4/6 inhibitor containing regimens in patients with hormone receptor-positive HER2-negative metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-16-04] [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: Approximately 70% of patients with metastatic breast cancer (MBC) are hormone receptor (HR) - positive and the cyclin dependent kinases (CDK) along with their D-type cyclin catalysts, have been shown to play a role in mediating the resistance to endocrine therapy. Several CDK-targeted agents have been recently approved by FDA. Nevertheless, the risk of venous thromboembolism (VTE) with the use of different CDK 4/6 inhibitors has never been reported. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of VTE with abemaciclib based regimens versus other CDK 4/6 inhibitor containing regimens in patients with HR-positive HER2-negative MBC.
Methods: We systematically conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts through February 2018. The randomized controlled trials that mention deep vein thrombosis and pulmonary embolism as adverse effects of CDK 4/6 inhibitor therapy were incorporated in the analysis. The primary meta- analytic approach was a fixed effects model using the Mantel-Haenszel (MH) method. It was used to calculate the estimated pooled risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI).
Results: Five phase 3 studies and one phase 2 study with a total of 3,159 patients with HR-positive HER2-negative MBC were eligible for analysis. The study arms used palbociclib-letrozole, palbociclib-fulvestrant, ribociclib-letrozole, abemaciclib-fulvestrant, and abemaciclib-nonsteroidal aromatase inhibitors (either letrozole or anastrozole) while the control arms utilized placebo in combination with letrozole or anastrozole or fulvestrant. The randomization ratio was 2 to 1 in PALOMA-2, PALOMA-3, MONARCH-2 and MONARCH-3 studies and 1 to 1 in PALOMA-1 and MONALEESA-2 trials. CDK 4/6 inhibitors were utilized as first line treatment in PALOMA-1, PALOMA-2, MONALEESA-2 and MONARCH-3. The I2 statistic for heterogeneity was 0, and the heterogeneity X2 (Cochran's Q) was 1 (P= 0.707), suggesting homogeneity among RCTs. The VTE incidence was 25 (3.255%) in the abemaciclib group vs 2 (0.520%) in the control group. The pooled relative risk for VTE was 6.222 (95% CI: 1.481 – 26.145, P = 0.013) and the absolute RD was 0.027 (95% CI: 0.013 – 0.042, P < 0.0001). In other CDK 4/6 inhibitor containing regimens, the VTE incidence was reported at 15 (1.243%) vs 2 (0.374%) in the control arm. The pooled RR for VTE was 2.312 (95% CI: 0.852 –6.272, P = 0.100) and the absolute RD was 0.008 (95% CI: - 0.000 – 0.017, P = 0.259).
Conclusion: VTE is a major cause of morbidity and mortality and is particularly common in patients with breast cancer. Our meta-analysis demonstrated that the addition of abemaciclib to endocrine therapy notably contributed to a higher incidence of VTE with a relative risk of 6.22. However, no significant increase in the risk of VTE was noted in other CDK 4/6 inhibitor-based regimen. More randomized trials are required to determine the actual relation and definitive incidence of VTE among different CDK-targeted agents when added to endocrine therapy.
Citation Format: Thein KZ, Ball S, Zaw MH, Quirch M, Hardwicke F, Awasthi S, Oo TH, Jones C. Risk of venous thromboembolism with abemaciclib based regimen versus other CDK 4/6 inhibitor containing regimens in patients with hormone receptor-positive HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-16-04.
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Affiliation(s)
- KZ Thein
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Ball
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - MH Zaw
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M Quirch
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - F Hardwicke
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Awasthi
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - TH Oo
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C Jones
- Texas Tech University Health Sciences Center, Lubbock, TX; Brooklyn Hospital Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston, TX
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Gannon K, Ball S. Estimating renal function in lung cancer patients. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30178-3] [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: 10/27/2022]
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Thein K, Swarup S, Ball S, Quirch M, Vorakunthada Y, Htwe K, D'Cunha N, Hardwicke F, Awasthi S, Tijani L. Incidence of cardiac toxicities in patients with advanced non-small cell lung cancer treated with osimertinib: A combined analysis of two phase III randomized controlled trials. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thein K, Ball S, Zaw M, Tun A, Quirch M, Hardwicke F, D'Cunha N, Tijani L, Jones C, Oo T. Updated meta-analysis of randomized controlled trials (RCTs) to determine the CDK 4/6 inhibitors associated venous thromboembolism (VTE) risk in hormone receptor-positive breast cancer (BC) patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Swarup S, Thein K, Ball S, Quirch M, Vorakunthada Y, Sultan A, Hardwicke F, Tijani L, Awasthi S. P3.01-93 Osimertinib-Related Hematological and Pulmonary Toxicities in Advanced NSCLC Patients: Combined Analysis of Phase III Trials. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1653] [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: 10/28/2022]
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Baldeweg SE, Ball S, Brooke A, Gleeson HK, Levy MJ, Prentice M, Wass J. SOCIETY FOR ENDOCRINOLOGY CLINICAL GUIDANCE: Inpatient management of cranial diabetes insipidus. Endocr Connect 2018; 7:G8-G11. [PMID: 29930026 PMCID: PMC6013691 DOI: 10.1530/ec-18-0154] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022]
Abstract
Cranial diabetes insipidus (CDI) is a treatable chronic condition that can potentially develop into a life-threatening medical emergency. CDI is due to the relative or absolute lack of the posterior pituitary hormone vasopressin (AVP), also known as anti-diuretic hormone. AVP deficiency results in uncontrolled diuresis. Complete deficiency can lead to polyuria exceeding 10 L/24 h. Given a functioning thirst mechanism and free access to water, patients with CDI can normally maintain adequate fluid balance through increased drinking. Desmopressin (DDAVP, a synthetic AVP analogue) reduces uncontrolled water excretion in CDI and is commonly used in treatment. Critically, loss of thirst perception (through primary pathology or reduced consciousness) or limited access to water (through non-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients with CDI. These adverse outcomes and deaths have occurred through a combination of lack of knowledge and treatment failures by health professionals. Here, with our guideline, we recommend treatment pathways for patients with known CDI admitted to hospital. Following these guidelines is essential for the safe management of patients with CDI.
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Affiliation(s)
- S E Baldeweg
- Department of Diabetes and EndocrinologyUniversity College London NHS Foundation Trust and Univeristy College London, London, UK
| | - S Ball
- Department of Medicine and EndocrinologyManchester University Foundation Trust & Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - A Brooke
- Royal Devon and Exeter NHS Foundation TrustExeter, UK
| | - H K Gleeson
- Department of EndocrinologyQueen Elizabeth Hospital, Birmingham, UK
| | - M J Levy
- University of Leicester and University of Leicester Hospitals TrustLeicester, UK
| | - M Prentice
- Croydon Health Services NHS TrustCroydon, UK
| | - J Wass
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, UK
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Papp K, Leonardi C, Blauvelt A, Reich K, Korman N, Ohtsuki M, Paul C, Ball S, Cameron G, Erickson J, Zhang L, Mallbris L, Griffiths C. 伊赛珠单抗对银屑病的治疗:三项双盲对照研究的综合药效分析(发现-1、发现-2、发现-3). Br J Dermatol 2018. [DOI: 10.1111/bjd.16461] [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: 11/27/2022]
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Papp K, Leonardi C, Blauvelt A, Reich K, Korman N, Ohtsuki M, Paul C, Ball S, Cameron G, Erickson J, Zhang L, Mallbris L, Griffiths C. Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3). Br J Dermatol 2018. [DOI: 10.1111/bjd.16395] [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: 12/01/2022]
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Papp KA, Leonardi CL, Blauvelt A, Reich K, Korman NJ, Ohtsuki M, Paul C, Ball S, Cameron GS, Erickson J, Zhang L, Mallbris L, Griffiths CEM. Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3). Br J Dermatol 2018; 178:674-681. [PMID: 28991370 DOI: 10.1111/bjd.16050] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, is approved for the treatment of moderate-to-severe psoriasis. OBJECTIVES This analysis represents an overview of the efficacy outcomes from three phase III psoriasis studies. METHODS Data were integrated from the 12-week induction period of three studies in which patients received ixekizumab 80 mg every 2 weeks (IXE Q2W; n = 1169) or every 4 weeks (IXE Q4W; n = 1165) after an initial 160-mg dose for both; etanercept (50 mg biweekly; n = 740; two studies) or placebo (n = 792). The coprimary end points were the percentages of patients with response of static Physician's Global Assessment (sPGA; score 0 or 1) and ≥ 75% improvement in baseline Psoriasis Area and Severity Index (PASI 75) at week 12. Response rates were compared between treatments using the Cochran-Mantel-Haenszel test stratified by study. Treatment comparisons with placebo included data from three studies, whereas etanercept comparisons were based on two studies. RESULTS Ixekizumab treatment was superior to placebo (P < 0·001) and etanercept (P < 0·001) on sPGA (0, 1) and PASI 75, with significant differences in PASI improvement at week 1. With IXE Q2W, at week 12, the frequencies of patients achieving PASI 75, 90 and 100 were nearly 90%, 70% and 40%, respectively. Ixekizumab-treated patients showed significantly greater improvement vs. placebo and etanercept in percentage body surface area involvement and fingernail psoriasis. IXE Q2W was superior to IXE Q4W on all treatment outcomes. CONCLUSIONS Ixekizumab therapy at both dosing regimens demonstrated rapid onset and superior efficacy to placebo and etanercept, with IXE Q2W providing better outcomes than IXE Q4W during the first 12 weeks of treatment.
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Affiliation(s)
- K A Papp
- K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
| | | | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - K Reich
- Dermatologikum Hamburg and SCIderm GmbH, Hamburg, Germany
| | - N J Korman
- Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A
| | - M Ohtsuki
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - C Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - S Ball
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - G S Cameron
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - J Erickson
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Zhang
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Mallbris
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
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Ball S, Rogers S, Kanesalingam K, Taylor R, Katsogridakis E, McCollum C. Carotid plaque volume in patients undergoing carotid endarterectomy. Br J Surg 2018; 105:262-269. [PMID: 29315509 PMCID: PMC5873399 DOI: 10.1002/bjs.10670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/10/2017] [Accepted: 07/11/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated. METHODS The volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA. Time from last symptom and severity of stenosis measured by duplex ultrasonography were recorded. Middle cerebral artery emboli were counted using transcranial Doppler imaging (TCD) in a subset of patients. RESULTS Some 339 patients were included, 270 with symptomatic and 69 with asymptomatic carotid stenosis. Mean(s.d.) CPV was higher in symptomatic than in asymptomatic patients (0·97(0·43) versus 0.74(0·41) cm3 ; P < 0·001). CPV did not correlate with severity of carotid stenosis (P = 0·770). Mean CPV was highest at 1·03(0·46) cm3 in the 4 weeks following cerebral symptoms, declining to 0·78(0·36) cm3 beyond 8 weeks. Among 33 patients who had TCD, mean CPV was 1·00(0·48) cm3 in the 27 patients with ipsilateral cerebral emboli compared with 0·67(0·16) cm3 in those without (P = 0·142). There was excellent correlation between CPV measured by tomographic ultrasound imaging and the endarterectomy specimen in 34 patients (r = 0·93, P < 0·001). CONCLUSION CPV correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA.
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Affiliation(s)
- S Ball
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - S Rogers
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Independent Vascular Services Ltd, University Hospital of South Manchester, Manchester, UK
| | - K Kanesalingam
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - R Taylor
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - E Katsogridakis
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - C McCollum
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Simpson S, Beavis D, Dyer J, Ball S. Should old age psychiatry develop memory clinics? A comparison with domiciliary work. Psychiatr bull 2018. [DOI: 10.1192/pb.28.3.78] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodMemory clinics have become very popular in old age psychiatry and there is some pressure for them to be developed in old age services. However, there is little evidence to suggest that they are more advantageous over the traditional domiciliary visits or who should be seen in clinic. This was a naturalistic comparison of 76 consecutive new referrals to a memory clinic, with 74 consecutive new domiciliary requests within the same service over the same period of time. A retrospective case note review collected the clinical features and an 18-month prospective follow-up examined the subsequent clinical management.Clinical ImplicationsThe two groups were characterised more by their similarities than their differences. However, the domiciliary group had greater behavioural and psychological complications. The memory clinic patients were less likely to receive psychotropic medication and here more likely to be followed up.ResultsWe conclude that memory clinics might be less suitable for patients with prominent psychiatric complications. Memory clinics could complement the domiciliary model by providing early psychosocial/neuropsychiatric approaches, although this is likely to lead to an increased clinical case-load.
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Blauvelt A, Gooderham M, Iversen L, Ball S, Zhang L, Agada N, Reich K, Dossenbach M. 398 Efficacy and safety of ixekizumab for the treatment of plaque psoriasis: Results through 108 weeks randomised, phase III clinical trial (UNCOVER-3). J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Solomon DH, Kay J, Duryea J, Lu B, Bolster MB, Yood RA, Han R, Ball S, Coleman C, Lo E, Wohlfahrt A, Sury M, Yin M, Yu Z, Zak A, Gravallese EM. Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol 2017; 69:1741-1750. [PMID: 28544807 DOI: 10.1002/art.40156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/16/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Articular erosions correlate with disability in rheumatoid arthritis (RA). Biologic agents reduce erosion progression in RA, but erosion healing occurs infrequently. This study was undertaken to assess the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor (TNFi). METHODS We conducted a randomized controlled trial in 24 patients with erosive RA, osteopenia, and disease activity controlled by TNFi treatment for at least 3 months. Half were randomized to receive teriparatide for 1 year and the others constituted a wait-list control group. Subjects and primary rheumatologists were not blinded with regard to treatment assignment, but all outcomes were assessed in a blinded manner. The primary outcome measure was change in erosion volume determined by computed tomography at 6 anatomic sites. Significance within each hand and anatomic site was based on a 2-tailed test, with P values less than 0.05 considered significant. RESULTS Baseline characteristics of the treatment groups were well balanced. After 52 weeks, the median change in erosion volume in the teriparatide group was -0.4 mm3 (interquartile range [IQR] -34.5, 29.6) and did not differ significantly from that in controls (median change +9.1 mm3 [IQR -29.6, 26.4]) (P = 0.28). No significant difference in change in erosion volume was noted at the radius, ulna, or metacarpophalangeal joints. Bone mineral density improved at the femoral neck and lumbar spine in the teriparatide group. CONCLUSION Our findings indicate that teriparatide treatment for 1 year does not significantly reduce erosion volume in the hands or wrists of patients with established RA with disease activity controlled by TNFi treatment.
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Affiliation(s)
- D H Solomon
- Brigham and Women's Hospital, Boston, Massachusetts
| | - J Kay
- University of Massachusetts Memorial Medical Center, Worcester
| | - J Duryea
- Brigham and Women's Hospital, Boston, Massachusetts
| | - B Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - R A Yood
- Reliant Medical Group, Worcester, Massachusetts
| | - R Han
- Brigham and Women's Hospital, Boston, Massachusetts
| | - S Ball
- University of Massachusetts Memorial Medical Center, Worcester
| | - C Coleman
- Brigham and Women's Hospital, Boston, Massachusetts
| | - E Lo
- Brigham and Women's Hospital, Boston, Massachusetts
| | - A Wohlfahrt
- Brigham and Women's Hospital, Boston, Massachusetts
| | - M Sury
- Brigham and Women's Hospital, Boston, Massachusetts
| | - M Yin
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Z Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - A Zak
- Brigham and Women's Hospital, Boston, Massachusetts
| | - E M Gravallese
- University of Massachusetts Memorial Medical Center, Worcester
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Sykes* A, Costley AE, Gryaznevich MP, Kingham D, Hugill J, Windsor C, Buxton P, Morgan JG, Huang B, Hammond G, Fanthome J, Smith G, Ball S, Chappell S, Melhem Z. Opportunities and Challenges for Compact Fusion Energy. Fusion Science and Technology 2017. [DOI: 10.13182/fst14-984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Sykes*
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - A. E. Costley
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | | | - D. Kingham
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - J. Hugill
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - C. Windsor
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - P. Buxton
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - J. G. Morgan
- Culham Electromagnetics Ltd, Culham Science Centre, Abingdon, OX14 3DB
| | - B. Huang
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - G. Hammond
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - J. Fanthome
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
| | - G. Smith
- Tokamak Energy Ltd, Culham Science Centre, Abingdon, OX14 3DB UK
- Department of Materials, University of Oxford 16 Parks Road, Oxford OX1 3PH UK
| | - S. Ball
- Oxford Instruments, Abingdon, OX13 5QX, UK
| | | | - Z. Melhem
- Oxford Instruments, Abingdon, OX13 5QX, UK
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Blauvelt A, Griffiths CEM, Lebwohl M, Mrowietz U, Puig L, Ball S, Zhang L, Edson-Heredia E, Warner M, Zhu B, Lin CY, Nikaï E, Dey D, Mallbris L, Reich K. Reaching complete or near-complete resolution of psoriasis: benefit and risk considerations. Br J Dermatol 2017; 177:587-590. [PMID: 28301048 DOI: 10.1111/bjd.15463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Blauvelt
- Oregon Medical Research Center, Suite G, 9495 S. Locust Street, Portland, OR 97223, OR, U.S.A
| | - C E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - M Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, NY, U.S.A
| | - U Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Germany
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - S Ball
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - L Zhang
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | | | - M Warner
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - B Zhu
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - C-Y Lin
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - E Nikaï
- Eli Lilly Belgium, Brussels, Belgium
| | - D Dey
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - L Mallbris
- Eli Lilly and Co., Indianapolis, IN, U.S.A
| | - K Reich
- Dermatologikum Hamburg, Hamburg, Germany
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van de Kerkhof P, Guenther L, Gottlieb AB, Sebastian M, Wu JJ, Foley P, Morita A, Goldblum O, Zhang L, Erickson J, Ball S, Rich P. Ixekizumab treatment improves fingernail psoriasis in patients with moderate-to-severe psoriasis: results from the randomized, controlled and open-label phases of UNCOVER-3. J Eur Acad Dermatol Venereol 2016; 31:477-482. [PMID: 27910156 DOI: 10.1111/jdv.14033] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fingernail psoriasis is difficult to treat. OBJECTIVE The objective was to evaluate the effect of ixekizumab, a monoclonal antibody selectively targeting IL-17A, on fingernail psoriasis. METHODS This Phase 3, double-blind trial (UNCOVER-3) randomized patients to placebo, etanercept (50-mg twice weekly), or 80 mg ixekizumab as one injection every 4 (IXE Q4W) or 2 weeks (IXE Q2W) after a 160-mg starting dose. At Week 12, ixekizumab patients received open-label IXE Q4W through Week 60; placebo patients received a 160-mg starting ixekizumab dose and etanercept patients a 4-week placebo washout before starting IXE Q4W. Efficacy was assessed by mean per cent Nail Psoriasis Severity Index (NAPSI) improvement at Weeks 12 and 60. RESULTS Of 1346 patients in the UNCOVER-3 trial, this subgroup analysis included only patients with baseline fingernail psoriasis: 116 (60.1%) placebo, 236 (61.8%) etanercept, 228 (59.1%) IXE Q4W and 229 (59.5%) IXE Q2W. At Week 12, greater mean per cent NAPSI improvements were achieved in IXE Q4W (36.7%) and IXE Q2W (35.2%) vs. placebo (-34.3%, P < 0.001 each comparison) and etanercept (20.0%, P = 0.048 vs. Q4W, P = 0.072 vs. Q2W). At Week 60, mean per cent NAPSI improvement was >80% regardless of initial treatment. At Week 12 (nonresponder imputation), complete resolution (NAPSI = 0) was achieved in 19.7% (IXE Q4W), 17.5% (IXE Q2W), 4.3% (placebo, P < 0.001 each comparison) and 10.2% (etanercept, P < 0.05 each comparison) of patients. By Week 60, >50% of patients achieved complete resolution. CONCLUSIONS At Week 12, significant improvements in fingernail psoriasis were achieved with ixekizumab therapy. With IXE Q4W maintenance dosing, additional improvement was demonstrated through 60 weeks, and >50% of patients achieved complete resolution. Registered at clinicaltrials.gov: NCT01646177.
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Affiliation(s)
- P van de Kerkhof
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L Guenther
- Division of Dermatology, Department of Medicine, Western University, London, ON, Canada.,Guenther Research, Inc., London, ON, Canada
| | - A B Gottlieb
- Department of Dermatology, New York Medical College, Valhalla, NY, USA
| | - M Sebastian
- Private Practice Dermatologist, Mahlow, Germany
| | - J J Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - P Foley
- Department of Medicine (Dermatology), The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia.,Department of Dermatology, Skin and Cancer Foundation, Carlton, Vic., Australia
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - O Goldblum
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J Erickson
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S Ball
- Eli Lilly and Company, Indianapolis, IN, USA
| | - P Rich
- Dermatology and Clinical Research, Oregon Health Science University, Portland, OR, USA
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Papp K, Leonardi C, Blauvelt A, Korman N, Ohtsuki M, Reich K, Mallbris L, Ball S, Erickson J, Griffiths C. 058 Efficacy of ixekizumab therapy: integrated analysis of 3 double-blind, controlled trials UNCOVER-1, UNCOVER-2, UNCOVER-3. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shabir S, Smith H, Kaul B, Pachnio A, Jham S, Kuravi S, Ball S, Chand S, Moss P, Harper L, Borrows R. Cytomegalovirus-Associated CD4(+) CD28(null) Cells in NKG2D-Dependent Glomerular Endothelial Injury and Kidney Allograft Dysfunction. Am J Transplant 2016; 16:1113-28. [PMID: 26603521 DOI: 10.1111/ajt.13614] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 01/25/2023]
Abstract
Emerging data suggest that expansion of a circulating population of atypical, cytotoxic CD4(+) T cells lacking costimulatory CD28 (CD4(+) CD28(null) cells) is associated with latent cytomegalovirus (CMV) infection. The purpose of the current study was to increase the understanding of the relevance of these cells in 100 unselected kidney transplant recipients followed prospectively for a median of 54 months. Multicolor flow cytometry of peripheral blood mononuclear cells before transplantation and serially posttransplantation was undertaken. CD4(+) CD28(null) cells were found predominantly in CMV-seropositive patients and expanded in the posttransplantation period. These cells were predominantly effector-memory phenotype and expressed markers of endothelial homing (CX3CR1) and cytotoxicity (NKG2D and perforin). Isolated CD4(+) CD27(-) CD28(null) cells proliferated in response to peripheral blood mononuclear cells previously exposed to CMV-derived (but not HLA-derived) antigens and following such priming incubation with glomerular endothelium resulted in signs of endothelial damage and apoptosis (release of fractalkine and von Willebrand factor; increased caspase 3 expression). This effect was mitigated by NKG2D-blocking antibody. Increased CD4(+) CD28(null) cell frequencies were associated with delayed graft function and lower estimated glomerular filtration rate at end follow-up. This study suggests an important role for this atypical cytotoxic CD4(+) CD28(null) cell subset in kidney transplantation and points to strategies that may minimize the impact on clinical outcomes.
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Affiliation(s)
- S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - H Smith
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - B Kaul
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK.,School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - A Pachnio
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Jham
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - S Kuravi
- Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - S Ball
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - S Chand
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - P Moss
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Harper
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - R Borrows
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
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Pasha N, Woolf D, Jiad E, Ball S, Raouf S. EP-1285: Is watch and wait policy after chemoradiotherapy for rectal cancer detrimental to outcome? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32535-x] [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]
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Jiad E, Woolf D, Pasha N, Ball S, Raouf S. EP-1283: Outcomes and toxicities in advanced anal cancer treated with radical VMAT chemoradiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Griffiths C, Reich K, Lebwohl M, Van De Kerkhof P, Paul C, Menter A, Cameron G, Erickson J, Zhang L, Secrest R, Ball S, Braun D, Osuntokun O, Heffernan M, Nickoloff B, Papp K. Essai de phase 3 comparant l’ixekizumab au placebo et à l’étanercept dans le traitement du psoriasis en plaques modéré à sévère : résultats de la période d’induction de 12 semaines de l’essai UNCOVER-2. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.102] [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]
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Wharton R, Henckel J, Bhattee G, Ball S, Church S. Segond fracture in an adult is not pathognomonic for ACL injury. Knee Surg Sports Traumatol Arthrosc 2015; 23:1925-8. [PMID: 24687316 DOI: 10.1007/s00167-014-2965-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/19/2014] [Indexed: 01/26/2023]
Abstract
The Segond fracture is an avulsion fracture of the lateral tibial plateau and is considered pathognomonic for anterior cruciate ligament (ACL) injury. A case of a Segond fracture occurring with a clinically, radiologically and arthroscopically intact ACL is presented. This was associated with a serious injury to the posterolateral corner requiring surgical reconstruction. Relevant literature is discussed, and the suggestion is made that, whilst an ACL rupture may be the most commonly noted soft tissue component associated with a Segond fracture, the clinician should have a high level of suspicion for other serious soft tissue injuries. Level of evidence V.
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Affiliation(s)
- R Wharton
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK,
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Shabir S, Girdlestone J, Briggs D, Kaul B, Smith H, Daga S, Chand S, Jham S, Navarrete C, Harper L, Ball S, Borrows R. Transitional B lymphocytes are associated with protection from kidney allograft rejection: a prospective study. Am J Transplant 2015; 15:1384-91. [PMID: 25808898 DOI: 10.1111/ajt.13122] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
Abstract
Recent cross-sectional studies suggest an important role for transitional B lymphocytes (CD19 + CD24hiCD38hi) in promoting transplant tolerance, and protecting from late antibody-mediated rejection (ABMR). However, prospective studies are lacking. This study enrolled 73 de novo transplant recipients, and collected serial clinical, immunological and biochemical information over 48 ± 6 months. Cell phenotyping was conducted immediately prior to transplantation, and then on five occasions during the first year posttransplantation. When modeled as a time-dependent covariate, transitional B cell frequencies (but not total B cells or "regulatory" T cells) were associated with protection from acute rejection (any Banff grade; HR: 0.60; 95% CI: 0.37-0.95; p = 0.03). No association between transitional B cell proportions and either de novo donor-specific or nondonor-specific antibody (dnDSA; dnNDSA) formation was evident, although preserved transitional B cell proportions were associated with reduced rejection rates in those patients developing dnDSA. Three episodes of ABMR occurred, all in the context of nonadherence, and all associated with in vitro anti-HLA T cell responses in an ELISPOT assay (p = 0.008 versus antibody-positive patients not experiencing ABMR). This prospective study supports the potential relevance of transitional ("regulatory") B cells as a biomarker and therapeutic intervention in transplantation, and highlights relationships between humoral immunity, cellular immunity and nonadherence.
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Affiliation(s)
- S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, UK; Centre for Translational Inflammation Research, University of Birmingham, UK
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Gonzalez VH, Ball S, Cramer R, Smith A. Anatomical and Morphometric Variations in the Arterial System of the Domestic Cat. Anat Histol Embryol 2014; 44:428-32. [DOI: 10.1111/ahe.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- V. H. Gonzalez
- Biological Sciences; Southwestern Oklahoma State University; 100 Campus Drive Weatherford OK 73096 USA
| | - S. Ball
- Biological Sciences; Southwestern Oklahoma State University; 100 Campus Drive Weatherford OK 73096 USA
| | - R. Cramer
- Biological Sciences; Southwestern Oklahoma State University; 100 Campus Drive Weatherford OK 73096 USA
| | - A. Smith
- Biological Sciences; Southwestern Oklahoma State University; 100 Campus Drive Weatherford OK 73096 USA
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Mellor AJ, Boos CJ, Ball S, Burnett A, Pattman S, Redpath M, Woods DR. Copeptin and arginine vasopressin at high altitude: relationship to plasma osmolality and perceived exertion. Eur J Appl Physiol 2014; 115:91-8. [PMID: 25213006 DOI: 10.1007/s00421-014-2994-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE A diuresis is a key part of acclimatisation to high altitude (HA). Arginine vasopressin (AVP) is a hormone involved in salt and water balance and may potentially have a role in the development of altitude illness. ProAVP (copeptin) is more stable than AVP and is assayed by a straightforward, automated method. We investigated the relationship of AVP to copeptin and the copeptin response to exercise and altitude illness in a large cohort during a field study at HA. METHODS 48 subjects took part in a 10-day trek at HA. Venous blood samples were taken at 3,833, 4,450 and 5,129 m post-trek (exercise) and the following day at rest. Daily recordings of symptoms of altitude illness, oxygen saturations and perceived exertion were carried out. RESULTS AVP and copeptin levels increased with exercise and correlated closely (ρ 0.621 p < 0.001), this was strongest in the stressed state when AVP secretion was highest, at 5,129 m post-exercise (ρ 0.834 p < 0.001). On two-way ANOVA, both altitude (F = 3.5; p = 0.015) and exercise (F = 10.2; p = 0.002) influenced copeptin levels (interaction F = 2.2; p = 0.08). AVP levels were influenced by exercise (F = 14.4; p = 0.0002) but not altitude (F = 2.0; p = 0.12) with no overall group interactions (F = 1.92.6; p = 0.06). There was no association between copeptin or arginine vasopressin and altitude illness. Copeptin correlated with the Borg RPE score and was significantly higher in the group with a Borg score ≥15 (7.9 vs. 3.7 p < 0.001). CONCLUSION We have shown that arginine vasopressin and copeptin levels correlate and are suppressed below 5,129 m. Furthermore, we have demonstrated that exertion, rather than altitude illness or increasing osmolality, is the stimulus for increases in copeptin.
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Affiliation(s)
- A J Mellor
- Defence Medical Services, Lichfield, UK,
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