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Kyriacou C, Yang W, Kapur S, Maheetharan S, Pikovsky M, Parker N, Barcroft J, Bobdiwala S, Sur S, Stalder C, Gould D, Ofili-Yebovi D, Day A, Unsworth N, Wilkes EH, Tan T, Bourne T. Ambulatory human chorionic gonadotrophin (hCG) testing: a verification of two hCG point of care devices. Clin Chem Lab Med 2024; 62:664-673. [PMID: 37886834 DOI: 10.1515/cclm-2023-0703] [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: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Quantitative human chorionic gonadotropin (hCG) measurements are used to manage women classified with a pregnancy of unknown location (PUL). Two point of care testing (POCT) devices that quantify hCG are commercially available. We verified the i-STAT 1 (Abbott) and the AQT 90 FLEX (Radiometer) prior to use in PUL triage. METHODS Tests for precision, external quality assurance (EQA), correlation, hook effect and recovery were undertaken alongside a POCT usability assessment during this prospective multi-center verification. RESULTS Coefficients of variation ranged between 4.0 and 5.1 % for the three i-STAT 1 internal quality control (IQC) solutions and between 6.8 and 7.3 % for the two AQT IQC solutions. Symmetric differences in POCT EQA results when compared with laboratory and EQA stock values ranged between 3.2 and 24.5 % for the i-STAT 1 and between 3.3 and 36.9 % for the AQT. Correlation coefficients (i-STAT 1: 0.96, AQT: 0.99) and goodness of fit curves (i-STAT 1: 0.92, AQT: 0.99) were excellent when using suitable whole blood samples. An hCG hook effect was noted with the i-STAT 1 between 572,194 and 799,089 IU/L, lower than the hook effect noted with the AQT, which was between 799,089 and 1,619,309 IU/L. When hematocrit concentration was considered in sample types validated for use with each device, hCG recovery was 108 % with the i-STAT 1 and 98 % with the AQT. The i-STAT 1 scored lower on usability overall (90/130) than the AQT (121/130, p<0.001, Mann-Whitney). CONCLUSIONS Both hCG POCT devices were verified for use in clinical practice. Practical factors must also be considered when choosing which device to use in each unit.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Dede Ofili-Yebovi
- Early Pregnancy Assessment Unit, Chelsea and Westminster Hospital, London, UK
| | - Andrea Day
- Early Pregnancy Assessment Unit, West Middlesex University Hospital, London, UK
| | - Nick Unsworth
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Edmund H Wilkes
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tricia Tan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Kyriacou C, Kapur S, Jeyapala S, Parker N, Yang W, Pikovsky M, Bobdiwala S, Barcroft J, Maheetharan S, Sur S, Stalder C, Gould D, Syed S, Tan T, Bourne T. Beta-human chorionic gonadotrophin point of care testing for the management of pregnancy of unknown location. Reprod Biomed Online 2024; 48:103643. [PMID: 38262209 DOI: 10.1016/j.rbmo.2023.103643] [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: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Abstract
RESEARCH QUESTION Does a commercially available quantitative beta-human chorionic gonadotrophin (BHCG) point of care testing (POCT) device improve workflow management in early pregnancy by performing comparably to gold standard laboratory methods, and is the performance of a validated pregnancy of unknown location (PUL) triage strategy maintained using POCT BHCG results? DESIGN Women classified with a PUL between 2018 and 2021 at three early pregnancy units were included. The linear relationship of untreated whole-blood POCT and serum laboratory BHCG values was defined using coefficients and regression. Paired serial BHCG values were then incorporated into the validated M6 multinomial logistic regression model to stratify the PUL as at high risk or at low risk of clinical complications. The sensitivity and negative predictive value were assessed. The timings required for equivocal POCT and laboratory care pathways were compared. RESULTS A total of 462 PUL were included. The discrepancy between 571 laboratory and POCT BHCG values was -5.2% (-6.2 IU/l), with a correlation coefficient of 0.96. The 133 PUL with paired 0 and 48 h BHCG values were compared using the M6 model. The sensitivity for high-risk outcomes (96.2%) and negative predictive values (98.5%) was excellent for both. Sample receipt and laboratory processing took 135 min (421 timings), compared with 12 min (91 timings) when using POCT (P < 0.0001). CONCLUSIONS POCT BHCG values correlated well with laboratory testing measurements. The M6 model retained its performance when using POCT BHCG values. Using the model with POCT may improve workflow and patient care without compromising on effective PUL triage.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Sobanakumari Jeyapala
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shabana Syed
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Tricia Tan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Shiraiwa M, Fang T, Wei J, Lakey P, Hwang B, Edwards KC, Kapur S, Mena J, Huang YK, Digman MA, Weichenthal SA, Nizkorodov S, Kleinman MT. Chemical and Cellular Formation of Reactive Oxygen Species from Secondary Organic Aerosols in Epithelial Lining Fluid. Res Rep Health Eff Inst 2023:1-56. [PMID: 38420854] [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: 03/02/2024] Open
Abstract
INTRODUCTION Oxidative stress mediated by reactive oxygen species (ROS) is a key process for adverse aerosol health effects. Secondary organic aerosols (SOA) account for a major fraction of particulate matter with aerodynamic diameter ≤2.5 µm (PM2.5). PM2.5 inhalation and deposition into the respiratory tract causes the formation of ROS by chemical reactions and phagocytosis of macrophages in the epithelial lining fluid (ELF), but their relative contributions are not well quantified and their link to oxidative stress remains uncertain. The specific aims of this project were (1) elucidating the chemical mechanism and quantifying the formation kinetics of ROS in the ELF by SOA; (2) quantifying the relative importance of ROS formation by chemical reactions and macrophages in the ELF. METHODS SOA particles were generated using reaction chambers from oxidation of various precursors including isoprene, terpenes, and aromatic compounds with or without nitrogen oxides (NOx). We collected size-segregated PM at two highway sites in Anaheim, CA, and Long Beach, CA, and at an urban site in Irvine, CA, during two wildfire events. The collected particles were extracted into water or surrogate ELF that contained lung antioxidants. ROS generation was quantified using electron paramagnetic resonance (EPR) spectroscopy with a spin-trapping technique. PM oxidative potential (OP) was also quantified using the dithiothreitol assay. In addition, kinetic modeling was applied for analysis and interpretation of experimental data. Finally, we quantified cellular superoxide release by RAW264.7 macrophage cells upon exposure to quinones and isoprene SOA using a chemiluminescence assay as calibrated with an EPR spin-probing technique. We also applied cellular imaging techniques to study the cellular mechanism of superoxide release and oxidative damage on cell membranes. RESULTS Superoxide radicals (·O2-) were formed from aqueous reactions of biogenic SOA generated by hydroxy radical (·OH) photooxidation of isoprene, β-pinene, α-terpineol, and d-limonene. The temporal evolution of ·OH and ·O2- formation was elucidated by kinetic modeling with a cascade of aqueous reactions, including the decomposition of organic hydroperoxides (ROOH), ·OH oxidation of primary or secondary alcohols, and unimolecular decomposition of α-hydroxyperoxyl radicals. Relative yields of various types of ROS reflected the relative abundance of ROOH and alcohols contained in SOA, which generated under high NOx conditions, exhibited lower ROS yields. ROS formation by SOA was also affected by pH. Isoprene SOA had higher ·OH and organic radical yields at neutral than at acidic pH. At low pH ·O2- was the dominant species generated by all types of SOA. At neutral pH, α-terpineol SOA exhibited a substantial yield of carbon-centered organic radicals (R·), while no radical formation was observed by aromatic SOA. Organic radicals in the ELF were formed by mixtures of Fe2+ and SOA generated from photooxidation of isoprene, α-terpineol, and toluene. The molar yields of organic radicals by SOA were 5-10 times higher in ELF than in water. Fe2+ enhanced organic radical yields by a factor of 20-80. Ascorbate mediated redox cycling of iron ions and sustained organic peroxide decomposition, as supported by kinetic modeling reproducing time- and concentration-dependence of organic radical formation, as well as by additional experiments observing the formation of Fe2+ and ascorbate radicals in mixtures of ascorbate and Fe3+. ·OH and superoxide were found to be efficiently scavenged by antioxidants. Wildfire PM mainly generated ·OH and R· with minor contributions from superoxide and oxygen-centered organic radicals (RO·). PM OP was high in wildfire PM, exhibiting very weak correlation with radical forms of ROS. These results were in stark contrast with PM collected at highway and urban sites, which generated much higher amounts of radicals dominated by ·OH radicals that correlated well with OP. By combining field measurements of size-segregated chemical composition, a human respiratory tract model, and kinetic modeling, we quantified production rates and concentrations of different types of ROS in different regions of the ELF by considering particle-size-dependent respiratory deposition. While hydrogen peroxide (H2O2) and ·O2- production were governed by Fe and Cu ions, ·OH radicals were mainly generated by organic compounds and Fenton-like reactions of metal ions. We obtained mixed results for correlations between PM OP and ROS formation, providing rationale and limitations of the use of oxidative potential as an indicator for PM toxicity in epidemiological and toxicological studies. Quinones and isoprene SOA activated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in macrophages, releasing massive amounts of superoxide via respiratory burst and overwhelming the superoxide formation by aqueous chemical reactions in the ELF. The threshold dose for macrophage activation was much smaller for quinones compared with isoprene SOA. The released ROS caused lipid peroxidation to increase cell membrane fluidity, inducing oxidative damage and stress. Further increases of doses led to the activation of antioxidant response elements, reducing the net cellular superoxide production. At very high doses and long exposure times, chemical production became comparably important or dominant if the escalation of oxidative stress led to cell death. CONCLUSIONS The mechanistic understandings and quantitative information on ROS generation by SOA particles provided a basis for further elucidation of adverse aerosol health effects and oxidative stress by PM2.5. For a comprehensive assessment of PM toxicity and health effects via oxidative stress, it is important to consider both chemical reactions and cellular processes for the formation of ROS in the ELF. Chemical composition of PM strongly influences ROS formation; further investigations are required to study ROS formation from various PM sources. Such research will provide critical information to environmental agencies and policymakers for the development of air quality policy and regulation.
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Affiliation(s)
- M Shiraiwa
- Department of Chemistry, University of California, Irvine, CA, USA
| | - T Fang
- Department of Chemistry, University of California, Irvine, CA, USA
| | - J Wei
- Department of Chemistry, University of California, Irvine, CA, USA
| | - Psj Lakey
- Department of Chemistry, University of California, Irvine, CA, USA
| | - Bch Hwang
- Department of Chemistry, University of California, Irvine, CA, USA
| | - K C Edwards
- Department of Chemistry, University of California, Irvine, CA, USA
| | - S Kapur
- Department of Chemistry, University of California, Irvine, CA, USA
| | - Jem Mena
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA, USA
| | - Y-K Huang
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - M A Digman
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - S A Weichenthal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - S Nizkorodov
- Department of Chemistry, University of California, Irvine, CA, USA
| | - M T Kleinman
- Division of Occupational and Environmental Medicine, University of California, Irvine, CA, USA
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Tombal B, Saad F, Fizazi K, Sternberg C, Crawford E, Gratzke C, Grabbert M, Vilaseca A, Shore N, Kopyltsov E, Bögemann M, Kapur S, Srinivasan S, Verholen F, Kuss I, Joensuu H, Smith M, Hussain M. Efficacy and safety of darolutamide (DARO) in combination with androgen-deprivation therapy (ADT) and docetaxel (DOC) in patients (pts) with metastatic hormone sensitive prostate cancer (mHSPC) by metastatic burden: Subgroup analyses of ARASENS. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01221-6] [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: 02/12/2023]
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Fizazi K, Smith M, Hussain M, Saad F, Sternberg C, Crawford E, Aragon-Ching J, Thiele S, Kapur S, Mohamed A, Srinivasan S, Li R, Kuss I, Joensuu H, Tombal B. 1360MO Quality of life and patient-relevant endpoints with darolutamide in the phase III ARASENS study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1492] [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] Open
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Kapur S, Gauri LA, Singh U, Liyakat N, Khan A, Fatima Q. Association of CRP Haplotypes in Rheumatoid Arthritis and their Correlation with Severity of the Disease. J Assoc Physicians India 2022; 70:11-12. [PMID: 35062811] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Rheumatoid arthritis is a heterogenous autoimmune disorder of unknown cause with variable clinical expression. Genetic factors play an important role and likely account for about 60% of disease susceptibility and expression. The aim of this study to find out the association of CRP haplotypes in rheumatoid arthritis and their correlation with severity of the disease. MATERIAL AND METHODS This was case control study where in all available patients and volunteers (only for blood samples) were recruited. Peripheral blood samples of patients were collected at Rheumatology Clinic and Medicine Department of S.P. Medical College, Bikaner in collaboration with Department of Biological Sciences, BITS, Pilani-Hyderabad during July 2009 to January 2012. 100 control subjects with no known history of disease and 135 cases were recruited as per pre-decided inclusion and exclusion criteria. A tag SNP approach captured common variation at the CRP locus and the relationship between genotype and serum CRP was explored by linear modelling. RESULTS Cases comprised of 98 females (Mean age 43.01+13.23 yrs) and 37 (mean age 47.4+14.9 years) males. The Control group comprised of 100 unrelated healthy controls. The cases and controls did not differ significantly for any of the clinical parameters, except for serum CRP levels. The allele distribution of rs1205 polymorphism among the studied cases and controls, which was statistical non-significant. The rs3093066 polymorphism located at the 3` position of the gene in the UTR at position number 157949723. The rs3116640 polymorphism located at 157948938 position on chromosome1 and the allele distribution of rs3116637 polymorphism among cases and controls which was also found to be monomorphic respectively. CONCLUSION Extending the studies to a larger cohort will also allow genetic analyses of clinically defined endophenotypes observed in the patients of this chronic metabolic disease with attributes of autoimmune disorder and multiple symptoms in patients. Genetic studies can also impact strategies adopted for effective personalized treatment for this progressively debilitating disease.
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Affiliation(s)
- S Kapur
- Senior professor, and Dean, BITS Pilani, Hyderabad, Telangana
| | - Liyakat Ali Gauri
- Senior Professor, Medicine and Additional Principal-1, SP Medical College, Bikaner, Rajasthan; Corresponding Author
| | - Ummed Singh
- Assistant Professor, Medicine, SK Government Medical College, Sikar, Rajasthan
| | - Nadeem Liyakat
- 3rd Year Resident, MD Radiodiagnosis, GMCH, Udaipur, Rajasthan
| | - Asim Khan
- Associate professor, Opthalmology, NIMS, Jaipur, Rajasthan
| | - Qadir Fatima
- Senior Professor, Pathology, SP Medical College, Bikaner, Rajasthan
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Koshal SS, Ray A, Mehra R, Kaur A, Quadri SF, Agarwal P, Kapur S, Debroy A, Haldar P. Partnering for rotavirus vaccine introduction in India: A retrospective analysis. Vaccine 2021; 39:6470-6476. [PMID: 34538521 DOI: 10.1016/j.vaccine.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pre-existing partner network created in India for the delivery of polio vaccines was initially used to eradicate polio and later on embedded in the health systems network to promote routine immunization and other health interventions efficiently. The experience from this network offered lessons for strengthening the health care systems and provided a well-established network that could be utilized for other vaccine initiatives. It has also been established that successful partnerships between a broad range of stakeholders provide support, strengthen the health system, and accelerate vaccine innovation, introduction, access, logistics, and communication support. However, beyond polio eradication, there have not been too many documented success stories of vaccine introduction, which could be replicated in other new vaccine introductions and allied health initiatives. The authors have reviewed the successful and time-bound introduction of rotavirus vaccine (RVV) in India in the present article. METHODS The review was conducted based on a partnership framework which analysed multiple factors-partnership prerequisites, partnership model, partnership process, and partnership performance, thereby providing a comprehensive insight into the successful utilization of partnership networks for rotavirus vaccine introduction under the Universal Immunization Program in India. RESULTS & CONCLUSION The review also highlights the role of a lead agency in creating a fertile ground for lush, efficient, and effective partnerships amongst different stakeholders. The already existing RVV partnership framework reviewed by the authors can be successfully utilized for future new vaccine introductions.
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Affiliation(s)
| | - A Ray
- Bill and Melinda Gates Foundation, New Delhi, India
| | - R Mehra
- John Snow India, New Delhi, India
| | - A Kaur
- John Snow India, New Delhi, India
| | | | | | - S Kapur
- John Snow India, New Delhi, India
| | - A Debroy
- John Snow India, New Delhi, India
| | - P Haldar
- Ministry of Health and Family Welfare, New Delhi, India
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Gupta N, Kapur S. Medical publishing: a flawed model in dire need of reform. Eur J Psychiatry 2021; 37:136-138. [PMID: 34511685 PMCID: PMC8418935 DOI: 10.1016/j.ejpsy.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
Recently, in the midst of the Covid-19 pandemic, high-profile retractions of some papers published in prestigious medical journals have highlighted the necessity for structural reform to the current model of medical publishing. We discuss what ails the current system and what can be done to remedy it.
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Affiliation(s)
- N Gupta
- Speciality Trainee ST6, General Adult Community Mental Health Team, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - S Kapur
- Pain Management & Anaesthesia, University Hospital Birmingham, Birmingham, UK
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Mahammedi A, Ramos A, Bargalló N, Gaskill M, Kapur S, Saba L, Carrete H, Sengupta S, Salvador E, Hilario A, Revilla Y, Sanchez M, Perez-Nuñez M, Bachir S, Zhang B, Oleaga L, Sergio J, Koren L, Martin-Medina P, Wang L, Benegas M, Ostos F, Gonzalez-Ortega G, Calleja P, Udstuen G, Williamson B, Khandwala V, Chadalavada S, Woo D, Vagal A. Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study. AJNR Am J Neuroradiol 2021; 42:1008-1016. [PMID: 33707278 DOI: 10.3174/ajnr.a7072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.
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Affiliation(s)
- A Mahammedi
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Ramos
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Bargalló
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Gaskill
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - S Kapur
- Cardiopulmonary Imaging, (S.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - L Saba
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - H Carrete
- Department of Neuroradiology (H.C.), Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - S Sengupta
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - E Salvador
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hilario
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Y Revilla
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sanchez
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - M Perez-Nuñez
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - L Oleaga
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - J Sergio
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - L Koren
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Martin-Medina
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Wang
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Benegas
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - F Ostos
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Gonzalez-Ortega
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Calleja
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Udstuen
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B Williamson
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - V Khandwala
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - D Woo
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Vagal
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
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Lim H, Kim Y, Huang YH, Shao G, Kim D, Cho S, Hsu CH, Lin SM, Jeng LB, Kuo KK, Mao Y, Zhu K, Hong Y, Lee H, Ryoo BY, Niu Z, Wu L, Fiala-Buskies S, Kapur S, Qin S. 173P Regorafenib in patients (pts) with unresectable hepatocellular carcinoma (uHCC) in real-world practice in Asia: Interim results from the observational REFINE study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.194] [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] Open
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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15
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Cibelli M, White J, Singh H, Vivona L, Agarwal S, Metha R, Oelofse T, Duncan F, Kapur S, Morgese C, Brodier E, Midgley-Hunt A, Veenith T, Smith FG. A novel ultrasound-guided pectoralis-intercostal rectus-sheath (PIRS) block for the management of chest wall analgesia after cardiac surgery: a prospective hospital-based cross-sectional control study. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lim H, Kim Y, Huang YH, Shao G, Kim D, Cho S, Hsu CH, Lin SM, Jeng LB, Kuo KK, Mao Y, Zhu K, Hong Y, Lee H, Ryoo BY, Niu Z, Wu L, Fiala-Buskies S, Kapur S, Qin S. 1009P Regorafenib in patients (pts) with unresectable hepatocellular carcinoma (uHCC) in real-world practice in Asia: Interim results from the observational REFINE study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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So S, Chau A, Peters E, Swendsen J, Garety P, Kapur S. Moment-to-moment associations between emotional disturbances, aberrant salience and persecutory delusions. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.1653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionExperiences of depression and anxiety are common among patients with persecutory delusions. It has been theorized that emotional disturbances affect the formation and appraisal of persecutory delusions directly and possibly via increasing the sense of aberrant salience.ObjectivesUsing a time-lagged analysis of experience sampling data, this study modelled the role of momentary levels of negative emotions and aberrant salience in maintaining persecutory delusions in patients with active delusions.MethodsClinically acute participants with at least a mild level of persecutory delusions were assessed using experience sampling method (ESM; 7 entries per day for 14 days) and clinical rating scales. ESM data of participants who completed at least 30 ESM entries were analysed by using multilevel regression modelling.ResultsThe final sample consisted of 14 participants, with a total of 1161 momentary observations. Time-lagged analysis revealed that both negative emotions (B = 0.125, P = .009) and aberrant salience (B = 0.267, P< .001) predicted an increase in persecutory delusions in the next moment. Conversely, persecutory delusions did not predict change in negative emotions or change in aberrant salience in the next moment (ps> .05). Negative emotions also predicted an increase in aberrant salience in the next moment (B = 0.087, P = .009).ConclusionsOur results supported the hypothesis that both negative emotions and aberrant salience exacerbate persecutory delusions, rather than being merely the sequelae of the symptoms. Our results suggested both direct and indirect (via aberrant salience) pathways from negative emotions to persecutory delusions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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18
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Bégin P, Chan ES, Kim H, Wagner M, Cellier MS, Favron-Godbout C, Abrams EM, Ben-Shoshan M, Cameron SB, Carr S, Fischer D, Haynes A, Kapur S, Primeau MN, Upton J, Vander Leek TK, Goetghebeur MM. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol 2020; 16:20. [PMID: 32206067 PMCID: PMC7079444 DOI: 10.1186/s13223-020-0413-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.
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Affiliation(s)
- P Bégin
- 1Division of Clinical Immunology, Rheumatology and Allergy, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC Canada.,2Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada.,3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - E S Chan
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada
| | - H Kim
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,6Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - M Wagner
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
| | - M S Cellier
- 3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - C Favron-Godbout
- 8Department of Bioethics, School of Public Health of the University of Montreal, Montreal, Canada
| | - E M Abrams
- 9Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - M Ben-Shoshan
- 10Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC Canada
| | - S B Cameron
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada.,Community Allergy Clinic, Victoria, BC Canada
| | - S Carr
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - D Fischer
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - A Haynes
- 13Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL Canada
| | - S Kapur
- 14Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - M N Primeau
- 15Division of Allergy and Clinical Immunology, Department of Medicine, CISSS Laval, Laval, QC Canada
| | - J Upton
- 16Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - T K Vander Leek
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - M M Goetghebeur
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
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19
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Fielding A, Woods R, Moosvi SR, Wharton RQ, Speakman CTM, Kapur S, Shaikh I, Hernon JM, Lines SW, Stearns AT. Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis 2020; 22:269-278. [PMID: 31562789 DOI: 10.1111/codi.14866] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
AIM High stoma output and dehydration is common following ileostomy formation. However, the impact of this on renal function, both in the short term and after ileostomy reversal, remains poorly defined. We aimed to assess the independent impact on kidney function of an ileostomy after rectal cancer surgery and subsequent reversibility after ileostomy closure. METHODS This retrospective single-site cohort study identified patients undergoing rectal cancer resection from 2003 to 2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and 6 months after ileostomy reversal (or matched times for patients without ileostomy). Demographics, oncological treatments and nephrotoxic drug prescriptions were assessed. Outcome measures were deterioration from baseline renal function and development of moderate/severe chronic kidney disease (CKD ≥ 3). Multivariate analysis was performed to assess independent risk factors for postoperative renal impairment. RESULTS Five hundred and eighty-three of 1213 patients had an ileostomy. Postoperative renal impairment occurred more frequently in ileostomates (9.5% absolute increase in rate of CKD ≥ 3; P < 0.0001) vs no change in patients without an ileostomy (P = 0.757). Multivariate analysis identified ileostomy formation, age, anastomotic leak and renin-angiotensin system inhibitors as independently associated with postoperative renal decline. Despite stoma closure, ileostomates remained at increased risk of progression to new or worse CKD [74/438 (16.9%)] compared to patients without an ileostomy [36/437 (8.2%), P = 0.0001, OR 2.264 (1.49-3.46)]. CONCLUSIONS Ileostomy formation is independently associated with kidney injury, with an increased risk persisting after stoma closure. Strategies to protect against kidney injury may be important in higher risk patients (elderly, receiving renin-angiotensin system antihypertensives, or following anastomotic leakage).
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Affiliation(s)
- A Fielding
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Woods
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - S R Moosvi
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - R Q Wharton
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - C T M Speakman
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Kapur
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - I Shaikh
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - J M Hernon
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - S W Lines
- Department of Nephrology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Department of Nephrology, St Bernard's Hospital, Gibraltar, Gibraltar
| | - A T Stearns
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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20
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Kapur S, Gruber A, Sekar H, Mafuta J, Lodhi W, Sivashanmugarajan V, Yoong W. Does temperature of distending medium matter in outpatient hysteroscopy? A double-blinded cohort control observational study of room temperature versus warmed saline. J Obstet Gynaecol Res 2020; 46:485-489. [PMID: 31991520 DOI: 10.1111/jog.14207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
AIM There is little data assessing outcomes of outpatient hysteroscopy using warmed versus room temperature saline. The aim of this study was to determine if the temperature of the distending medium during outpatient hysteroscopy affect ease of procedure, clarity of view, procedural discomfort/pain and patient satisfaction. METHODS This was a double-blinded cohort control quasi-randomized prospective study involving 100 women undergoing outpatient diagnostic and operative hysteroscopy for abnormal uterine bleeding, intrauterine contraceptive devices retrieval and removal of endometrial polyps. Outpatient hysteroscopy was performed either with normal saline either at room temperature (control at 25°C) or warmed to body temperature (37°C). RESULTS Confounding variables such as age, parity, previous cervical surgery, previous vaginal births, menopausal status and indications for hysteroscopy were similar in the room temperature (n = 48) and warmed saline (n = 52) groups. Mean procedure duration (256 vs 233 s), ease of entry (Visual Analogue Scale [VAS] 9.55 vs 9.4) and the clarity of view (VAS 9.02 vs 9.3) were statistically similar in both groups (all P > 0.05) as was discomfort experienced during hysteroscopy (VAS 6.6/10 vs 6.8/10) and at 5 min post-procedure (VAS 4.2/10 vs 3.2/10) (both P > 0.05). The likelihood of recommending the procedure to a friend was similar in both groups (mean VAS 6.9/10 vs 7.2/10; P = 0.1). CONCLUSION The temperature of the distension medium did not influence ease of procedure, clarity of hysteroscopy view, procedural discomfort/pain and patient satisfaction. Patients were not any more likely to recommend the procedure to a friend in the warmed saline compared to the room temperature group.
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Affiliation(s)
- Shikha Kapur
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
| | - Amelia Gruber
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
| | - Hasviniya Sekar
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
| | - Joadel Mafuta
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
| | - Wasim Lodhi
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
| | | | - Wai Yoong
- Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK
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21
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Aly M, O'Brien JW, Clark F, Kapur S, Stearns AT, Shaikh I. Does intra-operative flexible endoscopy reduce anastomotic complications following left-sided colonic resections? A systematic review and meta-analysis. Colorectal Dis 2019; 21:1354-1363. [PMID: 31243879 DOI: 10.1111/codi.14740] [Citation(s) in RCA: 15] [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: 01/04/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
AIM Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left-sided colonic resection, comparing the use of intra-operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. METHODS PubMed/MEDLINE and Embase online databases were searched for non-randomized and randomized case-control studies that investigated postoperative AL and/or AB rates in left-sided colonic resections, comparing intra-operative FE against conventional tests. Data from eligible studies were pooled, and a meta-analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. RESULTS Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra-operative FE: 0.37 (95% CI 0.21-0.68, P = 0.001) for AL and 0.35 (95% CI 0.15-0.82, P = 0.02) for AB. CONCLUSION This meta-analysis showed that the use of intra-operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.
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Affiliation(s)
- M Aly
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - J W O'Brien
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - F Clark
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - S Kapur
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - A T Stearns
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - I Shaikh
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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22
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Kroon HM, Dudi-Venkata N, Bedrikovetski S, Thomas M, Kelly M, Aalbers A, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alberda W, Andric M, Antoniou A, Austin K, Baker R, Bali M, Baseckas G, Bednarski B, Beets G, Berg P, Beynon J, Biondo S, Bordeianou L, Brunner M, Buchwald P, Burger J, Burling D, Campain N, Chan K, Chang G, Chew M, C Chong P, Christensen H, Codd M, Colquhoun A, Corr A, Coscia M, Coyne P, Creavin B, Damjanovic L, Daniels I, Davies M, Davies R, de Wilt J, Denost Q, Dietz D, Dozois E, Duff M, Eglinton T, Enriquez-Navascues J, Evans M, Fearnhead N, Frizelle F, Garcia-Granero E, Garcia-Sabrido J, Gentilini L, George M, Glynn R, Golda T, Griffiths B, Harris D, Evans M, Hagemans J, Harji D, Heriot A, Hohenberger W, Holm T, Jenkins J, Kapur S, Kanemitsu Y, Kelley S, Keller D, Kim H, Koh C, Kok N, Kokelaar R, Kontovounisios C, Kusters M, Larson D, Law W, Laurberg S, Lee P, Lydrup M, Lynch A, Mantyh C, Mathis K, Martling A, Meijerink W, Merkel S, Mehta A, McDermott F, McGrath J, Mirnezami A, Morton J, Mullaney T, Mesquita-Neto J, Nielsen M, Nieuwenhuijzen G, Nilsson P, O'Connell P, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan R, Rasheed S, Rasmussen P, Regenbogen S, Rocha R, Rothbarth J, Roxburgh C, Rutten H, Ryan É, Sagar P, Saklani A, Schizas A, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart N, Smith J, Solomon M, Sørensen M, Steele S, Steffens D, Stocchi L, Stylianides N, Tekkis P, Taylor C, Tsarkov P, Tsukamoto S, Turner W, Tuynman J, van Ramshorst G, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Wasmuth H, Weiser M, Wheeler J, Wild J, Yip J, Winter D, Sammour T. Palliative pelvic exenteration: A systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45:1787-1795. [DOI: 10.1016/j.ejso.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
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Winton-Brown T, Schmidt A, Roiser JP, Howes OD, Egerton A, Fusar-Poli P, Bunzeck N, Grace AA, Duzel E, Kapur S, McGuire P. Correction: Altered activation and connectivity in a hippocampal-basal ganglia-midbrain circuit during salience processing in subjects at ultra high risk for psychosis. Transl Psychiatry 2018; 8:170. [PMID: 30171182 PMCID: PMC6119195 DOI: 10.1038/s41398-018-0189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This Article was originally published under Nature Research's License to Publish, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the Article have been modified accordingly.
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Affiliation(s)
- T. Winton-Brown
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK ,0000 0004 1936 7857grid.1002.3Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, VIC Australia
| | - A. Schmidt
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK
| | - J. P. Roiser
- 0000000121901201grid.83440.3bInstitute of Cognitive Neuroscience, University College London, London, UK
| | - O. D. Howes
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK ,0000 0001 0705 4923grid.413629.bPsychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
| | - A. Egerton
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK
| | - P. Fusar-Poli
- 0000 0001 2322 6764grid.13097.3cEarly Psychosis: Intervention and Clinical-prediction (EPIC) Lab, Department of Psychosis Studies, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK ,OASIS Service, South London and Maudsley (SLaM) NHS Foundation Trusts, Beckenham, UK
| | - N. Bunzeck
- 0000 0001 0057 2672grid.4562.5Institute of Psychology, University of Luebeck, Luebeck, Germany ,0000 0001 2180 3484grid.13648.38Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A. A. Grace
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA USA
| | - E. Duzel
- 0000000121901201grid.83440.3bInstitute of Cognitive Neuroscience, University College London, London, UK
| | - S. Kapur
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK ,0000 0001 2179 088Xgrid.1008.9Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - P. McGuire
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK
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Kumar R, Raizner Y, Kruh LI, Menashe O, Azaizeh H, Kapur S, Kurzbaum E. Extracellular laccase production and phenolic degradation by an olive mill wastewater isolate. Grasas y Aceites 2018. [DOI: 10.3989/gya.0776171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Olive mill wastewater (OMWW) presents a challenge to the control of effluents due to the presence of a high organic load, antimicrobial agents (monomeric-polymeric phenols, volatile acids, polyalcohols, and tannins), salinity and acidity. In this study, the production of extracellular laccase, monomeric or polymeric phenol, from an OMWW isolate based on its ability to biodegrade phenols and gallic acid as a model of phenolic compounds in OMWW was investigated. Phylogenetic analysis of the 16S RNA gene sequences identified the bacterial isolate (Acinetobacter REY) as being closest to Acinetobacter pittii. This isolate exhibited a constitutive production of extracellular laccase with an activity of 1.5 and 1.3 U ml/L when supplemented with the inducers CuSO4 and CuSO4+phenols, respectively. Batch experiments containing minimal media supplemented with phenols or gallic acid as the sole carbon and energy source were performed in order to characterize their phenolic biodegradability. Acinetobacter REY was capable of biodegrading up to 200 mg/L of phenols and gallic acid both after 10 h and 72 h, respectively.
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25
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Srikrupa N, Srilekha S, Sen P, Arokiasamy T, Meenakshi S, Bhende M, Kapur S, Soumittra N. Genetic profile and mutation spectrum of Leber congenital amaurosis in a larger Indian cohort using high throughput targeted re-sequencing. Clin Genet 2018; 93:329-339. [DOI: 10.1111/cge.13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 01/02/2023]
Affiliation(s)
- N.N. Srikrupa
- SNONGC Department of Genetics and Molecular Biology; Vision Research Foundation; Chennai India
- PhD Scholar; Birla Institute of Technology & Science (BITS); Hyderabad India
| | - S. Srilekha
- SNONGC Department of Genetics and Molecular Biology; Vision Research Foundation; Chennai India
| | - P. Sen
- Department of Vitreo-Retinal Services; Medical Research Foundation; Chennai India
| | - T. Arokiasamy
- SNONGC Department of Genetics and Molecular Biology; Vision Research Foundation; Chennai India
| | - S. Meenakshi
- Department of Pediatric Ophthalmology; Medical Research Foundation; Chennai India
| | - M. Bhende
- Department of Vitreo-Retinal Services; Medical Research Foundation; Chennai India
| | - S. Kapur
- Department of Biological Sciences; Birla Institute of Technology & Science (BITS); Hyderabad India
| | - N. Soumittra
- SNONGC Department of Genetics and Molecular Biology; Vision Research Foundation; Chennai India
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26
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Axelrod D, Lentine KL, Schnitzler MA, Luo X, Xiao H, Orandi BJ, Massie A, Garonzik-Wang J, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Osama Gaber A, Montgomery RA, Segev DL. The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis. Am J Transplant 2017; 17:3123-3130. [PMID: 28613436 DOI: 10.1111/ajt.14392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/29/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 01/25/2023]
Abstract
Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end-stage renal disease patients with willing but HLA-incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource-intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell-depleting antibody treatment, as well as protocol biopsies and donor-specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
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Affiliation(s)
- D Axelrod
- Department of Transplantation, Lahey Hospital and Health System, Burlington, MA
| | - K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - M A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - X Luo
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - H Xiao
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - B J Orandi
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A Massie
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - J Garonzik-Wang
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - M D Stegall
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - S C Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - J Oberholzer
- Department of Surgery, University of Illinois-Chicago, Chicago, IL
| | - T B Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - L E Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - S Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - R P Pelletier
- Department of Surgery, The Ohio State University, Columbus, OH
| | - J P Roberts
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - M L Melcher
- Department of Surgery, Stanford University, Palo Alto, CA
| | - P Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D L Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - M P Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - J M El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - R Shapiro
- Department of Surgery, Mt. Sinai Medical Center, New York, NY
| | - M Cooper
- Medstar Georgetown Transplant Institute, Washington, DC
| | - G S Lipkowitz
- Department of Surgery, Baystate Medical Center, Springfield, MA
| | - M A Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - C L Marsh
- Division of Organ Transplantation, Scripps Center for Organ Transplantation, Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, CA
| | - B R Sankari
- Department of Urology, Cleveland Clinic, Cleveland, OH
| | - D A Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - P W Nelson
- Department of Surgery, University of Nevada, Las Vegas, NV
| | - J Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - A Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - R A Montgomery
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - D L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
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27
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Lees J, Michalopoulou PG, Lewis SW, Preston S, Bamford C, Collier T, Kalpakidou A, Wykes T, Emsley R, Pandina G, Kapur S, Drake RJ. Modafinil and cognitive enhancement in schizophrenia and healthy volunteers: the effects of test battery in a randomised controlled trial. Psychol Med 2017; 47:2358-2368. [PMID: 28464963 DOI: 10.1017/s0033291717000885] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive deficits in schizophrenia have major functional impacts. Modafinil is a cognitive enhancer whose effect in healthy volunteers is well-described, but whose effects on the cognitive deficits of schizophrenia appear to be inconsistent. Two possible reasons for this are that cognitive test batteries vary in their sensitivity, or that the phase of illness may be important, with patients early in their illness responding better. METHODS A double-blind, randomised, placebo-controlled single-dose crossover study of modafinil 200 mg examined this with two cognitive batteries [MATRICS Consensus Cognitive Battery (MCCB) and Cambridge Neuropsychological Test Automated Battery (CANTAB)] in 46 participants with under 3 years' duration of DSM-IV schizophrenia, on stable antipsychotic medication. In parallel, the same design was used in 28 age-, sex-, and education-matched healthy volunteers. Uncorrected p values were calculated using mixed effects models. RESULTS In patients, modafinil significantly improved CANTAB Paired Associate Learning, non-significantly improved efficiency and significantly slowed performance of the CANTAB Stockings of Cambridge spatial planning task. There was no significant effect on any MCCB domain. In healthy volunteers, modafinil significantly increased CANTAB Rapid Visual Processing, Intra-Extra Dimensional Set Shifting and verbal recall accuracy, and MCCB social cognition performance. The only significant differences between groups were in MCCB visual learning. CONCLUSIONS As in earlier chronic schizophrenia studies, modafinil failed to produce changes in cognition in early psychosis as measured by MCCB. CANTAB proved more sensitive to the effects of modafinil in participants with early schizophrenia and in healthy volunteers. This confirms the importance of selecting the appropriate test battery in treatment studies of cognition in schizophrenia.
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Affiliation(s)
- J Lees
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - P G Michalopoulou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - S W Lewis
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - S Preston
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - C Bamford
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - T Collier
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - A Kalpakidou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - T Wykes
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R Emsley
- Division of Population Health,Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - G Pandina
- Janssen Research & Development, LLC,New Brunswick,New Jersey,USA
| | - S Kapur
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R J Drake
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
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28
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Collins DS, Kourtis LC, Thyagarajapuram NR, Sirkar R, Kapur S, Harrison MW, Bryan DJ, Jones GB, Wright JM. Optimizing the Bioavailability of Subcutaneously Administered Biotherapeutics Through Mechanochemical Drivers. Pharm Res 2017; 34:2000-2011. [PMID: 28707164 PMCID: PMC5579144 DOI: 10.1007/s11095-017-2229-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/07/2017] [Indexed: 01/09/2023]
Abstract
The subcutaneous route offers myriad benefits for the administration of biotherapeutics in both acute and chronic diseases, including convenience, cost effectiveness and the potential for automation through closed-loop systems. Recent advances in parenteral administration devices and the use of additives which enhance drug dispersion have generated substantial additional interest in IV to SQ switching studies. Designing pre-clinical and clinical studies using SQ mediated delivery however requires deep understanding of complex inter-related physiologies and transport pathways governing the interstitial matrix, vascular system and lymphatic channels. This expert review will highlight key structural features which contribute to transport and biodistribution in the subcutaneous space and also assess the impact of drug formulations. Based on the rapidly growing interest in the SQ delivery route, a number of potential areas for future development are highlighted, which are likely to allow continued evolution and innovation in this important area.
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Affiliation(s)
- D S Collins
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - L C Kourtis
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - N R Thyagarajapuram
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - R Sirkar
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - S Kapur
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - M W Harrison
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
| | - D J Bryan
- Division of Plastic and Reconstructive Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, 01805, USA
| | - G B Jones
- Clinical & Translational Science Institute, Tufts University Medical Center, 800 Washington St, Boston, Massachusetts, 02111, USA.
| | - J M Wright
- Eli Lilly Innovation Center, 450 Kendall Street, Cambridge, Massachusetts, 02142, USA
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29
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Bulwer C, Conn R, Shankar A, Ferrau F, Kapur S, Ederies A, Korbonits M, Spoudeas HA. Cabergoline-related impulse control disorder in an adolescent with a giant prolactinoma. Clin Endocrinol (Oxf) 2017; 86:862-864. [PMID: 28346715 DOI: 10.1111/cen.13339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/19/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C Bulwer
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, University College London Institute of Child Health, London, UK
| | - R Conn
- Transformation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - A Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Ferrau
- Centre for Endocrinology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - S Kapur
- Centre for Endocrinology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - A Ederies
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Korbonits
- Centre for Endocrinology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - H A Spoudeas
- The London Centre for Pediatric Endocrinology & Diabetes, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- The London Centre for Pediatric Endocrinology and Diabetes, University College London Hospital, London, UK
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30
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Sidhu R, Reilly S, Kapur S. Misaligned bupivacaine ampoule labels obscuring the expiry date. Anaesthesia 2017; 72:796-797. [DOI: 10.1111/anae.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R. Sidhu
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - S. Reilly
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - S. Kapur
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
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31
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Jauhar S, Veronese M, Rogdaki M, Bloomfield M, Natesan S, Turkheimer F, Kapur S, Howes OD. Regulation of dopaminergic function: an [ 18F]-DOPA PET apomorphine challenge study in humans. Transl Psychiatry 2017; 7:e1027. [PMID: 28170002 PMCID: PMC5438020 DOI: 10.1038/tp.2016.270] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023] Open
Abstract
Dopaminergic function has a key role in normal brain function, dopaminergic dysfunction being implicated in numerous neuropsychiatric disorders. Animal studies show that dopaminergic stimulation regulates dopaminergic function, but it is not known whether this exists in humans. In the first study (study 1), we measured dopamine synthesis capacity (indexed as Kicer) to identify the relationship between baseline and change in Kicer under resting conditions for comparison with effects of dopaminergic stimulation. In the second study (study 2), we used a within-subjects design to test effects of dopaminergic stimulation on dopamine synthesis capacity. In study 1, eight volunteers received two 18F-DOPA scans on separate days, both at rest. In study 2, 12 healthy male volunteers received two 18F-DOPA positron emission tomographic (PET) scans after treatment with either the dopamine partial agonist apomorphine (0.03 or 0.005 mg kg-1) or placebo. In study 1, no significant correlation was found between baseline and change in dopamine synthesis capacity between scans (r=-0.57, n=8, P=0.17, two-tailed). In study 2, a significant negative correlation was found between baseline dopamine synthesis capacity and percentage change in dopamine synthesis capacity after apomorphine challenge (r=-0.71, n=12, P=0.01, two-tailed). This correlation was significantly different (P<0.01) from the correlation between baseline and change in dopamine synthesis capacity under unstimulated conditions. One-way repeated-measures analysis of variance showed a significant group (study 1/study 2) × time interaction (F(1,18)=11.5, P=0.003). Our findings suggest that regulation of dopamine synthesis capacity by apomorphine depends on baseline dopamine function, consistent with dopamine stimulation stabilizing dopaminergic function. Loss of this autoregulation may contribute to dopaminergic dysfunction in brain disorders such as schizophrenia, substance dependence, and Parkinson's disease.
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Affiliation(s)
- S Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M Veronese
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M Rogdaki
- MRC London Institute of Medical Sciences, London, UK
| | - M Bloomfield
- MRC London Institute of Medical Sciences, London, UK
| | - S Natesan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - F Turkheimer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - S Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - O D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK,MRC London Institute of Medical Sciences, London, UK,Institute of Clinical Sciences, Department of Medicine, Imperial College London, London, UK,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, Box 67, Camberwell, London SE5 8AF, UK. E-mail:
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32
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Stone JM, Morrison PD, Koychev I, Gao F, Reilly TJ, Kolanko M, Mohammadinasab A, Kapur S, McGuire PK. The effect of sodium nitroprusside on psychotic symptoms and spatial working memory in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial. Psychol Med 2016; 46:3443-3450. [PMID: 27655012 DOI: 10.1017/s0033291716002245] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sodium nitroprusside (SNP) has been reported to rapidly reduce psychotic symptoms in patients with schizophrenia. This has the potential to revolutionize treatment for schizophrenia. In this study, we tested the hypothesis that SNP leads to a reduction in psychotic symptoms and an improvement in spatial working memory (SWM) performance in patients with schizophrenia. METHOD This was a single-centre, randomized, double-blind, placebo-controlled trial performed from 27 August 2014 to 10 February 2016 (clinicaltrials.gov identifier: NCT02176044). Twenty patients with schizophrenia aged 18-60 years with a diagnosis of schizophrenia or schizoaffective disorder were recruited from psychiatric outpatient clinics in the South London and Maudsley NHS Trust, London, UK. Baseline symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS-18), and SWM was assessed using the CANTAB computerized test. Participants received either an infusion of SNP (0.5 μg/kg per min for 4 h) or placebo and were re-assessed for symptoms and SWM performance immediately after the infusion, and 4 weeks later. RESULTS SNP did not lead to any reduction in psychotic symptoms or improvement in SWM performance compared to placebo. CONCLUSIONS Although this study was negative, it is possible that the beneficial effects of SNP may occur in patients with a shorter history of illness, or with more acute exacerbation of symptoms.
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Affiliation(s)
- J M Stone
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - P D Morrison
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - I Koychev
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - F Gao
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - T J Reilly
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - M Kolanko
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - A Mohammadinasab
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - S Kapur
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
| | - P K McGuire
- King's College London, Institute of Psychiatry Psychology and Neuroscience,London,UK
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33
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Crum WR, Danckaers F, Huysmans T, Cotel MC, Natesan S, Modo MM, Sijbers J, Williams SCR, Kapur S, Vernon AC. Chronic exposure to haloperidol and olanzapine leads to common and divergent shape changes in the rat hippocampus in the absence of grey-matter volume loss. Psychol Med 2016; 46:3081-3093. [PMID: 27516217 PMCID: PMC5108303 DOI: 10.1017/s0033291716001768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND One of the most consistently reported brain abnormalities in schizophrenia (SCZ) is decreased volume and shape deformation of the hippocampus. However, the potential contribution of chronic antipsychotic medication exposure to these phenomena remains unclear. METHOD We examined the effect of chronic exposure (8 weeks) to clinically relevant doses of either haloperidol (HAL) or olanzapine (OLZ) on adult rat hippocampal volume and shape using ex vivo structural MRI with the brain retained inside the cranium to prevent distortions due to dissection, followed by tensor-based morphometry (TBM) and elastic surface-based shape deformation analysis. The volume of the hippocampus was also measured post-mortem from brain tissue sections in each group. RESULTS Chronic exposure to either HAL or OLZ had no effect on the volume of the hippocampus, even at exploratory thresholds, which was confirmed post-mortem. In contrast, shape deformation analysis revealed that chronic HAL and OLZ exposure lead to both common and divergent shape deformations (q = 0.05, FDR-corrected) in the rat hippocampus. In particular, in the dorsal hippocampus, HAL exposure led to inward shape deformation, whereas OLZ exposure led to outward shape deformation. Interestingly, outward shape deformations that were common to both drugs occurred in the ventral hippocampus. These effects remained significant after controlling for hippocampal volume suggesting true shape changes. CONCLUSIONS Chronic exposure to either HAL or OLZ leads to both common and divergent effects on rat hippocampal shape in the absence of volume change. The implications of these findings for the clinic are discussed.
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Affiliation(s)
- W. R. Crum
- Department of Neuroimaging,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience,
Centre for Neuroimaging Sciences, De Crespigny
Park, London, UK
| | - F. Danckaers
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - T. Huysmans
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - M.-C. Cotel
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - S. Natesan
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - M. M. Modo
- Department of Basic and Clinical
Neuroscience, King's College London,
Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute for Clinical
Neuroscience, London, UK
| | - J. Sijbers
- Department of Physics,
iMinds-Vision Laboratory, University of
Antwerp, Antwerp, Belgium
| | - S. C. R. Williams
- Department of Neuroimaging,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience,
Centre for Neuroimaging Sciences, De Crespigny
Park, London, UK
| | - S. Kapur
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
| | - A. C. Vernon
- Department of Psychosis Studies,
King's College London, Institute of
Psychiatry, Psychology and Neuroscience, De
Crespigny Park, London, UK
- Department of Basic and Clinical
Neuroscience, King's College London,
Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute for Clinical
Neuroscience, London, UK
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Starr M, Haraoui B, Choquette D, Bessette L, Chow A, Baer P, Kapur S, Kelsall J, Teo M, Rampakakis E, Psaradellis E, Nantel F, Lehman A, Osborne B, Maslova K, Tkaczyk C. AB0220 What Proportion of Patients Fail To Achieve CDAI and SDAI Remission Based on Physician Global Assessment? An Analysis from A Prospective, Observational Registry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4801] [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: 11/04/2022]
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Bessette L, Kapur S, Zummer M, Starr M, Choquette D, Sheriff M, Olszynski W, Rampakakis E, Psaradellis E, Osborne B, Maslova K, Nantel F, Lehman A, Tkaczyk C. AB0661 Predictors of Response in Patients with Ankylosing Spondylitis Treated with Infliximab or Golimumab in A Real-World Setting. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4769] [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: 11/04/2022]
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Rashid S, Fox J, Kapur S, Kang M, Schlosshan D, Blackman D, Malkin C. 31 Pulmonary hypertension in severe aortic stenosis: prevalence and reversibility with transcatheter aortic valve implant. Heart 2016. [DOI: 10.1136/heartjnl-2016-309588.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Warchol I, Gora M, Wysocka-Kapcinska M, Komaszylo J, Swiezewska E, Sojka M, Danikiewicz W, Plochocka D, Maciejak A, Tulacz D, Leszczynska A, Kapur S, Burzynska B. Genetic engineering and molecular characterization of yeast strain expressing hybrid human-yeast squalene synthase as a tool for anti-cholesterol drug assessment. J Appl Microbiol 2016; 120:877-88. [PMID: 26757023 DOI: 10.1111/jam.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/27/2015] [Accepted: 01/05/2016] [Indexed: 11/29/2022]
Abstract
AIMS The main objective of the study is molecular and biological characterization of the human-yeast hybrid squalene synthase (SQS), as a promising target for treatment of hypercholesterolaemia. METHODS AND RESULTS The human-yeast hybrid SQS, with 67% amino acids, including the catalytic site derived from human enzyme, was expressed in Saccharomyces cerevisiae strain deleted of its own SQS gene. The constructed strain has a decreased level of sterols compared to the control strain. The mevalonate pathway and sterol biosynthesis genes are induced and the level of triacylglycerols is increased. Treatment of the strain with rosuvastatin or zaragozic acid, two mevalonate pathway inhibitors, decreased the amounts of squalene, lanosterol and ergosterol, and up-regulated expression of several genes encoding enzymes responsible for biosynthesis of ergosterol precursors. Conversely, expression of the majority genes implicated in the biosynthesis of other mevalonate pathway end products, ubiquinone and dolichol, was down-regulated. CONCLUSIONS The S. cerevisiae strain constructed in this study enables to investigate the physiological and molecular effects of inhibitors on cell functioning. SIGNIFICANCE AND IMPACT OF THE STUDY The yeast strain expressing hybrid SQS with the catalytic core of human enzyme is a convenient tool for efficient screening for novel inhibitors of cholesterol-lowering properties.
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Affiliation(s)
- I Warchol
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - M Gora
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - M Wysocka-Kapcinska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - J Komaszylo
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - E Swiezewska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - M Sojka
- Institute of Organic Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - W Danikiewicz
- Institute of Organic Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - D Plochocka
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - A Maciejak
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - D Tulacz
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - A Leszczynska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - S Kapur
- Department of Biological Science, Birla Institute of Technology & Science (BITS), Hyderabad, India
| | - B Burzynska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
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Rabinowitz J, Werbeloff N, Mandel F, De Ridder F, Schacht A, Menard F, Caears I, Stauffer V, Kapur S. Usefulness of interim analyses in portending study results in antipsychotic and antidepressant trials. Eur Neuropsychopharmacol 2015; 25:1999-2007. [PMID: 26256009 DOI: 10.1016/j.euroneuro.2015.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
It is unknown whether interim analyses portend final study results. Fatigue, pressure to complete trials and recruitment differences may mitigate against this. We examined the similarity of efficacy results of the first and second half of recruited patients to complete trials and explore possible intervening variables. Using data from the NewMeds repository of patient level data from placebo-controlled randomized trials of antipsychotics (AP) (22 studies, n=7056) and antidepressants (AD) (39 studies, n=12,217) we compared treatment effect size (placebo vs. active treatment) of the first and second half of patients recruited in completed trials. We found that in AP studies median difference in treatment effect between cohorts was -0.03, indicating that overall first and second cohorts yielded similar results. In AD studies, median difference between cohorts was 0.04, indicating that overall the second cohort had slightly larger active-placebo-difference. Overall, on average there were minimal differences in effect size between the first and the second cohorts, and in 30 of 39 trials interim results were a good estimate of the results on the 2nd cohort. In AD trials first and second cohort results were more similar when the proportion of patients per study centre and recruitment time of the two cohorts was similar. Results suggest that interim analyses in AD and AP studies may reliably serve to estimate ultimate effects and, at least in AD trials, are more accurate when the same sites are used to a similar extent and recruitment time of the two consequent cohorts is similar.
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Affiliation(s)
| | | | | | - F De Ridder
- Janssen Research & Development, Beerse, Belgium
| | | | | | - I Caears
- Janssen Research & Development, Beerse, Belgium
| | | | - S Kapur
- Institute of Psychiatry, Kings College, London, United Kingdom
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Fleischer DM, Sicherer S, Greenhawt M, Campbell D, Chan E, Muraro A, Halken S, Katz Y, Ebisawa M, Eichenfield L, Sampson H, Lack G, Du Toit G, Roberts G, Bahnson H, Feeney M, Hourihane J, Spergel J, Young M, As'aad A, Allen K, Prescott S, Kapur S, Saito H, Agache I, Akdis CA, Arshad H, Beyer K, Dubois A, Eigenmann P, Fernandez-Rivas M, Grimshaw K, Hoffman-Sommergruber K, Host A, Lau S, O'Mahony L, Mills C, Papadopoulos N, Venter C, Agmon-Levin N, Kessel A, Antaya R, Drolet B, Rosenwasser L. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. Allergy 2015; 70:1193-5. [PMID: 26148305 DOI: 10.1111/all.12687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - M. Greenhawt
- American College of Allergy, Asthma & Immunology (ACAAI)
| | - D. Campbell
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - E. Chan
- Canadian Society of Allergy and Clinical Immunology (CSACI)
| | - A. Muraro
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - S. Halken
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - Y. Katz
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | | | | | | | - G. Lack
- World Allergy Organization (WAO)
| | - G. Du Toit
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - G. Roberts
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | | | - J. Hourihane
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - J. Spergel
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - M. Young
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - A. As'aad
- American College of Allergy, Asthma & Immunology (ACAAI)
| | - K. Allen
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - S. Prescott
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - S. Kapur
- Canadian Society of Allergy and Clinical Immunology (CSACI)
| | - H. Saito
- Japanese Society for Allergology (JSA)
| | - I. Agache
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - C. A. Akdis
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - H. Arshad
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - K. Beyer
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - A. Dubois
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - P. Eigenmann
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - K. Grimshaw
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - A. Host
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - S. Lau
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - L. O'Mahony
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - C. Mills
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - C. Venter
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - N. Agmon-Levin
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | - A. Kessel
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | - R. Antaya
- Society for Pediatric Dermatology (SPD)
| | - B. Drolet
- Society for Pediatric Dermatology (SPD)
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Chow A, Bensen W, Arendse R, Keystone E, Baer P, Kelsall J, Olszynski W, Rodrigues J, Avina-Zubieta A, Baker M, Olszynski W, Bensen W, Baer P, Choquette D, Kapur S, Jaroszynska A, Sampalis J, Choquette D, Rampakakis E, Kapur S, Stewart J, Tkaczyk C, Sampalis J, Shawi M, Rampakakis E, Lehman A, Nantel F, Otawa S, Tkaczyk C, Lehman A. SAT0062 What is the Effect of TNF Inhibitors on Employment Status in Rheumatoid Arthritis Patients and what are the Predictors of Progression to Unemployment? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6199] [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: 11/04/2022]
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Bensen W, Keystone E, Baer P, Rodrigues J, Avina-Zubieta A, Olszynski W, Choquette D, Kapur S, Sampalis J, Rampakakis E, Tkaczyk C, Shawi M, Lehman A, Nantel F, Otawa S. SAT0090 Exploring The Das: What is the Level of Agreement in the Classification of Remission and Low Disease Activity Among the Various Versions of the Disease Activity Score (DAS) and Their Correlation? An Analysis from a Prospective, Observational Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Winton-Brown T, Kumari V, Windler F, Moscoso A, Stone J, Kapur S, McGuire P. Sensorimotor gating, cannabis use and the risk of psychosis. Schizophr Res 2015; 164:21-7. [PMID: 25801237 PMCID: PMC4435667 DOI: 10.1016/j.schres.2015.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 06/09/2014] [Revised: 02/16/2015] [Accepted: 02/21/2015] [Indexed: 12/13/2022]
Abstract
Sensorimotor gating, measured as the modification of eye blink startle reflexes to loud acoustic stimuli by quieter preceding stimuli, is altered in those with psychosis, their relatives and those at high clinical risk for psychosis. Alterations have also been shown in cannabis users, albeit to a lesser extent, and cannabis is a known risk factor for the onset of psychosis in clinically and genetically susceptible individuals. We examined the interaction between clinical risk for psychosis and cannabis use on sensorimotor gating, both Prepulse Inhibition (PPI) and Prepulse Facilitation (PPF). We tested PPI and PPF in participants with an At Risk Mental State (ARMS) for psychosis and a matched control group. Both groups included a proportion of subjects who had recently used cannabis, as confirmed by urinary drug screening (UDS) on the day of testing. We found that ARMS participants showed reduced PPF and PPI relative to controls, the latter driven by a group by cannabis use interaction, with recent use reducing PPI in ARMS participants but not in controls. When the analysis was limited to UDS-negative participants there was significantly reduced PPF in ARMS subjects relative to controls, but no differences in PPI. Within the ARMS group reduced sensorimotor gating, measured by both PPI and PPF, related to reduced overall level of function. Cannabis use in clinical high risk individuals may increase the risk of psychosis in part through worsening PPI, while PPF is altered in ARMS individuals irrespective of cannabis use. This develops our understanding of cognitive mechanisms leading to the experience of aberrant perceptual phenomena and the subsequent development of psychotic symptoms.
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Affiliation(s)
- T. Winton-Brown
- Department of Psychosis Studies, Institute of Psychiatry, Kings College London, United Kingdom,Corresponding author at: PO 67 Institute of Psychiatry, De Crespigny Park, London, United Kingdom. Tel.: + 44 61481262243.
| | - V. Kumari
- Department of Psychology, Institute of Psychiatry, Kings College London, United Kingdom
| | - F. Windler
- Center of Advanced European Studies and Research, Bonn, Germany
| | - A. Moscoso
- Department of Child and Adolescent Psychiatry, Hospital de D. Estefânia Lisboa, Portugal
| | - J. Stone
- Department of Psychosis Studies, Institute of Psychiatry, Kings College London, United Kingdom
| | - S. Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Kings College London, United Kingdom
| | - P. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Kings College London, United Kingdom
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So S, Peters E, Swendsen J, Zhu C, Garety P, Kapur S. Assessing Belief Flexibility with Experience Sampling Methodology in Patients with Acute Psychosis. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Michalopoulou P, Lewis S, Drake R, Reichenberg A, Emsley R, Kalpakidou A, Lees J, Bobin T, Gilleen J, Applegate E, Pandina G, Wykes T, Kapur S. The Effects of a Combined Intervention for Cognition in Schizophrenia On Cogstate Schizophrenia Battery. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30210-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
BACKGROUND Patients with schizophrenia have substantially reduced subjective well-being (SW) compared to healthy individuals. It has been suggested that diminished SW may be related to deficits in the neural processing of reward but this has not been shown directly. We hypothesized that, in schizophrenia, lower SW would be associated with attenuated reward-related activation in the reward network. METHOD Twenty patients with schizophrenia with a range of SW underwent a functional magnetic resonance imaging (fMRI) reward task. The brain activity underlying reward anticipation and outcome in schizophrenia was examined and compared to that of 12 healthy participants using a full factorial analysis. Region of interest (ROI) analyses of areas within the reward network and whole-brain analyses were conducted to reveal neural correlates of SW. RESULTS Reward-related neural activity in schizophrenia was not significantly different from that of healthy participants; however, the patients with schizophrenia showed significantly diminished SW. Both ROI and whole-brain analyses confirmed that SW scores in the patients correlated significantly with activity, specifically in the dorsal anterior cingulate cortex (dACC), during both reward anticipation and reward outcome. This association was not seen in the healthy participants. CONCLUSIONS In patients with schizophrenia, reduced activation of the dACC during multiple aspects of reward processing is associated with lower SW. As the dACC has been widely linked to coupling of reward and action, and the link to SW is apparent over anticipation and outcome, these findings suggest that SW deficits in schizophrenia may be attributable to reduced integration of environmental rewarding cues, motivated behaviour and reward outcome.
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Affiliation(s)
- J Gilleen
- Department of Psychosis Studies, Institute of Psychiatry,King's CollegeLondon,UK
| | - S S Shergill
- Department of Psychosis Studies, Institute of Psychiatry,King's CollegeLondon,UK
| | - S Kapur
- Department of Psychosis Studies, Institute of Psychiatry,King's CollegeLondon,UK
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McCormick S, Kapur S. Levobupivacaine ampoule labelling about sterility. Anaesthesia 2014; 70:110-1. [DOI: 10.1111/anae.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - S. Kapur
- Russells Hall Hospital; Dudley UK
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Orandi BJ, Garonzik-Wang JM, Massie AB, Zachary AA, Montgomery JR, Van Arendonk KJ, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Gaber AO, Montgomery RA, Segev DL. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant 2014; 14:1573-80. [PMID: 24913913 DOI: 10.1111/ajt.12786] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [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: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023]
Abstract
Incompatible live donor kidney transplantation (ILDKT) offers a survival advantage over dialysis to patients with anti-HLA donor-specific antibody (DSA). Program-specific reports (PSRs) fail to account for ILDKT, placing this practice at regulatory risk. We collected DSA data, categorized as positive Luminex, negative flow crossmatch (PLNF) (n = 185), positive flow, negative cytotoxic crossmatch (PFNC) (n = 536) or positive cytotoxic crossmatch (PCC) (n = 304), from 22 centers. We tested associations between DSA, graft loss and mortality after adjusting for PSR model factors, using 9669 compatible patients as a comparison. PLNF patients had similar graft loss; however, PFNC (adjusted hazard ratio [aHR] = 1.64, 95% confidence interval [CI]: 1.15-2.23, p = 0.007) and PCC (aHR = 5.01, 95% CI: 3.71-6.77, p < 0.001) were associated with increased graft loss in the first year. PLNF patients had similar mortality; however, PFNC (aHR = 2.04; 95% CI: 1.28-3.26; p = 0.003) and PCC (aHR = 4.59; 95% CI: 2.98-7.07; p < 0.001) were associated with increased mortality. We simulated Centers for Medicare & Medicaid Services flagging to examine ILDKT's effect on the risk of being flagged. Compared to equal-quality centers performing no ILDKT, centers performing 5%, 10% or 20% PFNC had a 1.19-, 1.33- and 1.73-fold higher odds of being flagged. Centers performing 5%, 10% or 20% PCC had a 2.22-, 4.09- and 10.72-fold higher odds. Failure to account for ILDKT's increased risk places centers providing this life-saving treatment in jeopardy of regulatory intervention.
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Affiliation(s)
- B J Orandi
- Departments of Surgery and Medicine, Johns Hopkins Hospital, Baltimore, MD
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Kelsall J, Jovaisas A, Rahman P, Sholter D, Starr M, Bensen W, Sheriff M, Olszynski W, Zummer M, Faraawi R, Chow A, Kapur S, Rampakakis E, Sampalis J, Nantel F, Otawa S, Shawi M, Lehman A. AB1059 Assessing Treatment Durability of Infliximab in the Management of Psoriatic Arthritis and Rheumatoid Arthritis Patients in A Canadian Setting. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4013] [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: 11/04/2022]
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50
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Jovaisas A, Starr M, Choquette D, Zummer M, Arendse R, Sholter D, Faraawi R, Rodrigues J, Kapur S, Rampakakis E, Sampalis J, Nantel F, Lehman A, Otawa S, Shawi M. AB0302 Profile of Joint Involvement over Time in Rheumatoid Arthritis and Psoriatic Arthritis Patients Treated with Anti-TNF in A Real-World Setting. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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