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Qiao X, Sil A, Sangtarash S, Smith SM, Wu C, Robertson CM, Nichols RJ, Higgins SJ, Sadeghi H, Vezzoli A. Nuclear Magnetic Resonance Chemical Shift as a Probe for Single-Molecule Charge Transport. Angew Chem Int Ed Engl 2024; 63:e202402413. [PMID: 38478719 DOI: 10.1002/anie.202402413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Indexed: 04/05/2024]
Abstract
Existing modelling tools, developed to aid the design of efficient molecular wires and to better understand their charge-transport behaviour and mechanism, have limitations in accuracy and computational cost. Further research is required to develop faster and more precise methods that can yield information on how charge transport properties are impacted by changes in the chemical structure of a molecular wire. In this study, we report a clear semilogarithmic correlation between charge transport efficiency and nuclear magnetic resonance chemical shifts in multiple series of molecular wires, also accounting for the presence of chemical substituents. The NMR data was used to inform a simple tight-binding model that accurately captures the experimental single-molecule conductance values, especially useful in this case as more sophisticated density functional theory calculations fail due to inherent limitations. Our study demonstrates the potential of NMR spectroscopy as a valuable tool for characterising, rationalising, and gaining additional insights on the charge transport properties of single-molecule junctions.
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Affiliation(s)
- X Qiao
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - A Sil
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - S Sangtarash
- Device Modelling Group, School of Engineering, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - S M Smith
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - C Wu
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
- Institute of Optoelectronic Materials and Devices, Faculty of Materials Metallurgy and Chemistry, Jiangxi University of Science and Technology, Ganzhou, 341000, China
| | - C M Robertson
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - R J Nichols
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - S J Higgins
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - H Sadeghi
- Device Modelling Group, School of Engineering, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - A Vezzoli
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
- Stephenson Institute for Renewable Energy, University of Liverpool, Peach Street, Liverpool, L69 7ZF, United Kingdom
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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.2023.10.024] [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: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Scheele J, Smith SM, Wahab RJ, Bais B, Steegers-Theunissen RPM, Gaillard R, Harmsen van der Vliet-Torij HW. Current preconception care practice in the Netherlands - An evaluation study among birth care professionals. Midwifery 2023; 127:103855. [PMID: 37890235 DOI: 10.1016/j.midw.2023.103855] [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: 02/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care. METHODS We have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results. FINDINGS Respondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations. KEY CONCLUSION Birth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians. IMPLICATIONS FOR PRACTICE To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.
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Affiliation(s)
- J Scheele
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, the Netherlands.
| | - S M Smith
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - B Bais
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - H W Harmsen van der Vliet-Torij
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
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Yadegar A, Nabavi-Rad A, Smith SM. Editorial: Helicobacter pylori infection and antibiotic resistance: clinical, translational and experimental studies. Front Cell Infect Microbiol 2023; 13:1296784. [PMID: 37850053 PMCID: PMC10577589 DOI: 10.3389/fcimb.2023.1296784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Nabavi-Rad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sinéad Marian Smith
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Zack EH, Smith SM, Angielczyk KD. From Fairies to Giants: Untangling the Effect of Body Size, Phylogeny, and Ecology on Vertebral Bone Microstructure of Xenarthran Mammals. Integr Org Biol 2023; 5:obad002. [PMID: 36844392 PMCID: PMC9949600 DOI: 10.1093/iob/obad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Trabecular bone is a spongy bone tissue that serves as a scaffolding-like support inside many skeletal elements. Previous research found allometric variation in some aspects of trabecular bone architecture (TBA) and bone microstructure, whereas others scale isometrically. However, most of these studies examined very wide size and phylogenetic ranges or focused exclusively on primates or lab mice. We examined the impact of body size on TBA across a smaller size range in the mammalian clade Xenarthra (sloths, armadillos, and anteaters). We µCT-scanned the last six presacral vertebrae of 23 xenarthran specimens (body mass 120 g-35 kg). We collected ten gross-morphology measurements and seven TBA metrics and analyzed them using phylogenetic and nonphylogenetic methods. Most metrics had similar allometries to previous work. However, because ecology and phylogeny align closely in Xenarthra, the phylogenetic methods likely removed some covariance due to ecology; clarifying the impact of ecology on TBA in xenarthrans requires further work. Regressions for Folivora had high P-values and low R-squared values, indicating that the extant sloth sample either is too limited to determine patterns or that the unique way sloths load their vertebral columns causes unusually high TBA variation. The southern three-banded armadillo sits far below the regression lines, which may be related to its ability to roll into a ball. Body size, phylogeny, and ecology impact xenarthran TBA, but parsing these effects is highly complex.
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Affiliation(s)
| | - S M Smith
- Negaunee Integrative Research Center, Field Museum of Natural History, Chicago, IL 60605, USA
| | - K D Angielczyk
- Negaunee Integrative Research Center, Field Museum of Natural History, Chicago, IL 60605, USA
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Butler TJ, Smith SM. Strategies for the Purification of Membrane Proteins. Methods Mol Biol 2023; 2699:477-491. [PMID: 37647009 DOI: 10.1007/978-1-0716-3362-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Membrane proteins account for approximately 30% of the coding regions of all sequenced genomes, and they play crucial roles in many fundamental cell processes. However, there are relatively few membrane proteins with known three-dimensional structures. This is likely due to technical challenges associated with membrane protein extraction, solubilization, and purification. Membrane proteins are classified based on the level of interaction with membrane lipid bilayers, with peripheral membrane proteins associating non-covalently with the membrane, and integral membrane proteins associating more strongly by means of hydrophobic interactions. Generally speaking, peripheral membrane proteins can be purified by milder techniques than integral membrane proteins, with the latter's extraction requiring phospholipid bilayer disruption using detergents or organic solvents. In this chapter, important considerations for membrane protein purification are addressed, with a focus on the initial stages of membrane protein solubilization, where problems are most frequently encountered. Protocols are outlined for the extraction of peripheral membrane proteins, solubilization of integral membrane proteins, and sample clean-up and concentration.
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Affiliation(s)
- Thomas J Butler
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sinéad Marian Smith
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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Murphy AW, Moran D, Smith SM, Wallace E, Glynn LG, Hanley K, Kelly ME. Supporting Medical Students Towards Future Careers in General Practice: A Quantitative Study of Irish Medical Schools. Ir Med J 2022; 115:10. [PMID: 36917466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Nabavi-Rad A, Sadeghi A, Asadzadeh Aghdaei H, Yadegar A, Smith SM, Zali MR. The double-edged sword of probiotic supplementation on gut microbiota structure in Helicobacter pylori management. Gut Microbes 2022; 14:2108655. [PMID: 35951774 PMCID: PMC9373750 DOI: 10.1080/19490976.2022.2108655] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
As Helicobacter pylori management has become more challenging and less efficient over the last decade, the interest in innovative interventions is growing by the day. Probiotic co-supplementation to antibiotic therapies is reported in several studies, presenting a moderate reduction in drug-related side effects and a promotion in positive treatment outcomes. However, the significance of gut microbiota involvement in the competence of probiotic co-supplementation is emphasized by a few researchers, indicating the alteration in the host gastrointestinal microbiota following probiotic and drug uptake. Due to the lack of long-term follow-up studies to determine the efficiency of probiotic intervention in H. pylori eradication, and the delicate interaction of the gut microbiota with the host wellness, this review aims to discuss the gut microbiota alteration by probiotic co-supplementation in H. pylori management to predict the comprehensive effectiveness of probiotic oral administration.Abbreviations: acyl-CoA- acyl-coenzyme A; AMP- antimicrobial peptide; AMPK- AMP-activated protein kinase; AP-1- activator protein 1; BA- bile acid; BAR- bile acid receptor; BCAA- branched-chain amino acid; C2- acetate; C3- propionate; C4- butyrate; C5- valeric acid; CagA- Cytotoxin-associated gene A; cAMP- cyclic adenosine monophosphate; CD- Crohn's disease; CDI- C. difficile infection; COX-2- cyclooxygenase-2; DC- dendritic cell; EMT- epithelial-mesenchymal transition; FMO- flavin monooxygenases; FXR- farnesoid X receptor; GPBAR1- G-protein-coupled bile acid receptor 1; GPR4- G protein-coupled receptor 4; H2O2- hydrogen peroxide; HCC- hepatocellular carcinoma; HSC- hepatic stellate cell; IBD- inflammatory bowel disease; IBS- irritable bowel syndrome; IFN-γ- interferon-gamma; IgA immunoglobulin A; IL- interleukin; iNOS- induced nitric oxide synthase; JAK1- janus kinase 1; JAM-A- junctional adhesion molecule A; LAB- lactic acid bacteria; LPS- lipopolysaccharide; MALT- mucosa-associated lymphoid tissue; MAMP- microbe-associated molecular pattern; MCP-1- monocyte chemoattractant protein-1; MDR- multiple drug resistance; mTOR- mammalian target of rapamycin; MUC- mucin; NAFLD- nonalcoholic fatty liver disease; NF-κB- nuclear factor kappa B; NK- natural killer; NLRP3- NLR family pyrin domain containing 3; NOC- N-nitroso compounds; NOD- nucleotide-binding oligomerization domain; PICRUSt- phylogenetic investigation of communities by reconstruction of unobserved states; PRR- pattern recognition receptor; RA- retinoic acid; RNS- reactive nitrogen species; ROS- reactive oxygen species; rRNA- ribosomal RNA; SCFA- short-chain fatty acids; SDR- single drug resistance; SIgA- secretory immunoglobulin A; STAT3- signal transducer and activator of transcription 3; T1D- type 1 diabetes; T2D- type 2 diabetes; Th17- T helper 17; TLR- toll-like receptor; TMAO- trimethylamine N-oxide; TML- trimethyllysine; TNF-α- tumor necrosis factor-alpha; Tr1- type 1 regulatory T cell; Treg- regulatory T cell; UC- ulcerative colitis; VacA- Vacuolating toxin A.
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Affiliation(s)
- Ali Nabavi-Rad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,CONTACT Abbas Yadegar ; Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Shahid Arabi Ave., Yemen St., Velenjak, Tehran, Iran
| | - Sinéad Marian Smith
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland,Sinéad Marian Smith Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Neves NCV, de Mello MP, Smith SM, Boylan F, Caliari MV, Castilho RO. Chemical Composition and In Vitro Anti- Helicobacter pylori Activity of Campomanesia lineatifolia Ruiz & Pavón (Myrtaceae) Essential Oil. Plants (Basel) 2022; 11:plants11151945. [PMID: 35893649 PMCID: PMC9332794 DOI: 10.3390/plants11151945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 05/14/2023]
Abstract
Helicobacter pylori is the most common cause of gastritis and peptic ulcers, and the number of resistant strains to multiple conventional antimicrobial agents has been increasing in different parts of the world. Several studies have shown that some essential oils (EO) have bioactive compounds, which can be attributed to antimicrobial activity. Therefore, EOs have been proposed as a natural alternative to antibiotics, or for use in combination with conventional treatment for H. pylori infection. Campomanesia lineatifolia is an edible species found in the Brazilian forests, and their leaves are traditionally used for the treatment of gastrointestinal disorders. Anti-inflammatory, gastroprotective, and antioxidant properties are attributed to C. lineatifolia leaf extracts; however, studies related to the chemical constituents of the essential oil and anti-H. pylori activity is not described. This work aims to identify the chemical composition of the EO from C. lineatifolia leaves and evaluate the anti-H. pylori activity. The EO was obtained by hydrodistillation from C. lineatifolia leaves and characterized by gas chromatography-mass spectrometry analyses. To assess the in vitro anti-H. pylori activity of the C. lineatifolia leaf's EO (6 μL/mL-25 μL/mL), we performed broth microdilution assays by using type cultures (ATCC 49503, NCTC 11638, both clarithromycin-sensitive) and clinical isolate strains (SSR359, clarithromycin-sensitive, and SSR366, clarithromycin-resistant). A total of eight new compounds were identified from the EO (3-hexen-1-ol (46.15%), α-cadinol (20.35%), 1,1-diethoxyethane (13.08%), 2,3-dicyano-7,7-dimethyl-5,6-benzonorbornadiene (10.78%), aromadendrene 2 (3.0%), [3-S-(3α, 3aα, 6α, 8aα)]-4,5,6,7,8,8a-hexahydro-3,7,7-trimethyl-8-methylene-3H-3a,6-methanoazulene (2.99%), α-bisabolol (0.94%), and β-curcumene (0.8%)), corresponding to 98.09% of the total oil composition. The EO inhibited the growth of all H. pylori strains tested (MIC 6 μL/mL). To our knowledge, the current study investigates the relation between the chemical composition and the anti-H. pylori activity of the C. lineatifolia EO for the first time. Our findings show the potential use of the C. lineatifolia leaf EO against sensitive and resistant clarithromycin H. pylori strains and suggest that this antimicrobial activity could be related to its ethnopharmacological use.
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Affiliation(s)
- Nívea Cristina Vieira Neves
- GnosiaH, Laboratório de Farmacognosia, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Institute, Trinity College Dublin, Dublin 2, Ireland;
- Departamento de Farmácia, Centro Universitário Santa Rita, Conselheiro Lafaiete 36408-899, Brazil
- Correspondence: (N.C.V.N.); (R.O.C.)
| | - Morgana Pinheiro de Mello
- GnosiaH, Laboratório de Farmacognosia, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Sinéad Marian Smith
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre, Tallaght University Hospital, Dublin 24, Ireland;
| | - Fabio Boylan
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Institute, Trinity College Dublin, Dublin 2, Ireland;
| | - Marcelo Vidigal Caliari
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Rachel Oliveira Castilho
- GnosiaH, Laboratório de Farmacognosia, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
- Consórcio Acadêmico Brasileiro de Saúde Integrativa, CABSIN, São Paulo 05449-070, Brazil
- Correspondence: (N.C.V.N.); (R.O.C.)
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Sharp M, Forde Z, McGeown C, O'Murchu E, Smith SM, O'Neill M, Ryan M, Clyne B. Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency. Eur J Public Health 2021. [PMCID: PMC8574242 DOI: 10.1093/eurpub/ckab164.740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.
Methods
We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.
Results
Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.
Conclusions
Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.
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Affiliation(s)
- M Sharp
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z Forde
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - C McGeown
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Clyne B, Byrne P, Smith SM, O'Neill M, Ryan M. Evaluating rapid review provision to inform policy during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574241 DOI: 10.1093/eurpub/ckab164.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence based decision making is central to population health, particularly during a pandemic. Few studies examine the production and use of evidence in decision-making during crisis management. This study describes and evaluates the provision of rapid evidence products by a single agency to support national decision making.
Methods
Semi-structured interviews were conducted with a convenience sample of evidence providers (who gathered and disseminated the required evidence) and service users (policy makers). Interviews were transcribed verbatim and analysed using thematic analysis. Quantitative data of work activity were summarised descriptively.
Results
Three themes were generated from the data: the work, the use and the future, with a fourth theme cross-cutting across these: the team. The work followed clear protocols and was centrally managed. The scope and changing nature of the evidence were highlighted as issues. The service providers reported a strong sense of team work and ‘being in this together', however, the majority of the participants felt that the workload was huge and exhausting and not sustainable long-term. Overall the service users thought the rapid evidence synthesis was indispensable to the decision-making process and had trust and confidence in the work, largely based on existing working relationships with the team. While they recognised that the evidence synthesis support would be an essential component of the continued pandemic response, they did query the sustainability of the process and reflected on the amount of work the team performed.
Conclusions
This evaluation, drawing on qualitative data, has highlighted that, across the services users and evidence providers, the support provided by HIQA was generally perceived as positive. From the service users' perspective, having access to the team was indispensable to the decision making process. However, the sustainability of the work load was identified as a major challenge.
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Affiliation(s)
- B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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12
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Cardwell K, O'Murchu E, Byrne P, Broderick N, O'Neill S, Smith SM, Harrington P, O'Neill M, Ryan M. COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease. Eur J Public Health 2021. [PMCID: PMC8574924 DOI: 10.1093/eurpub/ckab164.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.
Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.
Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.
Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - S O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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13
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Vidaurre D, Llera A, Smith SM, Woolrich MW. Behavioural relevance of spontaneous, transient brain network interactions in fMRI. Neuroimage 2021; 229:117713. [PMID: 33421594 PMCID: PMC7994296 DOI: 10.1016/j.neuroimage.2020.117713] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/26/2020] [Indexed: 12/19/2022] Open
Abstract
How spontaneously fluctuating functional magnetic resonance imaging (fMRI) signals in different brain regions relate to behaviour has been an open question for decades. Correlations in these signals, known as functional connectivity, can be averaged over several minutes of data to provide a stable representation of the functional network architecture for an individual. However, associations between these stable features and behavioural traits have been shown to be dominated by individual differences in anatomy. Here, using kernel learning tools, we propose methods to assess and compare the relation between time-varying functional connectivity, time-averaged functional connectivity, structural brain data, and non-imaging subject behavioural traits. We applied these methods to Human Connectome Project resting-state fMRI data to show that time-varying fMRI functional connectivity, detected at time-scales of a few seconds, has associations with some behavioural traits that are not dominated by anatomy. Despite time-averaged functional connectivity accounting for the largest proportion of variability in the fMRI signal between individuals, we found that some aspects of intelligence could only be explained by time-varying functional connectivity. The finding that time-varying fMRI functional connectivity has a unique relationship to population behavioural variability suggests that it might reflect transient neuronal communication fluctuating around a stable neural architecture.
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Affiliation(s)
- D Vidaurre
- Center for Functionally Integrative Neuroscience, Department of Clinical Health, Aarhus University, 8000 Denmark; Department of Psychiatry, University of Oxford, OX37JX UK; Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK,.
| | - A Llera
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 Netherlands
| | - S M Smith
- Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK
| | - M W Woolrich
- Department of Psychiatry, University of Oxford, OX37JX UK; Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK
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14
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O'Neill SM, Clyne B, Bell M, Casey A, Leen B, Smith SM, Ryan M, O'Neill M. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emerg Med 2021; 21:15. [PMID: 33509099 PMCID: PMC7842002 DOI: 10.1186/s12873-021-00403-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorised into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence. Results Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, empowerment, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00403-9.
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Affiliation(s)
- S M O'Neill
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland.
| | - B Clyne
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland.,HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Bell
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Steevens' Lane, D08W2A8, Dublin, Ireland
| | - A Casey
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Steevens' Lane, D08W2A8, Dublin, Ireland
| | - B Leen
- Regional Librarian, Health Service Executive South, Kilkenny, Ireland
| | - S M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Ryan
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland
| | - M O'Neill
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland
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15
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Alavifard H, Mirzaei N, Yadegar A, Baghaei K, Smith SM, Sadeghi A, Zali MR. Investigation of Clarithromycin Resistance-Associated Mutations and Virulence Genotypes of Helicobacter pylori Isolated from Iranian Population: A Cross-Sectional Study. Curr Microbiol 2020; 78:244-254. [PMID: 33251569 DOI: 10.1007/s00284-020-02295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022]
Abstract
Antibiotic resistance has brought into question the efficiency of clarithromycin which is a vital component of eradication therapy for Helicobacter pylori infection. The point mutations within the 23S rRNA sequence of H. pylori isolates which contribute to clarithromycin resistance have yet to be fully characterized. This study was aimed to detect clarithromycin resistance-associated mutations and assess the prevalence of key virulence factors of H. pylori among Iranian patients. Amplification of 16S rRNA and glmM genes were done to identify H. pylori. Minimal inhibitory concentration (MIC) of clarithromycin in 82 H. pylori clinical isolates was determined by agar dilution method. Subsequently, various virulence markers including cagA, vacA, sabA, babA, and dupA of H. pylori were identified by PCR. PCR-sequencing was applied to detect point mutations in the 23S rRNA gene. Based on MIC values, 43.9% of H. pylori isolates showed resistance to clarithromycin. The babA and cagA genes were detected in 92.7% and 82.9% of isolates, assigned to be higher than other virulence factors. No significant relationship was found between the H. pylori virulence genotypes and clarithromycin susceptibility (P > 0.05). Analyzing the 23S rRNA sequences revealed A2143G (4/48, 8.3%) and A2142G (3/48, 6.2%) as the most prevalent mutations in clarithromycin-resistant isolates. Additionally, several novel mutations including G2220T, C2248T, A2624C, G2287A, T2188C, G2710C, C2248T, G2269A, and G2224T were also detected among either resistant or susceptible isolates. Our findings revealed the presence of several point mutations in the 23S rRNA gene of H. pylori isolates which may be associated with resistance to clarithromycin.
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Affiliation(s)
- Helia Alavifard
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Mirzaei
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Kaveh Baghaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sinéad Marian Smith
- School of Medicine & School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Synopsis
Teeth lie at the interface between an animal and its environment and, with some exceptions, act as a major component of resource procurement through food acquisition and processing. Therefore, the shape of a tooth is closely tied to the type of food being eaten. This tight relationship is of use to biologists describing the natural history of species and given the high instance of tooth preservation in the fossil record, is especially useful for paleontologists. However, correlating gross tooth morphology to diet is only part of the story, and much more can be learned through the study of dental biomechanics. We can explore the mechanics of how teeth work, how different shapes evolved, and the underlying forces that constrain tooth shape. This review aims to provide an overview of the research on dental biomechanics, in both mammalian and non-mammalian teeth, and to synthesize two main approaches to dental biomechanics to develop an integrative framework for classifying and evaluating dental functional morphology. This framework relates food material properties to the dynamics of food processing, in particular how teeth transfer energy to food items, and how these mechanical considerations may have shaped the evolution of tooth morphology. We also review advances in technology and new techniques that have allowed more in-depth studies of tooth form and function.
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Affiliation(s)
- S B Crofts
- Department of Evolution, Ecology, and Behavior, University of Illinois, 515 Morrill Hall, 505 S. Goodwin Avenue, Urbana, IL 61801, USA
| | - S M Smith
- Field Museum of Natural History, Negaunee Integrative Research Center, 1400 South Lake Shore Drive, Chicago, IL 60605-2496, USA
| | - P S L Anderson
- Department of Evolution, Ecology, and Behavior, University of Illinois, 515 Morrill Hall, 505 S. Goodwin Avenue, Urbana, IL 61801, USA
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17
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Sibonga J, Matsumoto T, Jones J, Shapiro J, Lang T, Shackelford L, Smith SM, Young M, Keyak J, Kohri K, Ohshima H, Spector E, LeBlanc A. Resistive exercise in astronauts on prolonged spaceflights provides partial protection against spaceflight-induced bone loss. Bone 2019; 128:112037. [PMID: 31400472 DOI: 10.1016/j.bone.2019.07.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
Bone loss in astronauts during spaceflight may be a risk factor for osteoporosis, fractures and renal stone formation. We previously reported that the bisphosphonate alendronate, combined with exercise that included an Advanced Resistive Exercise Device (ARED), can prevent or attenuate group mean declines in areal bone mineral density (aBMD) measured soon after ~ 6-month spaceflights aboard the International Space Station (ISS). It is unclear however if the beneficial effects on postflight aBMD were due to individual or combined effects of alendronate and ARED. Hence, 10 additional ISS astronauts were recruited who used the ARED (ARED group) without drug administration using similar measurements in the previous study, i.e., densitometry, biochemical assays and analysis of finite element (FE) models. In addition densitometry data (DXA and QCT only) were compared to published data from crewmembers (n = 14-18) flown prior to in-flight access to the ARED (Pre-ARED). Group mean changes from preflight (± SD %) were used to evaluate effects of countermeasures as sequentially modified on the ISS (i.e., Pre-ARED vs. ARED; ARED vs. Bis+ARED). Spaceflight durations were not significantly different between groups. Postflight bone density measurements were significantly reduced from preflight in the Pre-ARED group. As previously reported, combined Bis+ARED prevented declines in all DXA and QCT hip densitometry and in estimates of FE hip strengths; increased the aBMD of lumbar spine; and prevented elevations in urinary markers for bone resorption during spaceflight. ARED without alendronate partially attenuated declines in bone mass but did not suppress biomarkers for bone resorption or prevent trabecular bone loss. Resistive exercise in the ARED group did not prevent declines in hip trabecular vBMD, but prevented reductions in cortical vBMD of the femoral neck, in FE estimate of hip strength for non-linear stance (NLS) and in aBMD of the femoral neck. We conclude that a bisphosphonate, when combined with resistive exercise, enhances the preservation of bone mass because of the added suppression of bone resorption in trabecular bone compartment not evident with ARED alone.
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Affiliation(s)
- J Sibonga
- Human Health & Performance Directorate, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - T Matsumoto
- Fujii Memorial Institute of Medical Sciences, University of Tokushima, Tokushima 770-8503, Japan.
| | - J Jones
- Center for Space Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - J Shapiro
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - T Lang
- Department of Radiology, University of California, San Francisco, CA 94143, USA.
| | - L Shackelford
- Human Health & Performance Directorate, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - S M Smith
- Human Health & Performance Directorate, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - M Young
- Human Health & Performance Directorate, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - J Keyak
- Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA.
| | - K Kohri
- Department of Nephrology, Nagoya City University, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - H Ohshima
- Japan Aerospace Exploration Agency, Tsukuba Space Center, 2-1-1 Sengen, Tsukuba-Shi, Ibaraki 305-8505, Japan.
| | - E Spector
- KBRwyle, 2400 NASA Parkway, Houston, TX 77058, USA.
| | - A LeBlanc
- Center for Space Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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18
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Sava RI, Chen Y, Taha YK, Gong Y, Smith SM, Cooper-Dehoff R, Keeley EC, Pepine CJ, Handberg EM. P5730Do hypertensive women with coronary artery disease benefit from lowering systolic blood pressure under 130 mmHg? Long-term mortality in the INternational VErapamil SR-trandolapril STudy (INVEST). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension (HTN) and coronary artery disease (CAD) are a prevalent combination in women, however limited data are available to guide blood pressure (BP) management. We hypothesize older women with HTN and CAD may not derive the same prognostic benefit from systolic BP (SBP) lowering <130 mmHg.
Purpose
To investigate the long-term mortality implications of different achieved SBP levels in hypertensive women with CAD.
Methods
Long-term, all-cause mortality data were analyzed for 9216 women, stratified by risk attributable to clinical severity of CAD (women with prior myocardial infarction or revascularization considered at high, all others at low risk) and by age (50 - <65 or ≥65 yo). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130 to <140 and ≥140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics.
Results
During 108,838 person-years of follow-up, 2945 deaths occurred. High risk women (n=3011) had increased long-term mortality in comparison to low risk women (n=6205) (adjusted HR 1.38, CI 1.28–1.5, p<0.001). Within risk groups, crude mortality percentages decreased according to BP values (table). As expected, high risk women were more likely to be ≥65 yo (68.68% vs. 50.51%, p<0.0001) or have SBP ≥140 mmHg (43.08% vs. 31.18%, p<0.0001). In adjusted analyses, an SBP ≥140 mmHg was associated with worse outcomes than SBP <130 mmHg in the entire cohort (HR 1.3, CI 1.2–1.5, p<0.0001) and when stratifying by risk (low risk group, HR = 1.47, CI 1.28–1.7, p<0.0001; high risk group, HR = 1.71, CI 1.01–1.35, p=0.03). In analyses stratified by age and risk, women ≥65 years and at high risk had decreased mortality in the 130 - <140 SBP category vs. <130 mmHg (HR 0.812, 95% CI 0.689–0.957, p=0.0133; figure).
Women and deaths by risk and SBP group Group SBP category Women (n) Mortality (n) Mortality (%) High risk <130 773 338 44 130–<140 941 414 44 ≥140 1297 694 54 Low risk <130 2187 390 18 130–<140 2083 451 22 ≥140 1935 658 34 SBP = systolic blood pressure; n = number; % = percent per each group.
Mortality adjusted HRs
Conclusion
In women ≥65 yo with hypertension and prior myocardial infarction and/or coronary revascularization enrolled in INVEST, a SBP between 130 to <140 mmHg was associated with lower all-cause, long-term mortality versus SBP <130 mmHg.
Acknowledgement/Funding
The main INVEST (International Verapamil [SR]/Trandolapril Study) was funded by grants from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, A
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Affiliation(s)
- R I Sava
- University of Florida, Division of Cardiovascular Medicine, College of Medicine, Gainesville, United States of America
| | - Y Chen
- University of Florida, Department of Pharmacotherapy and Translational Research, Gainesville, United States of America
| | - Y K Taha
- University of Florida, Division of Cardiovascular Medicine, College of Medicine, Gainesville, United States of America
| | - Y Gong
- University of Florida, Department of Pharmacotherapy and Translational Research, Gainesville, United States of America
| | - S M Smith
- University of Florida, Department of Pharmacotherapy and Translational Research, Gainesville, United States of America
| | - R Cooper-Dehoff
- University of Florida, Department of Pharmacotherapy and Translational Research, Gainesville, United States of America
| | - E C Keeley
- University of Florida, Division of Cardiovascular Medicine, College of Medicine, Gainesville, United States of America
| | - C J Pepine
- University of Florida, Division of Cardiovascular Medicine, College of Medicine, Gainesville, United States of America
| | - E M Handberg
- University of Florida, Division of Cardiovascular Medicine, College of Medicine, Gainesville, United States of America
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19
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Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, Brueckle MS, Cesari M, Tinetti ME, Valderas JM. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med 2019; 285:272-288. [PMID: 30357955 DOI: 10.1111/joim.12842] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [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] [Indexed: 11/29/2022]
Abstract
The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.
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Affiliation(s)
- C Muth
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S M Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - K Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - A I Gonzalez-Gonzalez
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - T S Nguyen
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M-S Brueckle
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M Cesari
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - M E Tinetti
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - J M Valderas
- Health Services and Policy Research Group, APEx Collaboration for Academic Primary Care, NIHR PenCLAHRC, University of Exeter Medical School, Exeter, UK
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20
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Mc Sharry J, Dinneen SF, Humphreys M, O'Donnell M, O'Hara MC, Smith SM, Winkley K, Byrne M. Barriers and facilitators to attendance at Type 2 diabetes structured education programmes: a qualitative study of educators and attendees. Diabet Med 2019; 36:70-79. [PMID: 30156335 DOI: 10.1111/dme.13805] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 01/16/2023]
Abstract
AIMS Attendance at structured diabetes education has been recommended internationally for all people with Type 2 diabetes. However, attendance rates are consistently low. This qualitative study aimed to explore experiences of attending and delivering Type 2 diabetes structured education programmes in Ireland and barriers and facilitators to attendance. METHODS People with Type 2 diabetes who had attended one of the three programmes delivered in Ireland and educators from the three programmes took part in semi-structured telephone interviews. Interviews were audio-taped, transcribed and analysed using inductive thematic analysis. RESULTS Twelve attendees and 14 educators were interviewed. Two themes were identified in relation to experiences of programme attendance and delivery: 'Structured education: addressing an unmet need' and 'The problem of non-attendance'. The third theme 'Barriers to attendance: can't go, won't go, don't know and poor system flow' outlined how practicalities of attending, lack of knowledge of the existence and benefits, and limited resources and support for education within the diabetes care pathway impacts on attendance. The final theme 'Supporting attendance: healthcare professionals and the diabetes care pathway' describes facilitators to participants' attendance and the strategies educators perceived to be important in increasing attendance. CONCLUSIONS Healthcare professionals have an important role in improving attendance at structured diabetes education programmes. Improving attendance may require promotion by healthcare professionals and for education to be better embedded and supported within the diabetes care pathway.
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Affiliation(s)
- J Mc Sharry
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
| | - S F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | | | - M O'Donnell
- School of Medicine, National University of Ireland, Galway, Ireland
| | - M C O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin, Ireland
| | - S M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Winkley
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - M Byrne
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
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21
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Cardwell K, Clyne B, Moriarty F, Wallace E, Fahey T, Boland F, McCullagh L, Clarke S, Finnigan K, Daly M, Barry M, Smith SM. Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care. Pilot Feasibility Stud 2018; 4:122. [PMID: 30002869 PMCID: PMC6034254 DOI: 10.1186/s40814-018-0311-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. Methods This non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted. Discussion This non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland and provide data on whether a randomised controlled trial of this intervention is indicated. It will also provide a deeper understanding as to how a pharmacist working as part of the general practice team will affect organisational processes and professional relationships in a mixed public and private primary healthcare system.
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Affiliation(s)
- Karen Cardwell
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - B Clyne
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - F Moriarty
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - E Wallace
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - T Fahey
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - F Boland
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - L McCullagh
- 2Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - S Clarke
- 3Health Service Executive Medicines Management Programme, Dublin, Ireland
| | - K Finnigan
- 3Health Service Executive Medicines Management Programme, Dublin, Ireland
| | - M Daly
- 3Health Service Executive Medicines Management Programme, Dublin, Ireland
| | - M Barry
- 2Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.,3Health Service Executive Medicines Management Programme, Dublin, Ireland
| | - S M Smith
- 1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
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22
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Teljeur C, Moran PS, Walshe S, Smith SM, Cianci F, Murphy L, Harrington P, Ryan M. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review. Diabet Med 2017; 34:1040-1049. [PMID: 27770591 DOI: 10.1111/dme.13281] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/17/2022]
Abstract
AIMS To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. RESULTS A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. CONCLUSIONS Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.
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Affiliation(s)
- C Teljeur
- Health Information and Quality Authority, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - P S Moran
- Health Information and Quality Authority, Dublin, Ireland
| | - S Walshe
- Health Information and Quality Authority, Dublin, Ireland
| | - S M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Cianci
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - L Murphy
- Health Information and Quality Authority, Dublin, Ireland
| | - P Harrington
- Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Information and Quality Authority, Dublin, Ireland
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23
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deJonge RB, Bourchier RS, Smith SM. Initial Response by a Native Beetle, Chrysochus auratus (Coleoptera: Chrysomelidae), to a Novel Introduced Host-Plant, Vincetoxicum rossicum (Gentianales: Apocynaceae). Environ Entomol 2017; 46:617-625. [PMID: 28398528 DOI: 10.1093/ee/nvx072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 06/07/2023]
Abstract
Native insects can form novel associations with introduced invasive plants and use them as a food source. The recent introduction into eastern North America of a nonnative European vine, Vincetoxicum rossicum (Kleopow) Barbar., allows us to examine the initial response of a native chrysomelid beetle, Chrysochus auratus F., that feeds on native plants in the same family as V. rossicum (Apocynaceae). We tested C. auratus on V. rossicum and closely related or co-occurring native plants (Apocynum spp., Asclepias spp., and Solidago canadensis L.) using all life stages of the beetle in lab, garden, and field experiments. Experiments measured feeding (presence or absence and amount), survival, oviposition, and whether previous exposure to V. rossicum in the lab or field affected adult beetle feeding. Beetles fed significantly less on V. rossicum than on native Apocynum hosts. Adult beetles engaged in exploratory feeding on leaves of V. rossicum and survived up to 10 d. Females oviposited on V. rossicum, eggs hatched, and larvae fed initially on the roots; however, no larvae survived beyond second instar. Beetles collected from Apocynum cannabinum L. field sites intermixed with V. rossicum were less likely to feed on this novel nonnative host than those collected from colonies further from and less likely to be exposed to V. rossicum (>5 km). Our experimental work indicates that V. rossicum may act as an oviposition sink for C. auratus and that this native beetle has not adapted to survive on this recently introduced novel host plant.
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Affiliation(s)
- R B deJonge
- Faculty of Forestry, University of Toronto, 33 Willcocks St. Toronto, ON M5S 3B3, Canada (; )
| | - R S Bourchier
- Agriculture and AgriFood Canada-Lethbridge Research Centre, 5403-1st Avenue S. Lethbridge, AB T1J 4B1, Canada
| | - S M Smith
- Faculty of Forestry, University of Toronto, 33 Willcocks St. Toronto, ON M5S 3B3, Canada (; )
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24
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Puglisi GM, Smith SM, Jankovich RD, Ashby CR, Jodlowski TZ. Paritaprevir/ritonavir/ombitasvir+dasabuvir plus ribavirin therapy and inhibition of the anticoagulant effect of warfarin: a case report. J Clin Pharm Ther 2016; 42:115-118. [PMID: 27813106 DOI: 10.1111/jcpt.12475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 04/16/2016] [Accepted: 10/02/2016] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Paritaprevir/ritonavir/ombitasvir+dasabuvir (PrOD) is a direct-acting antiviral (DAA) approved for the treatment of chronic hepatitis C virus. We report on a probable interaction between PrOD with ribavirin and warfarin. CASE DESCRIPTION Two weeks after the start of PrOD with ribavirin, the patient's international normalized ratio (INR) became subtherapeutic. Eleven weeks into therapy and following a 125% total increase in the weekly warfarin dose, therapeutic INR was achieved. Thirteen days after DAA therapy was completed and discontinued, the patient's INR became critically supratherapeutic. WHAT IS NEW AND CONCLUSION Patients on PrOD plus ribavirin with warfarin should have INR followed closely upon initiation and discontinuation of therapy due to a probable drug interaction.
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Affiliation(s)
- G M Puglisi
- PGY2 Pharmacy Resident, Ambulatory Care, VA Maine Healthcare System, Augusta, ME, USA
| | - S M Smith
- Clinical Pharmacy Specialist, Pharmacy Service, VA Maine Healthcare System, Augusta, ME, USA
| | - R D Jankovich
- Gastroenterology Section, Medical Service, VA Maine Healthcare System, Augusta, ME, USA
| | - C R Ashby
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA
| | - T Z Jodlowski
- Clinical Pharmacy Specialist, Pharmacy Service, VA North Texas Health Care System, Dallas, TX, USA
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25
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Schneider DA, Smith SM, Campbell C, Hayami T, Kapila S, Hatch NE. Locally limited inhibition of bone resorption and orthodontic relapse by recombinant osteoprotegerin protein. Orthod Craniofac Res 2016; 18 Suppl 1:187-95. [PMID: 25865548 DOI: 10.1111/ocr.12086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine minimal dose levels required for local inhibition of orthodontic relapse by recombinant OPG protein (OPG-Fc), while also determining effects of injected OPG-Fc on alveolar bone and long bone. SETTING AND SAMPLE POPULATION The Department of Orthodontics and Pediatric Dentistry at the University of Michigan. Eighteen male Sprague Dawley rats. MATERIALS & METHODS Maxillary molars were moved with nickel-titanium springs and then allowed to relapse in Sprague Dawley rats. Upon appliance removal, animals were injected with a single dose of 1.0 mg/kg OPG-Fc, 0.1 mg/kg OPG-Fc, or phosphate-buffered saline (vehicle) just distal to the molar teeth. Tooth movement measurements were made from stone casts, which were scanned and digitally measured. Alveolar tissues were examined by histology. Micro-computed tomography was used to quantify changes in alveolar and femur bone. RESULTS Local injection of OPG-Fc inhibited molar but not incisor relapse, when compared to vehicle-injected animals. No significant differences in alveolar or femur bone were seen between the three treatment groups after 24 days of relapse. CONCLUSIONS Our results demonstrate that a single local injection of OPG-Fc effectively inhibits orthodontic relapse, with minimal systemic bone metabolic effects. Our results also show that a single injection of OPG-Fc will influence tooth movement only in teeth close to the injection site. These findings indicate that OPG-Fc has potential as a safe and effective pharmacological means to locally control osteoclasts, for uses such as maintaining anchorage during orthodontic tooth movement and preventing orthodontic relapse in humans.
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Affiliation(s)
- D A Schneider
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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26
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Colclough GL, Woolrich MW, Tewarie PK, Brookes MJ, Quinn AJ, Smith SM. How reliable are MEG resting-state connectivity metrics? Neuroimage 2016; 138:284-293. [PMID: 27262239 PMCID: PMC5056955 DOI: 10.1016/j.neuroimage.2016.05.070] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 01/31/2023] Open
Abstract
MEG offers dynamic and spectral resolution for resting-state connectivity which is unavailable in fMRI. However, there are a wide range of available network estimation methods for MEG, and little in the way of existing guidance on which ones to employ. In this technical note, we investigate the extent to which many popular measures of stationary connectivity are suitable for use in resting-state MEG, localising magnetic sources with a scalar beamformer. We use as empirical criteria that network measures for individual subjects should be repeatable, and that group-level connectivity estimation shows good reproducibility. Using publically-available data from the Human Connectome Project, we test the reliability of 12 network estimation techniques against these criteria. We find that the impact of magnetic field spread or spatial leakage artefact is profound, creates a major confound for many connectivity measures, and can artificially inflate measures of consistency. Among those robust to this effect, we find poor test-retest reliability in phase- or coherence-based metrics such as the phase lag index or the imaginary part of coherency. The most consistent methods for stationary connectivity estimation over all of our tests are simple amplitude envelope correlation and partial correlation measures.
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Affiliation(s)
- G L Colclough
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK; Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK; Dept. Engineering Sciences, University of Oxford, Parks Rd, Oxford, UK.
| | - M W Woolrich
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK; Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - P K Tewarie
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, UK
| | - M J Brookes
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, UK
| | - A J Quinn
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK
| | - S M Smith
- Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK
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27
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Tavor I, Parker Jones O, Mars RB, Smith SM, Behrens TE, Jbabdi S. Task-free MRI predicts individual differences in brain activity during task performance. Science 2016; 352:216-20. [PMID: 27124457 PMCID: PMC6309730 DOI: 10.1126/science.aad8127] [Citation(s) in RCA: 475] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/29/2016] [Indexed: 12/24/2022]
Abstract
When asked to perform the same task, different individuals exhibit markedly different patterns of brain activity. This variability is often attributed to volatile factors, such as task strategy or compliance. We propose that individual differences in brain responses are, to a large degree, inherent to the brain and can be predicted from task-independent measurements collected at rest. Using a large set of task conditions, spanning several behavioral domains, we train a simple model that relates task-independent measurements to task activity and evaluate the model by predicting task activation maps for unseen subjects using magnetic resonance imaging. Our model can accurately predict individual differences in brain activity and highlights a coupling between brain connectivity and function that can be captured at the level of individual subjects.
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Affiliation(s)
- I Tavor
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK. Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - O Parker Jones
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - R B Mars
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK. Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 EZ Nijmegen, Netherlands
| | - S M Smith
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - T E Behrens
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK. Wellcome Trust Centre for Neuroimaging, University College London, London, WC1N 3BG, UK
| | - S Jbabdi
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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28
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Murphy AW, Cupples ME, Murphy E, Newell J, Scarrott CJ, Vellinga A, Gillespie P, Byrne M, Kearney C, Smith SM. Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice. BMJ Open 2015; 5:e007807. [PMID: 26534729 PMCID: PMC4636612 DOI: 10.1136/bmjopen-2015-007807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease. DESIGN A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction). SETTING 48 general practices in the Republic of Ireland and Northern Ireland. PARTICIPANTS 903 patients with established coronary heart disease at baseline in the original trial. INTERVENTION The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased. PRIMARY OUTCOME hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control. RESULTS At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol. CONCLUSIONS Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN24081411.
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Affiliation(s)
- A W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - M E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, Northern Ireland
| | - E Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - J Newell
- Health Research Board Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - C J Scarrott
- School of Mathematic and Statistics, University of Canterbury, Christchurch, New Zealand
| | - A Vellinga
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - P Gillespie
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - C Kearney
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - S M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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29
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Klyuchnikov E, Bacher U, Woo Ahn K, Carreras J, Kröger NM, Hari PN, Ku GH, Ayala E, Chen AI, Chen YB, Cohen JB, Freytes CO, Gale RP, Kamble RT, Kharfan-Dabaja MA, Lazarus HM, Martino R, Mussetti A, Savani BN, Schouten HC, Usmani SZ, Wiernik PH, Wirk B, Smith SM, Sureda A, Hamadani M. Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma. Bone Marrow Transplant 2015; 51:58-66. [PMID: 26437062 PMCID: PMC4703480 DOI: 10.1038/bmt.2015.223] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/29/2015] [Accepted: 08/15/2015] [Indexed: 01/04/2023]
Abstract
Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.
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Affiliation(s)
- E Klyuchnikov
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - U Bacher
- Department for Hematology/Oncology, Georg August University Göttingen, Göttingen, Germany
| | - K Woo Ahn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Carreras
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - N M Kröger
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - P N Hari
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - G H Ku
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California, San Diego, CA, USA
| | - E Ayala
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A I Chen
- Oregon Health and Science University, Portland, OR, USA
| | - Y-B Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - J B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - C O Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - R P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College of London, London, UK
| | - R T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - R Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Mussetti
- SC Ematologia e Trapianto Midollo Osseo, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - S Z Usmani
- Department of Hematology - Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - P H Wiernik
- Our Lady of Mercy Medical Center, Bronx, NY, USA
| | - B Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - S M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - A Sureda
- Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.,European Group for Blood and Marrow Transplantation, Barcelona, Spain
| | - M Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Carris NW, Ghushchyan V, Libby AM, Smith SM. Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives. J Hum Hypertens 2015; 30:191-6. [PMID: 26084656 DOI: 10.1038/jhh.2015.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/27/2015] [Accepted: 05/14/2015] [Indexed: 12/21/2022]
Abstract
Little is known about the impact of treatment-resistant hypertension (TRH) on health-related quality of life (HrQoL). We aimed to compare HrQoL measures in adults with apparent TRH (aTRH) and non-resistant hypertension among nationally representative US Medical Expenditure Panel Survey data pooled from 2000 to 2011. Cohorts compared were adults with aTRH (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the aTRH definition). Key outcomes were cohort differences in SF-12v2 physical component summary (PCS) and mental component summary (MCS) scores and disease-state utility using the SF-6D. Of 57 150 adults with hypertension, 2501 (4.4%) met criteria for aTRH. Persons with aTRH, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher BMI (30.9 vs 29.7 kg m(-)(2)) and were more likely to be Black (20% vs 14%), but less likely to be female (46% vs 54%). Persons with aTRH, compared with non-resistant hypertension, had lower mean PCS scores (35.8 vs 43.2; P<0.0001), and utility (0.68 vs 0.74; P<0.0001), but similar MCS scores (49.1 vs 50.4). In multivariable-adjusted analyses, aTRH was associated with a 2.37 (95% CI 1.71 to 3.02) lower PCS score and 0.02 (95% CI 0.01 to 0.03) lower utility, compared with non-resistant hypertension. In conclusion, aTRH was associated with substantially lower HrQoL in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. The multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.
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Affiliation(s)
- N W Carris
- Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL, USA
| | - V Ghushchyan
- Department of Economics, American University of Armenia,Yerevan, Armenia.,Department of Clinical Pharmacy and Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - A M Libby
- Department of Clinical Pharmacy and Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - S M Smith
- Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL, USA
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Colclough GL, Brookes MJ, Smith SM, Woolrich MW. A symmetric multivariate leakage correction for MEG connectomes. Neuroimage 2015; 117:439-48. [PMID: 25862259 PMCID: PMC4528074 DOI: 10.1016/j.neuroimage.2015.03.071] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/25/2022] Open
Abstract
Ambiguities in the source reconstruction of magnetoencephalographic (MEG) measurements can cause spurious correlations between estimated source time-courses. In this paper, we propose a symmetric orthogonalisation method to correct for these artificial correlations between a set of multiple regions of interest (ROIs). This process enables the straightforward application of network modelling methods, including partial correlation or multivariate autoregressive modelling, to infer connectomes, or functional networks, from the corrected ROIs. Here, we apply the correction to simulated MEG recordings of simple networks and to a resting-state dataset collected from eight subjects, before computing the partial correlations between power envelopes of the corrected ROItime-courses. We show accurate reconstruction of our simulated networks, and in the analysis of real MEGresting-state connectivity, we find dense bilateral connections within the motor and visual networks, together with longer-range direct fronto-parietal connections. A method for removing source leakage from multivariate network analyses in MEG. Network inference performed using regularised partial correlations between ROIs. Artificial correlations are removed using a symmetric orthogonalisation step. Simulations show accurate false-positive rates for network edge detection. Resting-state networks show increased bilateral connectivity after correction.
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Affiliation(s)
- G L Colclough
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK; University of Oxford, Dept. Engineering Sciences, Parks Rd., Oxford, UK; Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK.
| | - M J Brookes
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, UK
| | - S M Smith
- Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - M W Woolrich
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK; Centre for the Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK
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Bachanova V, Burns LJ, Wang T, Carreras J, Gale RP, Wiernik PH, Ballen KK, Wirk B, Munker R, Rizzieri DA, Chen YB, Gibson J, Akpek G, Costa LJ, Kamble RT, Aljurf MD, Hsu JW, Cairo MS, Schouten HC, Bacher U, Savani BN, Wingard JR, Lazarus HM, Laport GG, Montoto S, Maloney DG, Smith SM, Brunstein C, Saber W. Alternative donors extend transplantation for patients with lymphoma who lack an HLA matched donor. Bone Marrow Transplant 2014; 50:197-203. [PMID: 25402415 PMCID: PMC4336786 DOI: 10.1038/bmt.2014.259] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 01/26/2023]
Abstract
Alternative donor transplantation is increasingly used for high risk lymphoma patients. We analyzed 1593 transplant recipients (2000 to 2010) and compared transplant outcomes in recipients of 8/8 allele human leukocyte antigen (HLA)-A, -B, -C, and DRB1 matched unrelated donors (MUD; n=1176), 7/8 allele HLA-matched unrelated donors (MMUD; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared to MUD (35%; p=0.004), but similar to UCB recipients (37%; p=0.19), although UCB had lower rates of neutrophil and platelet recovery compared to unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, p=0.003) but similar between UCB and MUD (30% vs 33%; p=0.48). In multivariate analysis UCB recipients had lower risks of acute and chronic graft versus host disease compared with adult donor groups (UCB vs MUD: HR=0.68, p=0.05; HR=0.35; p<0.001). Adjusted 3-year overall survival was comparable (43% MUD, 37% MMUD and 41% UCB). Data highlight that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can expand the curative potential of allotransplant to patients who lack suitable HLA-matched sibling or MUD.
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Affiliation(s)
- V Bachanova
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - L J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - T Wang
- 1] Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA [2] Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R P Gale
- Division of Experimental Medicine, Department of Medicine, Hematology Research Center, Imperial College London, London, UK
| | - P H Wiernik
- Our Lady of Mercy Medical Center, Bronx, NY, USA
| | - K K Ballen
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - B Wirk
- BMT Program, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - R Munker
- Department of Hematology/Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - D A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Y-B Chen
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - J Gibson
- Department of Hematology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - G Akpek
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - L J Costa
- Medical University of South Carolina, Charleston, SC, USA
| | - R T Kamble
- Department of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - M D Aljurf
- Department of Oncology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - J W Hsu
- Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - M S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - H C Schouten
- Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - U Bacher
- 1] Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany [2] MLL Munich Leukemia Laboratory, Munich, Germany
| | - B N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - J R Wingard
- 1] Shands HealthCare & University of Florida, Gainesville, FL, USA [2] LifeSouth Community Blood Centers, Gainesville, FL, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - G G Laport
- Division of BMT, Stanford Hospitals & Clinics, Stanford, CA, USA
| | - S Montoto
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - D G Maloney
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - C Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - W Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Abramson JS, Feldman T, Kroll-Desrosiers AR, Muffly LS, Winer E, Flowers CR, Lansigan F, Nabhan C, Nastoupil LJ, Nath R, Goy A, Castillo JJ, Jagadeesh D, Woda B, Rosen ST, Smith SM, Evens AM. Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol 2014; 25:2211-2217. [PMID: 25193992 DOI: 10.1093/annonc/mdu443] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear. PATIENTS AND METHODS We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses. RESULTS PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission. CONCLUSIONS This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.
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Affiliation(s)
- J S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston
| | - T Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - A R Kroll-Desrosiers
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - L S Muffly
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - E Winer
- Department of Hematology/Oncology, Rhode Island Hospital, Providence
| | - C R Flowers
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - F Lansigan
- Department of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon
| | - C Nabhan
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - L J Nastoupil
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - R Nath
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - A Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - J J Castillo
- Department of Hematology/Oncology, Miriam Hospital, Providence
| | - D Jagadeesh
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - B Woda
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - S T Rosen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - S M Smith
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - A M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, USA.
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Smith SM, Castaneda-Sceppa C, O'Brien KO, Abrams SA, Gillman P, Brooks NE, Cloutier GJ, Heer M, Zwart SR, Wastney ME. Calcium kinetics during bed rest with artificial gravity and exercise countermeasures. Osteoporos Int 2014; 25:2237-44. [PMID: 24861908 PMCID: PMC4521405 DOI: 10.1007/s00198-014-2754-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Received: 04/04/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED We assessed the potential for countermeasures to lessen the loss of bone calcium during bed rest. Subjects ingested less calcium during bed rest, and with artificial gravity, they also absorbed less calcium. With exercise, they excreted less calcium. To retain bone during bed rest, calcium intake needs to be maintained. INTRODUCTION This study aims to assess the potential for artificial gravity (AG) and exercise (EX) to mitigate loss of bone calcium during space flight. METHODS We performed two studies: (1) a 21-day bed rest (BR) study with subjects receiving 1 h/day AG (n = 8) or no AG (n = 7) and (2) a 28-day BR study with 1 h/day resistance EX (n = 10) or no EX (n = 3). In both studies, stable isotopes of Ca were administered orally and intravenously, at baseline and after 10 days of BR, and blood, urine, and feces were sampled for up to 14 days post dosing. Tracers were measured using thermal ionization mass spectrometry. Data were analyzed by compartmental modeling. RESULTS Less Ca was absorbed during BR, resulting in lower Ca balance in BR+AG (-6.04 ± 3.38 mmol/day, P = 0.023). However, Ca balance did not change with BR+EX, even though absorbed Ca decreased and urinary Ca excretion increased, because endogenous excretion decreased, and there was a trend for increased bone deposition (P = 0.06). Urinary N-telopeptide excretion increased in controls during BR, but not in the EX group. Markers of bone formation were not different between treatment groups for either study. Ca intake decreased during BR (by 5.4 mmol/day in the AG study and 2.8 mmol/day in the EX study), resulting in lower absorbed Ca. CONCLUSIONS During BR (or space flight), Ca intake needs to be maintained or even increased with countermeasures such as exercise, to enable maintenance of bone Ca.
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Affiliation(s)
- S M Smith
- NASA Lyndon B. Johnson Space Center, Attn: Mail Code SK3, 2101 NASA Parkway, Houston, TX, 77058, USA,
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Lee MK, Smith SM, Banerjee MM, Li C, Minoo P, Volpe MV, Nielsen HC. The p66Shc adapter protein regulates the morphogenesis and epithelial maturation of fetal mouse lungs. Am J Physiol Lung Cell Mol Physiol 2013; 306:L316-25. [PMID: 24375794 DOI: 10.1152/ajplung.00062.2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Many signaling pathways are mediated by Shc adapter proteins that, in turn, are expressed as three isoforms with distinct functions. The p66(Shc) isoform antagonizes proliferation, regulates oxidative stress, and mediates apoptosis. It is highly expressed in the canalicular but not the later stages of mouse lung development, and its expression persists in bronchopulmonary dysplasia, a chronic disease associated with premature birth. These observations suggest that p66(Shc) has a developmental function. However, constitutive p66(Shc) deletion yields no morphological phenotype, and the structure of the Shc gene precludes its inducible deletion. To elucidate its function in lung development, we transfected p66(Shc) or nonsilencing small-interfering RNA (siRNA) into the epithelia of embryonic day 11 mouse lungs that were then cultured for 3 days and analyzed morphometrically. To assess cellular proliferation and epithelial differentiation, lung explants were immunostained and immunoblotted for p66(Shc), proliferating cell nuclear antigen (PCNA), the proximal airway differentiation antigens Clara cell 10-kDa protein (CC10) and thyroid transcription factor (TTF)-1, and the alveolar surfactant proteins (SP)-A, -B, and -C. Explants transfected with nonsilencing siRNA demonstrated specific epithelial uptake and normal morphological development relative to uninjected controls. In contrast, transfection with p66(Shc) siRNA significantly increased lumenal cross-sectional areas, decreased branching, and increased epithelial proliferation (P < 0.05 for all). Relative to controls, the expression of SP-B, SP-C, CC10, and TTF-1 was decreased by p66(Shc) knockdown. SP-A was not expressed in either control or treated lungs. These data suggest that p66(Shc) attenuates epithelial proliferation while promoting both distal and proximal epithelial maturation.
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Affiliation(s)
- M K Lee
- General Laboratories Bldg., 1201 E. Marengo St., Los Angeles, CA 90033.
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Abstract
This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain.
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Affiliation(s)
- S M Smith
- 1] Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia [2] Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, UK
| | - B Sumar
- Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia
| | - K A Dixon
- Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia
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Leblanc A, Matsumoto T, Jones J, Shapiro J, Lang T, Shackelford L, Smith SM, Evans H, Spector E, Ploutz-Snyder R, Sibonga J, Keyak J, Nakamura T, Kohri K, Ohshima H. Bisphosphonates as a supplement to exercise to protect bone during long-duration spaceflight. Osteoporos Int 2013; 24:2105-14. [PMID: 23334732 DOI: 10.1007/s00198-012-2243-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED We report the results of alendronate ingestion plus exercise in preventing the declines in bone mass and strength and elevated levels of urinary calcium and bone resorption in astronauts during 5.5 months of spaceflight. INTRODUCTION This investigation was an international collaboration between NASA and the JAXA space agencies to investigate the potential value of antiresorptive agents to mitigate the well-established bone changes associated with long-duration spaceflight. METHODS We report the results from seven International Space Station (ISS) astronauts who spent a mean of 5.5 months on the ISS and who took an oral dose of 70 mg of alendronate weekly starting 3 weeks before flight and continuing throughout the mission. All crewmembers had available for exercise a treadmill, cycle ergometer, and a resistance exercise device. Our assessment included densitometry of multiple bone regions using X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and assays of biomarkers of bone metabolism. RESULTS In addition to pre- and post-flight measurements, we compared our results to 18 astronauts who flew ISS missions and who exercised using an early model resistance exercise device, called the interim resistance exercise device, and to 11 ISS astronauts who exercised using the newer advanced resistance exercise device (ARED). Our findings indicate that the ARED provided significant attenuation of bone loss compared with the older device although post-flight decreases in the femur neck and hip remained. The combination of the ARED and bisphosphonate attenuated the expected decline in essentially all indices of altered bone physiology during spaceflight including: DXA-determined losses in bone mineral density of the spine, hip, and pelvis, QCT-determined compartmental losses in trabecular and cortical bone mass in the hip, calculated measures of fall and stance computed bone strength of the hip, elevated levels of bone resorption markers, and urinary excretion of calcium. CONCLUSIONS The combination of exercise plus an antiresoptive drug may be useful for protecting bone health during long-duration spaceflight.
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Affiliation(s)
- A Leblanc
- Universities Space Research Association, 3600 Bay Area Blvd, Houston, TX 77058, USA.
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Evens AM, Choquet S, Kroll-Desrosiers AR, Jagadeesh D, Smith SM, Morschhauser F, Leblond V, Roy R, Barton B, Gordon LI, Gandhi MK, Dierickx D, Schiff D, Habermann TM, Trappe R. Primary CNS posttransplant lymphoproliferative disease (PTLD): an international report of 84 cases in the modern era. Am J Transplant 2013; 13:1512-22. [PMID: 23721553 DOI: 10.1111/ajt.12211] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/28/2013] [Accepted: 01/31/2013] [Indexed: 01/25/2023]
Abstract
We performed a multicenter, International analysis of solid organ transplant (SOT)-related primary central nervous system (PCNS) posttransplant lymphoproliferative disease (PTLD). Among 84 PCNS PTLD patients, median time of SOT-to-PTLD was 54 months, 79% had kidney SOT, histology was monomorphic in 83% and tumor was EBV+ in 94%. Further, 33% had deep brain involvement, 10% had CSF involvement, while none had ocular disease. Immunosuppression was reduced in 93%; additional first-line therapy included high-dose methotrexate (48%), high-dose cytarabine (33%), brain radiation (24%) and/or rituximab (44%). The overall response rate was 60%, while treatment-related mortality was 13%. With 42-month median follow-up, three-year progression-free survival (PFS) and overall survival (OS) were 32% and 43%, respectively. There was a trend on univariable analysis for improved PFS for patients who received rituximab and/or high-dose cytarabine. On multivariable Cox regression, poor performance status predicted inferior PFS (HR 2.61, 95% CI 1.32-5.17, p = 0.006), while increased LDH portended inferior OS (HR 4.16, 95% CI 1.29-13.46, p = 0.02). Moreover, lack of response to first-line therapy was the most dominant prognostic factor on multivariable analysis (HR 8.70, 95% CI 2.56-29.57, p = 0.0005). Altogether, PCNS PTLD appears to represent a distinct clinicopathologic entity within the PTLD spectrum that is associated with renal SOT, occurs late, is monomorphic and retains EBV positivity.
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Affiliation(s)
- A M Evens
- Division of Hematology/Oncology, The University of Massachusetts Medical School, Worcester, MA, USA.
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Smith SM, Chaney EA, Bewley JM. Short communication: planning considerations for on-farm dairy processing enterprises. J Dairy Sci 2013; 96:4519-22. [PMID: 23660143 DOI: 10.3168/jds.2012-6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/16/2013] [Indexed: 11/19/2022]
Abstract
Across the world, more dairy producers are considering on-farm dairy processing to add value to the milk produced on their farms. Dairy producers may bottle milk or process their milk into cheese, ice cream, butter, yogurt, or cream. The primary objective of this research was to establish a series of sound factors or indicators of success for those considering on-farm processing. A survey was employed to collect opinions and advice from managers of on-farm processing enterprises. Surveys were distributed online (n=120), with 31 surveys returned, accounting for a 25.8% response rate. Most (64%) respondents had been involved in on-farm dairy processing for less than 10 yr. Sixty-one percent of respondents attained a positive cash flow in 1 to 3 yr. The primary products manufactured were cheese (69%), milk (59%), ice cream (31%), yogurt (25%), and butter (21%). Factors influencing the decision to start an on-farm dairy processing enterprise included commodity milk prices (61%), desire to work with the public (41%), an opportunity to promote the dairy industry (39%), a desire to maintain or expand a small family operation (29%), and product differentiation (16%). Respondents cited dealing with regulations (26%), product marketing (19%), manufacturing technicalities (19%), and securing funding (17%) as the most difficult parts of starting the business. Open-ended responses provided by the respondents of this survey were also documented to give future dairy producers advice. The most common advice to future on-farm processors was to work on realistic business plans, develop and follow realistic budgets, and observe and use market surveys within the industry. These results provide a useful array of information for future on-farm dairy processing enterprises.
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Affiliation(s)
- S M Smith
- Department of Animal and Food Sciences, University of Kentucky, Lexington 40546, USA
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Abstract
OBJECTIVES The aim of this systematic review was to examine the epidemiology of malpractice claims in primary care. DESIGN A computerised systematic literature search was conducted. Studies were included if they reported original data (≥10 cases) pertinent to malpractice claims, were based in primary care and were published in the English language. Data were synthesised using a narrative approach. SETTING Primary care. PARTICIPANTS Malpractice claimants. PRIMARY OUTCOME Malpractice claim (defined as a written demand for compensation for medical injury). We recorded: medical misadventure cited in claims, missed/delayed diagnoses cited in claims, outcome of claims, prevalence of claims and compensation awarded to claimants. RESULTS Of the 7152 articles retrieved by electronic search, a total of 34 studies met the inclusion criteria and were included in the narrative analysis. Twenty-eight studies presented data from medical indemnity malpractice claims databases and six studies presented survey data. Fifteen studies were based in the USA, nine in the UK, seven in Australia, one in Canada and two in France. The commonest medical misadventure resulting in claims was failure to or delay in diagnosis, which represented 26-63% of all claims across included studies. Common missed or delayed diagnoses included cancer and myocardial infarction in adults and meningitis in children. Medication error represented the second commonest domain representing 5.6-20% of all claims across included studies. The prevalence of malpractice claims in primary care varied across countries. In the USA and Australia when compared with other clinical disciplines, general practice ranked in the top five specialties accounting for the most claims, representing 7.6-20% of all claims. However, the majority of claims were successfully defended. CONCLUSIONS This review of malpractice claims in primary care highlights diagnosis and medication error as areas to be prioritised in developing educational strategies and risk management systems.
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Affiliation(s)
- E Wallace
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
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Affiliation(s)
- E Wallace
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
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Spatz JM, Fields EE, Yu EW, Divieti Pajevic P, Bouxsein ML, Sibonga JD, Zwart SR, Smith SM. Serum sclerostin increases in healthy adult men during bed rest. J Clin Endocrinol Metab 2012; 97:E1736-40. [PMID: 22767636 PMCID: PMC3431567 DOI: 10.1210/jc.2012-1579] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Animal models and human studies suggest that osteocytes regulate the skeleton's response to mechanical unloading in part by an increase in sclerostin. However, few studies have reported changes in serum sclerostin in humans exposed to reduced mechanical loading. OBJECTIVE We determined changes in serum sclerostin and bone turnover markers in healthy adult men undergoing controlled bed rest. DESIGN, SETTING, AND PARTICIPANTS Seven healthy adult men (31 ± 3 yr old) underwent 90 d of 6° head down tilt bed rest at the University of Texas Medical Branch Institute for Translational Sciences-Clinical Research Center. OUTCOMES Serum sclerostin, PTH, vitamin D, bone resorption and formation markers, urinary calcium and phosphorus excretion, and 24-h pooled urinary markers of bone resorption were evaluated before bed rest [baseline (BL)] and at bed rest d 28 (BR-28), d 60 (BR-60), and d 90 (BR-90). Bone mineral density was measured at BL, BR-60, and 5 d after the end of the study (BR+5). Data are reported as mean ± SD. RESULTS Consistent with prior reports, bone mineral density declined significantly (1-2% per month) at weight-bearing skeletal sites. Serum sclerostin was elevated above BL at BR-28 (+29 ± 20%; P = 0.003) and BR-60 (+42 ± 31%; P < 0.001), with a lesser increase at BR-90 (+22 ± 21%; P = 0.07). Serum PTH levels were reduced at BR-28 (-17 ± 16%; P = 0.02) and BR-60 (-24 ± 14%; P = 0.03) and remained lower than BL at BR-90 (-21 ± 21%; P = 0.14), but did not reach statistical significance. Serum bone turnover markers were unchanged; however, urinary bone resorption markers and calcium were significantly elevated at all time points after bed rest (P < 0.01). CONCLUSIONS In healthy men subjected to controlled bed rest for 90 d, serum sclerostin increased, with a peak at 60, whereas serum PTH declined, and urinary calcium and bone resorption markers increased.
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Affiliation(s)
- J M Spatz
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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Ryan K, De Groot P, Nott RW, Drabble S, Ochoa I, Davis C, Smith SM, Turgeon JJ. Natural enemies associated with Sirex noctilio (Hymenoptera: Siricidae) and S. nigricornis in Ontario, Canada. Environ Entomol 2012; 41:289-297. [PMID: 22507001 DOI: 10.1603/en11275] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sirex noctilio F. is an exotic woodwasp now found in eastern North America where it shares natural enemies with native woodwasps of Pinus spp. To study the extent to which native hymenopteran parasitoids and parasitic nematodes could affect woodwasp populations, 60 Pinus trees with symptoms of S. noctilio attack were felled in 2007 and 2008 in Ontario, Canada. Each tree bole was cut into 1-m sections that were placed in individual rearing tubes; emergence was monitored from May to November of the year of felling. Female S. noctilio were dissected to assess parasitism by the nematode Deladenus siricidicola Bedding. Two species of Siricidae emerged from these trees; S. noctilio, which accounted for most of the specimens collected, and S. nigricornis F. Of the three species of parasitoid that emerged, Ibalia leucospoides (Hochenwarth) was the most abundant, accounting for an overall hypothetical Siricidae parasitism rate of almost 20%. This parasitoid emerged over a similar time period as S. noctilio-between early July and early September. Except in trees >15 m in height, parasitism by I. leucospoides generally appeared uniform throughout the bole. Parasitism rates did not vary between the 2 yr, but did between sites in 1 yr. Parasitic nematodes were found in the haemocoel of about one third of S. noctilio females dissected but were never found sterilizing the eggs; none were found in S. noctilio emerging from P. resinosa. These findings suggest that I. leucospoides is currently the primary invertebrate natural enemy of S. noctilio in Ontario.
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Affiliation(s)
- K Ryan
- University of Toronto, Toronto, ON, Canada.
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Van Essen DC, Ugurbil K, Auerbach E, Barch D, Behrens TEJ, Bucholz R, Chang A, Chen L, Corbetta M, Curtiss SW, Della Penna S, Feinberg D, Glasser MF, Harel N, Heath AC, Larson-Prior L, Marcus D, Michalareas G, Moeller S, Oostenveld R, Petersen SE, Prior F, Schlaggar BL, Smith SM, Snyder AZ, Xu J, Yacoub E. The Human Connectome Project: a data acquisition perspective. Neuroimage 2012; 62:2222-31. [PMID: 22366334 DOI: 10.1016/j.neuroimage.2012.02.018] [Citation(s) in RCA: 1309] [Impact Index Per Article: 109.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 10/24/2011] [Accepted: 02/08/2012] [Indexed: 11/28/2022] Open
Abstract
The Human Connectome Project (HCP) is an ambitious 5-year effort to characterize brain connectivity and function and their variability in healthy adults. This review summarizes the data acquisition plans being implemented by a consortium of HCP investigators who will study a population of 1200 subjects (twins and their non-twin siblings) using multiple imaging modalities along with extensive behavioral and genetic data. The imaging modalities will include diffusion imaging (dMRI), resting-state fMRI (R-fMRI), task-evoked fMRI (T-fMRI), T1- and T2-weighted MRI for structural and myelin mapping, plus combined magnetoencephalography and electroencephalography (MEG/EEG). Given the importance of obtaining the best possible data quality, we discuss the efforts underway during the first two years of the grant (Phase I) to refine and optimize many aspects of HCP data acquisition, including a new 7T scanner, a customized 3T scanner, and improved MR pulse sequences.
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Affiliation(s)
- D C Van Essen
- Department of Anatomy & Neurobiology, Washington University, St. Louis, MO, USA.
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Smith SM, Bandettini PA, Miller KL, Behrens TEJ, Friston KJ, David O, Liu T, Woolrich MW, Nichols TE. The danger of systematic bias in group-level FMRI-lag-based causality estimation. Neuroimage 2012; 59:1228-9. [PMID: 21867760 DOI: 10.1016/j.neuroimage.2011.08.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/06/2011] [Accepted: 08/09/2011] [Indexed: 12/01/2022] Open
Abstract
Schippers, Renken and Keysers (NeuroImage, 2011) present a simulation of multi-subject lag-based causality estimation. We fully agree that single-subject evaluations (e.g., Smith et al., 2011) need to be revisited in the context of multi-subject studies, and Schippers' paper is a good example, including detailed multi-level simulation and cross-subject statistical modelling. The authors conclude that "the average chance to find a significant Granger causality effect when no actual influence is present in the data stays well below the p-level imposed on the second level statistics" and that "when the analyses reveal a significant directed influence, this direction was accurate in the vast majority of the cases". Unfortunately, we believe that the general meaning that may be taken from these statements is not supported by the paper's results, as there may in reality be a systematic (group-average) difference in haemodynamic delay between two brain areas. While many statements in the paper (e.g., the final two sentences) do refer to this problem, we fear that the overriding message that many readers may take from the paper could cause misunderstanding.
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Affiliation(s)
- S M Smith
- Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Oxford University, UK.
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Smith SM, Bell D, Hopkinson NS, Valentine J, Shaw EL, Partridge MR, Elkini SL. A review of discharge planning for people with chronic obstructive pulmonary disease at high risk for readmission. Clin Med (Lond) 2011; 11:510-1. [PMID: 22034725 PMCID: PMC4954260 DOI: 10.7861/clinmedicine.11-5-510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lacruz RS, Smith CE, Smith SM, Hu P, Bringas P, Sahin-Tóth M, Moradian-Oldak J, Paine ML. Chymotrypsin C (caldecrin) is associated with enamel development. J Dent Res 2011; 90:1228-33. [PMID: 21828354 DOI: 10.1177/0022034511418231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Two main proteases cleave enamel extracellular matrix proteins during amelogenesis. Matrix metalloprotease-20 (Mmp20) is the predominant enzyme expressed during the secretory stage, while kallikrein-related peptidase-4 (Klk4) is predominantly expressed during maturation. Mutations to both Mmp20 and Klk4 result in abnormal enamel phenotypes. During a recent whole-genome microarray analysis of rat incisor enamel organ cells derived from the secretory and maturation stages of amelogenesis, the serine protease chymotrypsin C (caldecrin, Ctrc) was identified as significantly up-regulated (> 11-fold) during enamel maturation. Prior reports indicate that Ctrc expression is pancreas-specific, albeit low levels were also noted in brain. We here report on the expression of Ctrc in the enamel organ. Quantitative PCR (qPCR) and Western blot analysis were used to confirm the expression of Ctrc in the developing enamel organ. The expression profile of Ctrc is similar to that of Klk4, increasing markedly during the maturation stage relative to the secretory stage, although levels of Ctrc mRNA are lower than for Klk4. The discovery of a new serine protease possibly involved in enamel development has important implications for our understanding of the factors that regulate enamel biomineralization.
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Affiliation(s)
- R S Lacruz
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, USA.
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Chan BY, Fuller ES, Russell AK, Smith SM, Smith MM, Jackson MT, Cake MA, Read RA, Bateman JF, Sambrook PN, Little CB. Increased chondrocyte sclerostin may protect against cartilage degradation in osteoarthritis. Osteoarthritis Cartilage 2011; 19:874-85. [PMID: 21619935 DOI: 10.1016/j.joca.2011.04.014] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the regulation of sclerostin (SOST) in osteoarthritis (OA) and its potential effects on articular cartilage degradation. METHODS SOST and other Wnt-β-catenin components were immuno-localised in osteochondral sections of surgically-induced OA in knees of sheep and mice, and human OA samples obtained at arthroplasty. Regulation of SOST mRNA and protein expression by ovine chondrocytes in response to interleukin-1α (IL-1α) or tumour necrosis factor-α (TNFα) was examined in explant cultures. The effect of 25 or 250 ng/ml recombinant SOST alone or in combination with IL-1α, on ovine articular cartilage explant aggrecan degradation, and chondrocyte gene expression of Wnt-β-catenin pathway proteins, metalloproteinases and their inhibitors, and cartilage matrix proteins was quantified. RESULTS Contrary to being an osteocyte-specific protein, SOST was expressed by articular chondrocytes, and mRNA levels were upregulated in vitro by IL-1α but not TNFα. Chondrocyte SOST staining was significantly increased only in the focal area of cartilage damage in surgically-induced OA in sheep and mice, as well as end-stage human OA. In contrast, osteocyte SOST was focally decreased in the subchondral bone in sheep OA in association with bone sclerosis. SOST was biologically active in chondrocytes, inhibiting Wnt-β-catenin signalling and catabolic metalloproteinase [matrix metalloproteinases (MMP) and distintegrin and metalloproteinase with thrombospndin repeats (ADAMTS)] expression, but also decreasing mRNA levels of aggrecan, collagen II and tissue inhibitors of metalloproteinaes (TIMPs). Despite this mixed effect, SOST dose-dependently inhibited IL-1α-stimulated cartilage aggrecanolysis in vitro. CONCLUSIONS These results implicate SOST in regulating the OA disease processes, but suggest opposing effects by promoting disease-associated subchondral bone sclerosis while inhibiting degradation of cartilage.
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Affiliation(s)
- B Y Chan
- Raymond Purves Bone and Joint Research Labs, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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