1
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Stanisce L, McGlone M, Koshkareva Y, Swendseid B, Lawrence I, Kubicek GJ, Gaughan JP, Solomon DH, Ahmad N. Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy. Otolaryngol Head Neck Surg 2023; 169:1499-1505. [PMID: 37422889 DOI: 10.1002/ohn.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. STUDY DESIGN Retrospective cohort analysis. SETTING Academic tertiary-care center from May 2014 to September 2021. METHODS In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. RESULTS Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003). CONCLUSION Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Mick McGlone
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Brian Swendseid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Ian Lawrence
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Division of Speech and Language Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Gregory J Kubicek
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Department of Radiation Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
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2
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Toledo-Jaldin L, Lazo-Vega L, Grau L, Lawrence I, Larrea-Alvarado A, Mizutani R, Rocabado S, Vasan V, Sammel M, Julian CG, Moore LG. Increased adherence to ACOG diagnostic guidelines for HDP following a workshop in Bolivia, a LMIC. Pregnancy Hypertens 2023; 34:19-26. [PMID: 37778281 PMCID: PMC10841895 DOI: 10.1016/j.preghy.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown. STUDY DESIGN We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods). MAIN OUTCOME MEASURES HDP diagnoses, maternal, and infant characteristics. RESULTS Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria. CONCLUSIONS Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE. FUNDING NIH TW010797, HD088590, HL138181.
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Affiliation(s)
| | - Litzi Lazo-Vega
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | - Laura Grau
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Ian Lawrence
- University of Colorado Denver School of Medicine, Aurora, CO 80045, United States
| | | | - Rodrigo Mizutani
- Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia
| | - Sebastian Rocabado
- Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia
| | - Vikram Vasan
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Mary Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, United States
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States.
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3
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Lazo-Vega L, Toledo-Jaldin L, Badner A, Barriga-Vera JL, Castro-Monrroy M, Euser AG, Larrea-Alvarado A, Lawrence I, Mérida C, Mizutani R, Pérez Y, Rocabado S, Vargas M, Vasan V, Julian CG, Moore LG. ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study. Lancet Reg Health Am 2022; 9:100194. [PMID: 35719175 PMCID: PMC9205446 DOI: 10.1016/j.lana.2022.100194] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Methods Medical records for all HDP discharge diagnoses (n = 734) and twice as many controls (n = 1647) were reviewed for one year at the three largest delivery sites. For the 690 cases and 1548 controls meeting inclusion criteria (singleton, 18-45 maternal age, local residence), health history, blood pressures, symptoms, lab tests, HDP diagnoses (i.e., gestational hypertension [GH]; preeclampsia [PE]; haemolysis, low platelets, high liver enzymes [HELLP] syndrome, eclampsia), and adverse outcomes were recorded. Bolivian diagnoses were compared to ACOG guidelines using accuracy analysis and associated with adverse outcomes by logistic regression. Findings Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Interpretation Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. Funding NIH TW010797, HD088590, HL138181, UL1 TR002535.
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Affiliation(s)
- Litzi Lazo-Vega
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | - Abraham Badner
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | | | - Anna G. Euser
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
| | | | - Ian Lawrence
- University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Carola Mérida
- Universidad Major de San Andrés, Escuela de Medicina, La Paz, Bolivia
| | | | | | - Sebastian Rocabado
- Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia
| | | | - Vikram Vasan
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Colleen G. Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Lorna G. Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
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4
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Chetan MR, Miksza JK, Lawrence I, Anjana RM, Unnikrishnan R, Amutha A, Shanthi Rani CS, Jebarani S, Mohan V, Khunti K, Narendran P. The increased risk of microvascular complications in South Asians with type 1 diabetes is influenced by migration. Diabet Med 2020; 37:2136-2142. [PMID: 31721280 DOI: 10.1111/dme.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
AIM We aimed to explore the association between South Asian ethnicity and complications of type 1 diabetes, and whether this is affected by migration. METHODS In this retrospective cohort study, data on diabetes control and complications were obtained for South Asians in India (South AsiansIndia , n = 2592) and the UK (South AsiansUK , n = 221) and white Europeans in the UK (n = 1431). Multivariable logistic regression was used to identify associations between ethnicity and diabetic kidney disease, retinopathy and neuropathy adjusting for age, sex, BMI, disease duration, HbA1c , blood pressure (BP) and cholesterol. RESULTS South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease [odds ratio (OR) 5.0, 95% confidence intervals (CI) 3.6-7.1] and retinopathy (OR 1.8, 95% CI 1.2-2.5), but lower odds of neuropathy (OR 0.5, 95% CI 0.4-0.6) than white Europeans. South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease (OR 3.0, 95% 1.8-5.3) than South AsiansUK , but there was no significant difference in the odds of other complications. CONCLUSIONS In this hypothesis-generating study, we report that South Asian ethnicity is associated with greater risk of diabetic kidney disease and retinopathy, and lower risk of neuropathy than white European ethnicity. Part of the excess diabetic kidney disease risk is reduced in South AsiansUK . These associations cannot be accounted for by differences in vascular risk factors. Our findings in South Asians with type 1 diabetes mirror previous findings in type 2 diabetes and now need to be validated in a study of the effect of ethnicity on type 1 diabetes complications where healthcare is provided in the same setting.
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Affiliation(s)
- M R Chetan
- College of Medical and Dental Sciences, Birmingham, UK
| | - J K Miksza
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - I Lawrence
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | | | - A Amutha
- Madras Diabetes Research Foundation, Chennai, India
| | | | - S Jebarani
- Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - P Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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5
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Baker J, Dickman A, Mason S, Bickerstaff M, Jackson R, McArdle A, Lawrence I, Stephenson F, Paton N, Kirk J, Waters B, Ellershaw J. An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions? BMC Palliat Care 2020; 19:99. [PMID: 32635902 PMCID: PMC7341565 DOI: 10.1186/s12904-020-00611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI over 48 h may have numerous benefits in both patient care and health service resource utilisation. This service evaluation aims to identify the frequency at which CSCI prescriptions are altered at NHS Acute Hospitals. METHODS Pharmacists or members of palliative care teams at seven acute NHS hospitals recorded anonymised prescription data relating to the drug combination(s), doses, diluent and compatibility of CSCIs containing two or more drugs on a daily basis for a minimum of 2 days, to a maximum of 7 days. RESULTS A total of 1301 prescriptions from 288 patients were recorded across the seven sites, yielding 584 discrete drug combinations. Of the 584 combinations, 91% (n = 533) included an opioid. The 10 most-common CSCI drug combinations represented 37% of the combinations recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days. CONCLUSION Data suggests medication delivered by CSCI over 48 h may be a viable option. Before a clinical feasibility study can be undertaken, a pharmacoeconomic assessment and robust chemical and microbiological stability data will be required, as will the assessment of the perceptions from clinical staff, patients and their families on the acceptability of such a change in practice.
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Affiliation(s)
- J Baker
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. .,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK.
| | - A Dickman
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - S Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - M Bickerstaff
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - A McArdle
- Pharmacy Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - I Lawrence
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - F Stephenson
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N Paton
- Pharmacy Department, The Christie NHS Foundation Trust, Manchester, UK
| | - J Kirk
- Pharmacy Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - B Waters
- Pharmacy Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Ellershaw
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
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6
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Abadie V, Kim SM, Lejeune T, Palanski BA, Ernest JD, Tastet O, Voisine J, Discepolo V, Marietta EV, Hawash MBF, Ciszewski C, Bouziat R, Panigrahi K, Horwath I, Zurenski MA, Lawrence I, Dumaine A, Yotova V, Grenier JC, Murray JA, Khosla C, Barreiro LB, Jabri B. IL-15, gluten and HLA-DQ8 drive tissue destruction in coeliac disease. Nature 2020; 578:600-604. [PMID: 32051586 PMCID: PMC7047598 DOI: 10.1038/s41586-020-2003-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [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: 10/30/2018] [Accepted: 12/16/2019] [Indexed: 11/09/2022]
Abstract
Coeliac disease is a complex, polygenic inflammatory enteropathy caused by exposure to dietary gluten that occurs in a subset of genetically susceptible individuals who express either the HLA-DQ8 or HLA-DQ2 haplotypes1,2. The need to develop non-dietary treatments is now widely recognized3, but no pathophysiologically relevant gluten- and HLA-dependent preclinical model exists. Furthermore, although studies in humans have led to major advances in our understanding of the pathogenesis of coeliac disease4, the respective roles of disease-predisposing HLA molecules, and of adaptive and innate immunity in the development of tissue damage, have not been directly demonstrated. Here we describe a mouse model that reproduces the overexpression of interleukin-15 (IL-15) in the gut epithelium and lamina propria that is characteristic of active coeliac disease, expresses the predisposing HLA-DQ8 molecule, and develops villous atrophy after ingestion of gluten. Overexpression of IL-15 in both the epithelium and the lamina propria is required for the development of villous atrophy, which demonstrates the location-dependent central role of IL-15 in the pathogenesis of coeliac disease. In addition, CD4+ T cells and HLA-DQ8 have a crucial role in the licensing of cytotoxic T cells to mediate intestinal epithelial cell lysis. We also demonstrate a role for the cytokine interferon-γ (IFNγ) and the enzyme transglutaminase 2 (TG2) in tissue destruction. By reflecting the complex interaction between gluten, genetics and IL-15-driven tissue inflammation, this mouse model provides the opportunity to both increase our understanding of coeliac disease, and develop new therapeutic strategies.
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Affiliation(s)
- Valérie Abadie
- Department of Microbiology, Infectiology, and Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
- Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Sangman M Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
- Department of Biology, University of San Francisco, San Francisco, CA, USA
| | - Thomas Lejeune
- Department of Microbiology, Infectiology, and Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Brad A Palanski
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Jordan D Ernest
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Olivier Tastet
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Jordan Voisine
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | | | - Eric V Marietta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Mohamed B F Hawash
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
- Department of Biochemistry, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Cezary Ciszewski
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Romain Bouziat
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | | | - Irina Horwath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Ian Lawrence
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anne Dumaine
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Vania Yotova
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Christophe Grenier
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Chaitan Khosla
- Department of Chemistry, Stanford University, Stanford, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
- Stanford ChEM-H, Stanford University, Stanford, CA, USA
| | - Luis B Barreiro
- Department of Genetics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, IL, USA
| | - Bana Jabri
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Committee on Immunology, University of Chicago, Chicago, IL, USA.
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA.
- Department of Pathology, University of Chicago, Chicago, IL, USA.
- University of Chicago Celiac Disease Center, University of Chicago, Chicago, IL, USA.
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7
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Bouziat R, Hinterleitner R, Brown JJ, Stencel-Baerenwald JE, Ikizler M, Mayassi T, Meisel M, Kim SM, Discepolo V, Pruijssers AJ, Ernest JD, Iskarpatyoti JA, Costes LMM, Lawrence I, Palanski BA, Varma M, Zurenski MA, Khomandiak S, McAllister N, Aravamudhan P, Boehme KW, Hu F, Samsom JN, Reinecker HC, Kupfer SS, Guandalini S, Semrad CE, Abadie V, Khosla C, Barreiro LB, Xavier RJ, Ng A, Dermody TS, Jabri B. Reovirus infection triggers inflammatory responses to dietary antigens and development of celiac disease. Science 2017; 356:44-50. [PMID: 28386004 DOI: 10.1126/science.aah5298] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 02/22/2017] [Indexed: 12/11/2022]
Abstract
Viral infections have been proposed to elicit pathological processes leading to the initiation of T helper 1 (TH1) immunity against dietary gluten and celiac disease (CeD). To test this hypothesis and gain insights into mechanisms underlying virus-induced loss of tolerance to dietary antigens, we developed a viral infection model that makes use of two reovirus strains that infect the intestine but differ in their immunopathological outcomes. Reovirus is an avirulent pathogen that elicits protective immunity, but we discovered that it can nonetheless disrupt intestinal immune homeostasis at inductive and effector sites of oral tolerance by suppressing peripheral regulatory T cell (pTreg) conversion and promoting TH1 immunity to dietary antigen. Initiation of TH1 immunity to dietary antigen was dependent on interferon regulatory factor 1 and dissociated from suppression of pTreg conversion, which was mediated by type-1 interferon. Last, our study in humans supports a role for infection with reovirus, a seemingly innocuous virus, in triggering the development of CeD.
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Affiliation(s)
- Romain Bouziat
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Reinhard Hinterleitner
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Judy J Brown
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer E Stencel-Baerenwald
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mine Ikizler
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Toufic Mayassi
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Marlies Meisel
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Sangman M Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Valentina Discepolo
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, and CeInGe-Biotecnologie Avanzate, Naples, Italy
| | - Andrea J Pruijssers
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan D Ernest
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Jason A Iskarpatyoti
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Léa M M Costes
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Laboratory of Pediatrics, Division of Gastroenterology and Nutrition, Erasmus University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Ian Lawrence
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Brad A Palanski
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Mukund Varma
- Division of Gastroenterology, Department of Medicine, Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Matthew A Zurenski
- Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Solomiia Khomandiak
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicole McAllister
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pavithra Aravamudhan
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karl W Boehme
- Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fengling Hu
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Janneke N Samsom
- Laboratory of Pediatrics, Division of Gastroenterology and Nutrition, Erasmus University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Hans-Christian Reinecker
- Division of Gastroenterology, Department of Medicine, Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sonia S Kupfer
- Department of Medicine, University of Chicago, Chicago, IL, USA.,University of Chicago Celiac Disease Center, University of Chicago, Chicago, IL, USA
| | - Stefano Guandalini
- University of Chicago Celiac Disease Center, University of Chicago, Chicago, IL, USA.,Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Carol E Semrad
- Department of Medicine, University of Chicago, Chicago, IL, USA.,University of Chicago Celiac Disease Center, University of Chicago, Chicago, IL, USA
| | - Valérie Abadie
- Department of Microbiology, Infectiology, and Immunology, University of Montreal, and the Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Chaitan Khosla
- Department of Chemistry, Stanford University, Stanford, CA, USA.,Department of Chemical Engineering, Stanford University, Stanford, CA, USA.,Stanford ChEM-H, Stanford University, Stanford, California, USA
| | - Luis B Barreiro
- Department of Genetics, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Ramnik J Xavier
- Division of Gastroenterology, Department of Medicine, Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA.,Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aylwin Ng
- Division of Gastroenterology, Department of Medicine, Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Terence S Dermody
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bana Jabri
- Department of Medicine, University of Chicago, Chicago, IL, USA. .,Committee on Immunology, University of Chicago, Chicago, IL, USA.,University of Chicago Celiac Disease Center, University of Chicago, Chicago, IL, USA.,Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Chicago, Chicago, IL, USA.,Department of Pathology, University of Chicago, Chicago, IL, USA
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Thompson G, Pepperell D, Lawrence I, McGettigan BD. Crohn's disease complicated by Epstein-Barr virus-driven haemophagocytic lymphohistiocytosis successfully treated with rituximab. BMJ Case Rep 2017; 2017:bcr-2016-218578. [PMID: 28228435 DOI: 10.1136/bcr-2016-218578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We report a case of Epstein-Barr virus (EBV)-driven haemophagocytic lymphohistiocytosis (HLH) in a man with Crohn's disease treated with 6-mercaptopurine and adalimumab therapy who was successfully treated with rituximab therapy alone. This is the first published case in an adult patient with EBV-driven HLH in the setting of thiopurine use and inflammatory bowel disease to be successfully treated with rituximab therapy alone. Here, we will discuss putative immunological mechanisms which may contribute to this potentially life-threatening complication.
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Affiliation(s)
- Grace Thompson
- Department of Immunology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Ian Lawrence
- Harry Perkins Institute of Medical Research Perkins South, Perth, Bahrain.,Centre for Inflammatory Bowel Diseases, Subiaco, Perth, Western Australia, Australia
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9
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O Hara MC, Byrne M, Müller UA, Müller N, Wolf G, Zillich F, Mansell P, Lawrence I, Heller SR, Dinneen SF, O Shea E. Länderübergreifende qualitative Untersuchung von Strukturierten Schulungsprogrammen für Erwachsene mit Diabetes mellitus Typ 1. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Hopkins D, Lawrence I, Mansell P, Thompson G, Amiel S, Campbell M, Heller S. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience. Diabetes Care 2012; 35:1638-42. [PMID: 22619082 PMCID: PMC3402270 DOI: 10.2337/dc11-1579] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE DAFNE (Dose Adjustment For Normal Eating), a structured education program in flexible insulin therapy, has been widely adopted in the U.K. after validation in a randomized trial. To determine benefits in routine practice, we collected biomedical and psychological data from all participants attending during a 12-month period. RESEARCH DESIGN AND METHODS HbA(1c), weight, self-reported hypoglycemia awareness, severe hypoglycemia frequency, PAID (Problem Areas In Diabetes), HADS (Hospital Anxiety and Depression Scale), and EuroQol Group 5-Dimension Self-Report Questionnaire scores were recorded prior to DAFNE and after 1 year. RESULTS Complete baseline and follow-up HbA(1c) data were available for 639 (54.9%) of 1,163 attendees. HbA(1c) fell from 8.51 ± 1.41 (mean ± SD) to 8.24 ± 1.29% (difference 0.27 [95% CI 0.16-0.38]; P < 0.001), with a greater mean fall of 0.44% from baseline HbA(1c) >8.5%. Severe hypoglycemia rate fell from 1.7 ± 8.5 to 0.6 ± 3.7 episodes per person per year (1.1 [0.7-1.4]) and hypoglycemia recognition improved in 43% of those reporting unawareness. Baseline psychological distress was evident, with a PAID score of 25.2 and HADS scores of 5.3 (anxiety) and 4.8 (depression), falling to 16.7 (8.5 [6.6-10.4]), 4.6 (0.7 [0.4-1.0]), and 4.2 (0.6 [0.3-0.8]), respectively (all P < 0.001 at 1 year). Clinically relevant anxiety and depression (HADS ≥ 8) fell from 24.4 to 18.0% and 20.9 to 15.5%, respectively. CONCLUSIONS A structured education program delivered in routine clinical practice not only improves HbA(1c) while reducing severe hypoglycemia rate and restoring hypoglycemia awareness but also reduces psychological distress and improves perceived well-being.
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Affiliation(s)
- David Hopkins
- Department of Diabetic Medicine, King’s College Hospital National Health Service Foundation Trust, London, UK.
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11
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Benhalima K, Song SH, Wilmot EG, Khunti K, Gray LJ, Lawrence I, Davies M. Characteristics, complications and management of a large multiethnic cohort of younger adults with type 2 diabetes. Prim Care Diabetes 2011; 5:245-250. [PMID: 21782538 DOI: 10.1016/j.pcd.2011.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [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: 12/22/2010] [Revised: 05/08/2011] [Accepted: 06/06/2011] [Indexed: 11/15/2022]
Abstract
AIMS To describe the characteristics and management of a cohort with type 2 diabetes (T2DM) <40 years. METHODS Cross-sectional study of the last visit of 648 adults attending 2 specialist centres in the UK. Differences between the lowest (≤22) vs. highest quintile (≥33) of age of diagnosis were analysed. RESULTS 57.9% were female; 45.5% Black or Minority Ethnic origin (91.9% of South Asian origin); median age at diagnosis was 28 years (24-31); diabetes duration of 4.0 years (1.9-7.0); BMI of 33.0 kg/m(2) (28.3-38.7). HbA1c of 8.2% (6.8-9.9) with HbA1c >7% in 70%. 71.8% had cholesterol >4 mmol/l, 54.9% triglycerides >1.7 mmol/l, 45% had hypertension, 19.8% retinopathy, 16.9% microalbuminuria. Insulin was used in 43.3%. 27.7% received antihypertensives and 31.5% a statin. Compared to the highest quintile of age of diagnosis, the lowest quintile had more often retinopathy (22.1% vs. 16.9%, p=0.021), was less on insulin (45.6% vs. 46.4%, p=0.039) and often managed with diet only (9.6% vs. 6.2%, p=0.005). CONCLUSIONS These younger adults with T2DM often have inadequately treated risk factors. In particular, patients from the lowest quintile of age of diagnosis were less aggressively treated. There is a need for tailored strategies to manage this high-risk group.
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Affiliation(s)
- Katrien Benhalima
- Diabetes Research, University Hospital of Leicester, Victoria Building Level 1, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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12
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Benhalima K, Wilmot E, Khunti K, Gray LJ, Lawrence I, Davies M. Type 2 diabetes in younger adults: clinical characteristics, diabetes-related complications and management of risk factors. Prim Care Diabetes 2011; 5:57-62. [PMID: 20851071 DOI: 10.1016/j.pcd.2010.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 08/01/2010] [Indexed: 10/19/2022]
Abstract
AIM To describe the clinical characteristics and risk factors of adults <35 years with type 2 diabetes (T2DM). METHODS Observational study of 185 younger adults attending a specialist diabetes clinic. RESULTS In this cohort 65% were female, 51% Caucasian, 43% South Asian. Characteristics at presentation: age 24 ± 5.5 years, BMI 33 ± 7.6 kg/m(2) and HbA1c 9.0% ± 2.3. Follow up of 3.2 ± 2.8 years with a diabetes duration of 4.5 ± 3.6 years. HbA1c had improved compared with diagnosis (8.3 ± 2.2% vs. 9.0% ± 2.3%, p<0.0001), but 63% still had an HbA1c>7%. Oral anti-diabetic drugs were used in 72%, insulin alone in 19% and both in 26%. 41% had a BP ≥ 140/80 mmHg, 78% total cholesterol >4 mmol/l, 63% LDL >2 mmol/l, 56% triglycerides >1.7 mmol/l. From diagnosis only the cholesterol and LDL improved significantly, with a modest increase in primary prevention therapy (statin 12-26%, p<0.0001, anti-hypertensives 16-29%, p<0.0001, aspirin 8-12%, p=0.18). 13% had retinopathy, 21% microalbuminuria. 46% had not been reviewed within the past year. CONCLUSIONS This group represents an extreme phenotype with a high prevalence of insufficiently treated metabolic risk factors. There is need for tailored management strategies to engage and aggressively manage this high-risk group.
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Affiliation(s)
- Katrien Benhalima
- Department of Diabetes Research, University Hospital of Leicester, Victoria Building Level 1, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom.
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13
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Nayyar V, Jarvis J, Lawrence I, Kong MF, Gregory R, Hiles S, Jackson S, McNally P, Davies MJ. Long-term follow up of patients on U-500 insulin: a case series. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Webb DR, Davies MJ, Gray LJ, Abrams KR, Srinivasan B, Das S, Taub N, Lawrence I, Sutton S, Khunti K. Searching for the right outcome? A systematic review and meta-analysis of controlled trials using carotid intima-media thickness or pulse wave velocity to infer antiatherogenic properties of thiazolidinediones. Diabetes Obes Metab 2010; 12:124-32. [PMID: 19922476 DOI: 10.1111/j.1463-1326.2009.01122.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent meta-analyses cast doubt over purported beneficial effects of Peroxisome Proliferator Activated Receptor-Gamma (PPAR-gamma) receptor agonists. Thiazolidinedione (TZD) trials using surrogate outcomes to postulate an antiatherogenic paradigm have been criticised as misinformative. We conducted an independent systematic review and meta-analysis of controlled TZD studies incorporating carotid intima-media thickness (CIMT) or pulse wave velocity (PWV) as primary outcome measures. The aim was to provide an evidence-based overview of TZD intervention studies using markers prospectively linked to vascular outcome in type 2 diabetes. METHODS Systematic search of known databases for TZD intervention trials using mean thickness CIMT(n = 9) and ankle-brachial PWV(n = 6) as primary outcome measures was performed. CIMT and PWV pooled weighted mean difference was calculated using a random effects model accounting for heterogeneity and publication bias. An indirect meta-analysis provided a comparison of rosiglitazone and pioglitazone effects. RESULTS A composite of combined placebo and comparator controlled trials demonstrated a significant weighted mean difference of-0.06 mm for CIMT (95% CI-0.09 to-0.02, p = 0.001) and-0.72 ms(-1) for PWV (95% CI-1.28 to-0.16, p = 0.011) in favour of thiazolidiendione treatment. No TZD intraclass variation in CIMT (p = 0.96) or PWV (p = 0.33) change was observed. CONCLUSION TZDs exhibit significant beneficial effects on aorto-carotid atherosclerosis when assessed using prospectively validated non-invasive techniques. Inferring clinical benefit in the absence of confirmatory outcome trials is questionable and caution should be exercised when interpreting intervention data with surrogate endpoints. TZD-induced congestive cardiac failure or other unknown PPAR-gamma adverse effects are plausible explanations for the conflicting results of intervention trials using markers of atherosclerosis and clinical event outcomes.
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Affiliation(s)
- D R Webb
- Department of Cardiovascular Sciences, Victoria Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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15
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Srinivasan B, Davies M, Lawrence I. Diabetes: glycaemic control in type 1. BMJ Clin Evid 2008; 2008:0607. [PMID: 19445743 PMCID: PMC2907997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Type 1 diabetes occurs when destruction of the pancreatic islet beta cells, usually attributable to an autoimmune process, causes the pancreas to produces too little insulin or none at all. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of intensive treatment programmes and educational interventions in adults and adolescents with type 1 diabetes? What are the effects of different insulin regimens on glycaemic control in adults and adolescents with type 1 diabetes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2006 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review, we present information relating to the effectiveness and safety of the following interventions: different frequencies of insulin administration (continuous subcutaneous insulin infusion compared with multiple daily subcutaneous insulin injections); different frequencies of blood glucose self-monitoring; educational interventions; and intensive treatment programmes.
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Affiliation(s)
- Bala Srinivasan
- Department of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
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16
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Esslemont G, Maher W, Ford P, Lawrence I. Riparian plant material inputs to the Murray River, Australia: composition, reactivity, and role of nutrients. J Environ Qual 2007; 36:963-74. [PMID: 17526875 DOI: 10.2134/jeq2006.0318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
By changing riparian plants from Eucalypts to pasture and exotic deciduous trees, modern development has altered the type of carbon assimilated by Australian rivers. To investigate influences of plant litter substrates on biochemical oxygen demand, plant materials entering the Murray River were analyzed for their composition and mineralization potential. Plant materials were distinguished compositionally by two principal components, structural carbon and macronutrients, as: (i) Eucalyptus leaves, (ii) Eucalyptus bark and Casuarina cunninghamiana seed cone, (iii) grasses, (iv) macrophytes, (v) aquatic herbs, (vi) non-eucalypt leaf (Salix, Casuarina, Acacia). Ratios of C/P (1879-14524) and C/N (65-267) were relatively high in Eucalyptus bark, while mean N/P (7-60) ratios were similar among plant materials. Terrestrial weathering increased C/P and C/N ratios, while N/P ratios remained similar, due to greater loss of N and P relative to C. Aerobic decay experiments showed that nutrient supplementation accelerated decay of all organic substrates, except for grasses that decayed efficiently without supplementation. Aquatic herbs also had substantial carbon availability, macrophytes and non-eucalypt leaves had intermediate carbon availability, while eucalypt leaf and bark had intermediate to low carbon availabilities. Because biochemical oxygen demand varies with organic substrates sampled from the Murray River, and also with soluble nutrient availability, it is plausible that that modern changes to riverine plant communities and land use have influenced the biogeochemistry of this river toward faster, and more complete, processing of allochthonous carbon.
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Affiliation(s)
- Graeme Esslemont
- Cooperative Research Centre for Freshwater Ecology, University of Canberra, ACT 2601 Australia
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17
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Dave J, Chatterjee S, Davies M, Higgins K, Morjaria H, McNally P, Lawrence I, Blackledge H. Evaluation of admissions and management of diabetic ketoacidosis in a large teaching hospital. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/pdi.622] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Lawrence I. Continuing education. Diabet Med 2003; 20 Suppl 1:1. [PMID: 12647832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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20
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Lawrence I, Bryan I. Bridging the gap between knowledge generation and technology development. Innovation 2002. [DOI: 10.5172/impp.2001.4.1-3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ian Lawrence
- The STEM Partnership Pty Ltd Melbourne, Victoria, Australia
| | - Ivor Bryan
- The STEM Partnership Pty Ltd Melbourne, Victoria, Australia
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21
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Cloarec JP, Deligianis N, Martin JR, Lawrence I, Souteyrand E, Polychronakos C, Lawrence MF. Immobilization of homooligonucleotide probe layers onto Si/SiO(2) substrates: characterization by electrochemical impedance measurements and radiolabelling. Biosens Bioelectron 2002; 17:405-12. [PMID: 11888731 DOI: 10.1016/s0956-5663(01)00282-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Radiolabelling and electrochemical impedance measurements were used to characterize the immobilization of single stranded homooligonucleotides onto silica surfaces and their subsequent hybridization with complementary strands. The immobilization procedure consists of grafting an epoxysilane onto microelectronic grade Si/SiO(2) substrates, and coupling oligonucleotides bearing a hexylamine linker onto the epoxy moiety. Radiolabelling was used as a reference method to quantify the amount of immobilized and hybridized oligonucleotides. These results show that the Si/SiO(2) substrates modified with an epoxysilane yield a surface concentration of approximately 10(11) strands/cm(2) for the immobilized oligonucleotides, after vigorous washings, and that approximately 36% of these undergo hybridization with complementary strands. The impedance measurements, which provide a direct means of detecting variations in electrical charge accumulation across the semiconductor/oxide/electrolyte structure when the oxide surface is chemically modified, show that the semiconductor's flat band potential undergoes reproducible shifts of -150 and -100 mV following the immobilization and the hybridization step, respectively. These results demonstrate that electrochemical impedance measurements using chemically modified semiconductor/oxide/electrolyte structures of this type offer a viable alternative for the direct detection of complementary DNA strands upon hybridization.
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Affiliation(s)
- J P Cloarec
- Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Province of Quebec, Canada H3G 1M8
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Abstract
Tacrolimus (FK506) is a calcineurin inhibitor with potent immunomodulating properties. It has been marketed worldwide since 1993-1994 for the rejection of liver and kidney transplants (Prograf). The pharmacologic properties of tacrolimus resulted in its development as an ointment for the treatment of atopic dermatitis. An outline of nonclinical pharmacology studies that provided a rationale for this development is presented. The key nonclinical toxicology-safety studies that supported clinical efficacy/safety trials are also discussed. Taken collectively, these studies contributed to the marketing approval of 0.03% and 0.1% tacrolimus ointment (Protopic) as a first in class treatment for atopic dermatitis.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare, Inc., Deerfield, IL 60015, USA.
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23
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Bekersky I, Fitzsimmons W, Tanase A, Maher RM, Hodosh E, Lawrence I. Nonclinical and early clinical development of tacrolimus ointment for the treatment of atopic dermatitis. J Am Acad Dermatol 2001; 44:S17-27. [PMID: 11145792 DOI: 10.1067/mjd.2001.109816] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tacrolimus ointment, formulated for the treatment of atopic dermatitis, is the first in a class of topical immunomodulators. Its mechanism of action is based on calcineurin inhibition, which results in suppression of antigen-specific T-cell activation and inhibition of inflammatory cytokine release. Animal and human studies have shown that topically applied tacrolimus is minimally absorbed into the systemic circulation, the fraction that is absorbed is extensively distributed, and tacrolimus does not accumulate in tissues following repeated topical application. In addition, tacrolimus ointment is not inherently irritating, sensitizing, phototoxic, or photoallergenic when applied to intact skin. Unlike some topical corticosteroids, tacrolimus ointment does not cause a decrease in collagen synthesis or skin thickness, nor does it produce skin abnormalities or depigmentation. In animal studies, repeated daily application of tacrolimus ointment up to 1 year is associated with dermal findings similar to those following vehicle application (mild to moderate dermal irritation and microscopic findings of acanthosis, hyperkeratosis, and superficial inflammation). In a 52-week study with Yucatan micropigs, no noteworthy macroscopic or microscopic changes (either dermal or systemic) related to the application of tacrolimus ointment (0.03% to 0.3% concentrations) were observed. Tacrolimus ointment was shown to be safe and effective in phase 2 and early phase 3 studies. Significant improvements in atopic dermatitis were observed in the majority of patients treated with tacrolimus ointment. The most common adverse events associated with its use were a transient burning sensation and pruritus at the site of application. Blood tacrolimus concentrations were below the limit of quantitation in most patients.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare Inc, Deerfield, and Fujisawa Pharmaceutical, Ltd, Osaka
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Soter NA, Fleischer AB, Webster GF, Monroe E, Lawrence I. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part II, safety. J Am Acad Dermatol 2001; 44:S39-46. [PMID: 11145794 DOI: 10.1067/mjd.2001.109817] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In two randomized, double-blind, multicenter studies, a total of 631 adult patients with moderate to severe atopic dermatitis applied tacrolimus ointment (0.03% or 0.1%) or vehicle twice daily for up to 12 weeks. The mean percent body surface area (%BSA) affected at baseline was 45%, and 56% of patients had severe atopic dermatitis. As previously reported, these studies showed that tacrolimus ointment was superior to vehicle for all efficacy parameters measured. This report focuses on the safety of tacrolimus ointment in these studies. The most common adverse events were the sensation of skin burning, pruritus, flu-like symptoms, skin erythema, and headache. Skin burning and pruritus were more common among patients with severe or extensive disease; these events were usually brief and were resolved during the first few days of treatment. Common adverse events with a significantly higher incidence in one or both of the tacrolimus ointment groups than in the vehicle group included skin burning, flu-like symptoms, and headache. More patients in the vehicle group discontinued the study because of an adverse event than in either of the tacrolimus ointment groups. There were no notable or consistent changes in any laboratory variables. Tacrolimus was not detected in 80% of blood samples collected. Measurable concentrations of tacrolimus were transitory and were not associated with adverse events. Tacrolimus ointment is a safe therapy for the treatment of adult patients with atopic dermatitis on the face, neck, or other body regions.
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Affiliation(s)
- N A Soter
- New York University School of Medicine, Department of Dermatology, NY 10016-6451, USA.
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Drake L, Prendergast M, Maher R, Breneman D, Korman N, Satoi Y, Beusterien KM, Lawrence I. The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis. J Am Acad Dermatol 2001; 44:S65-72. [PMID: 11145797 DOI: 10.1067/mjd.2001.109814] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atopic dermatitis can have detrimental effects on health-related quality of life (QOL). OBJECTIVE Our purpose was to examine the QOL impact of tacrolimus ointment in patients with atopic dermatitis. METHODS The Dermatology Life Quality Index (DLQI), Children's DLQI (CDLQI), and Toddler QOL Survey were used to assess QOL in adults (16 years or older), children (5-15 years), and toddlers (2-4 years) enrolled in 12-week, randomized, double-blind studies comparing two concentrations of tacrolimus ointment (0.03% and 0.1%) versus vehicle ointment for treatment of atopic dermatitis. QOL was assessed at baseline, week 3, and week 12/early discontinuation. RESULTS Of the 985 patients enrolled, 91.5% had evaluable QOL data. Among adults, both tacrolimus ointment groups experienced improved QOL relative to the vehicle control group for all QOL scales (P<.001). Among children and toddlers, both tacrolimus ointment groups demonstrated significant QOL improvements relative to the vehicle control group (P<.05) for all but the Personal Relationships scale in the 0.03% tacrolimus ointment group among children. CONCLUSION Tacrolimus ointment is associated with significant QOL benefits in adults, children, and toddlers with atopic dermatitis.
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Affiliation(s)
- L Drake
- Oklahoma University Health Science Center, Oklahoma City, USA
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Kang S, Lucky AW, Pariser D, Lawrence I, Hanifin JM. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol 2001; 44:S58-64. [PMID: 11145796 DOI: 10.1067/mjd.2001.109812] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tacrolimus ointment is a nonsteroidal topical immunomodulator that was formulated specifically for the treatment of atopic dermatitis. A total of 255 children, 2 to 15 years of age, with moderate to severe atopic dermatitis applied 0.1% tacrolimus ointment twice daily for up to 12 months to assess long-term safety and efficacy. Patients on average were treated with tacrolimus ointment for 279 days or 87% of study days. Substantial improvements in the signs and symptoms of atopic dermatitis, percent body surface area affected, and the patient's or parent's assessment of pruritus were observed during the first week of treatment and were maintained throughout the study. Transient skin burning and itching were the most common drug application site adverse events. Occurrence of these symptoms decreased after the first few days of treatment. There was no increased incidence of infections or other significant adverse events. Effectiveness of tacrolimus was maintained with prolonged daily use. Tacrolimus ointment (0.1%) is safe and effective for long-term treatment of atopic dermatitis in children.
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Affiliation(s)
- S Kang
- University of Michigan Medical Center, Ann Arbor 48109-0314, USA.
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Abstract
Amphotericin B has been the mainstay of systemic antifungal therapy for over 30 years, despite its serious side-effects, and, although numerous alternative antifungal agents have been developed, none to date has matched the efficacy of amphotericin B. However, modern drug delivery technology has improved the safety of amphotericin B by incorporating it into lipid-based delivery systems, including liposomes. Three such formulations, based on the natural affinity of amphotericin B for lipids, are currently marketed. All increase the therapeutic index of amphotericin B, thereby allowing more aggressive treatment than is possible with the conventional product. However, they differ in structure, side-effect profiles and evidence of proven efficacy as discussed in this review.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare, Inc., Three Parkway North, Deerfield, IL 60015, USA
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Alaiti S, Kang S, Fiedler VC, Ellis CN, Spurlin DV, Fader D, Ulyanov G, Gadgil SD, Tanase A, Lawrence I, Scotellaro P, Raye K, Bekersky I. Tacrolimus (FK506) ointment for atopic dermatitis: a phase I study in adults and children. J Am Acad Dermatol 1998; 38:69-76. [PMID: 9448208 DOI: 10.1016/s0190-9622(98)70541-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tacrolimus is a potent immunosuppressant used in organ transplant recipients; an ointment formulation is being developed as a therapeutic agent for atopic dermatitis. OBJECTIVE Our purpose was to define the pharmacokinetics and evaluate tacrolimus 0.3% ointment as therapy for moderate to severe atopic dermatitis. METHODS Thirty-nine patients, 5 to 75 years of age, received 14 applications over 8 days. Serial blood samples were collected on days 1 and 8, with predose samples collected on days 2 through 7. Overall response and signs/symptoms were rated daily on days 1 through 11. Incidence of adverse events and laboratory profile were determined. RESULTS Mean area under the curve (0.9 to 42.5 ng x hr/ml) was highly variable and appeared to be related to size of application area. No systemic accumulation of tacrolimus was observed. Comparison to historical intravenous data indicates that absolute bioavailability of topical tacrolimus was less than 0.5%. Ninety-five percent of patients showed at least good improvement. All adverse events were transient. Burning was the most common application site adverse event and vasodilatation ("flushing/warmth") was the most common nonapplication site adverse event. No drug-related changes in laboratory profile were observed. CONCLUSION The results of this study suggest that tacrolimus 0.3% ointment may be a safe and effective therapy for atopic dermatitis.
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Affiliation(s)
- S Alaiti
- Department of Dermatology, University of Illinois at Chicago, 60612, USA
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Souteyrand E, Cloarec JP, Martin JR, Wilson C, Lawrence I, Mikkelsen S, Lawrence MF. Direct Detection of the Hybridization of Synthetic Homo-Oligomer DNA Sequences by Field Effect. J Phys Chem B 1997. [DOI: 10.1021/jp963056h] [Citation(s) in RCA: 274] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Souteyrand
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - J. P. Cloarec
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - J. R. Martin
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - C. Wilson
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - I. Lawrence
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - S. Mikkelsen
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
| | - M. F. Lawrence
- Laboratoire de PhysicoChimie des Interfaces, Ecole Centrale de Lyon, BP 163, 69131 Ecully Cedex, France, and Department of Chemistry and Biochemistry, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8
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Lawrence I, Haacke S, Mariette H, Rühle WW, Ulmer-Tuffigo H, Cibert J, Feuillet G. Exciton tunneling revealed by magnetically tuned interwell coupling in semiconductor double quantum wells. Phys Rev Lett 1994; 73:2131-2134. [PMID: 10056979 DOI: 10.1103/physrevlett.73.2131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Owen JB, Lawrence I, Coia R, Hanks GE. Recent patterns of growth in radiation therapy facilities in the United States. Int J Radiat Oncol Biol Phys 1991. [DOI: 10.1016/0360-3016(91)90627-g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bernstein J, Lawrence I. Urticaria. Allergy Proc 1990; 11:178. [PMID: 2210369 DOI: 10.2500/108854190778879972] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Walker CL, Lawrence I. The detection of IgE antibody. Allergy Proc 1990; 11:172. [PMID: 2210363 DOI: 10.2500/108854190778880006] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Fitzsimons T, Lawrence I. Sinusitis. Allergy Proc 1990; 11:176. [PMID: 2210367 DOI: 10.2500/108854190778880132] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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