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Goteti K, Garcia R, Gillespie WR, French J, Klopp‐Schulze L, Li Y, Mateo CV, Roy S, Guenther O, Benincosa L, Venkatakrishnan K. Model-based meta-analysis using latent variable modeling to set benchmarks for new treatments of systemic lupus erythematosus. CPT Pharmacometrics Syst Pharmacol 2024; 13:281-295. [PMID: 38050332 PMCID: PMC10864929 DOI: 10.1002/psp4.13083] [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] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Several investigational agents are under evaluation in systemic lupus erythematosus (SLE) clinical trials but quantitative frameworks to enable comparison of their efficacy to reference benchmark treatments are lacking. To benchmark SLE treatment effects and identify clinically important covariates, we developed a model-based meta-analysis (MBMA) within a latent variable model framework for efficacy end points and SLE composite end point scores (BILAG-based Composite Lupus Assessment and Systemic Lupus Erythematosus Responder Index) using aggregate-level data on approved and investigational therapeutics. SLE trials were searched using PubMed and www.clinicaltrials.gov for treatment name, SLE and clinical trial as search criteria that resulted in four data structures: (1) study and investigational agent, (2) dose and regimen, (3) baseline descriptors, and (4) outcomes. The final dataset consisted of 25 studies and 81 treatment arms evaluating 16 different agents. A previously developed (K Goteti et al. 2022) SLE latent variable model of data from placebo arms (placebo + standard of care treatments) was used to describe aggregate SLE end points over time for the various SLE placebo and treatment arms in a Bayesian MBMA framework. Continuous dose-effect relationships using a maximum effect model were included for anifrolumab, belimumab, CC-220 (iberdomide), epratuzumab, lulizumab pegol, and sifalimumab, whereas the remaining treatments were modeled as discrete dose effects. The final MBMA model was then used to benchmark these compounds with respect to the maximal efficacy on the latent variable compared to the placebo. This MBMA illustrates the application of latent variable models in understanding the trajectories of composite end points in chronic diseases and should enable model-informed development of new investigational agents in SLE.
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Affiliation(s)
- Kosalaram Goteti
- EMD Serono Research and Development Institute, Inc.BillericaMassachusettsUSA
| | | | | | | | | | - Ying Li
- EMD Serono Research and Development Institute, Inc.BillericaMassachusettsUSA
- Merck KGaADarmstadtGermany
| | | | | | | | - Lisa Benincosa
- EMD Serono Research and Development Institute, Inc.BillericaMassachusettsUSA
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Johnston CK, Waterhouse T, Wiens M, Mondick J, French J, Gillespie WR. Bayesian estimation in NONMEM. CPT Pharmacometrics Syst Pharmacol 2024; 13:192-207. [PMID: 38017712 PMCID: PMC10864934 DOI: 10.1002/psp4.13088] [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] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
Bayesian estimation is a powerful but underutilized tool for answering drug development questions. In this tutorial, the principles of Bayesian model development, assessment, and prior selection will be outlined. An example pharmacokinetic (PK) model will be used to demonstrate the implementation of Bayesian modeling using the nonlinear mixed-effects modeling software NONMEM.
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Posobiec LM, Kopp C, Murzyn SM, Olitan T, Rendemonti J, French J, Tamborini E, Campey J, Longo M, Danberry T, Vaillancourt M, Nowland W, Daoud M, Qualls C, Harris SB. Harmonization of criteria and terminology in fetal rat skeletal evaluations. Birth Defects Res 2023. [PMID: 37243321 DOI: 10.1002/bdr2.2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND A survey of laboratories in North American and Europe that routinely conduct fetal skeletal examinations was performed with the purpose of (1) understanding current terminology used for classifying skeletal findings in developmental toxicity (DT) studies and (2) understanding the criteria used to identify relatively common findings that sufficiently deviate from normal. The goal was to promote terminology harmonization and improve interlaboratory consistency in the criteria used to identify developmental anomalies. METHODS The survey, designed based on terminology for developmental anomalies recommended by an international collaboration (Makris et al., Congenital Anomalies, 2009;49(3):123-246), was conducted by a subgroup (authors of this publication) of the Royal Society of Biology's International Register of Fetal Morphologists (IRFM). RESULTS Individual and summarized anonymized responses are provided here. The authors, who are expert fetal morphologists with experience performing fetal examinations, reviewed the responses and generated recommendations on preferred terminology and criteria for determining when morphological variations deviate from normal and warrant recording of the findings for skeletal observations in Sprague Dawley (SD) fetal rats. The objective of these recommendations is to complement Makris et al. (Congenital Anomalies, 2009;49(3):123-246). CONCLUSION The broad application will improve interlaboratory harmonization of recording fetal skeleton findings in developmental toxicity studies intended for regulatory submissions, including SEND (Standard for Exchange of Nonclinical Data).
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Affiliation(s)
| | - C Kopp
- Charles River Laboratories, Ashland, OH, USA
| | | | - T Olitan
- TAO DART Technical Consulting, LLC, New Brunswick, NJ, USA
| | | | - J French
- Syngenta Limited, Bracknell, United Kingdom
| | | | - J Campey
- Labcorp, Harrogate, United Kingdom
| | - M Longo
- Accelera S.r.l., Nerviano, Italy
| | - T Danberry
- Bristol Myers Squibb Company, New Brunswick, NJ, USA
| | | | | | - M Daoud
- CRL, Hertogenbosch, The Netherlands
| | | | - S B Harris
- Stephen B Harris Group, San Diego, CA, USA
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McMullin B, Fraser J, Robinson B, French J, Adisesh A. Work-related injuries and attendance at a Canadian regional emergency department. Occup Med (Lond) 2023; 73:138-141. [PMID: 36719101 DOI: 10.1093/occmed/kqad012] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Monitoring trends in the burden of illness and injury attributable to work is key in assessing occupational health hazards; however, New Brunswick does not participate in the Canadian National Ambulatory Care Reporting System which itself does not collect details of occupation and industry. AIMS We set out to determine the proportion of emergency department attendances that were attributable to a work-related cause. We also wanted to evaluate the recording of occupation in the electronic health record system, and to describe the characteristics of patients with a work-related presentation. METHODS A retrospective observational study over a 1-year period was conducted using an administrative database obtained from Canadian Emergency Department Information System. Descriptive statistics are used to present the analysis of categorical and continuous data. RESULTS A total of 49 365 patients were included for analysis. Two per cent of patients presented with a self-reported work-related condition. Health care and social assistance, construction, retail trade and manufacturing were the most common industries reported by patients. CONCLUSIONS This study found the rate of work-related medical conditions to be substantially less than expected, and that occupation was not captured for any patients presenting to the emergency department with a work-related condition, despite a field being available in the electronic health record registration system. We were able to analyse the industry sectors for work-related presentations. The recording and coding of occupation and industry would significantly benefit occupational epidemiology in emergency medicine as well as potentially improving patient outcomes and health system efficiencies.
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Affiliation(s)
- B McMullin
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
| | - J Fraser
- Department of Emergency Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
| | - B Robinson
- Research Services, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
| | - J French
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
- Department of Emergency Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick E2L 4L2, Canada
- Trauma New Brunswick, Saint John Regional Hospital, Saint John, New Brunswick E2L 4L2, Canada
| | - A Adisesh
- Dalhousie University, Dalhousie Medicine New Brunswick, Saint John, New Brunswick E2K 5E2, Canada
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
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Kay K, Goodwin J, Ehrlich H, Ou J, Freeman T, Wang K, Li F, Wade M, French J, Huang L, Aweeka F, Mwebaza N, Kajubi R, Riggs M, Ruiz-Garcia A, Parikh S. Impact of Drug Exposure on Resistance Selection Following Artemether-Lumefantrine Treatment for Malaria in Children With and Without HIV in Uganda. Clin Pharmacol Ther 2023; 113:660-669. [PMID: 36260349 PMCID: PMC9981240 DOI: 10.1002/cpt.2768] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Artemisinin-based combination therapies (ACTs) are the primary treatment for malaria. It is essential to characterize the pharmacokinetics (PKs) and pharmacodynamics (PDs) of ACTs in vulnerable populations at risk of suboptimal dosing. We developed a population PK/PD model using data from our previous study of artemether-lumefantrine in HIV-uninfected and HIV-infected children living in a high-transmission region of Uganda. HIV-infected children were on efavirenz-, nevirapine-, or lopinavir-ritonavir-based antiretroviral regimens, with daily trimethoprim-sulfamethoxazole prophylaxis. We assessed selection for resistance in two key parasite transporters, pfcrt and pfmdr1, over 42-day follow-up and incorporated genotyping into a time-to-event model to ascertain how resistance genotype in relation to drug exposure impacts recurrence risk. Two hundred seventy-seven children contributed 364 episodes to the model (186 HIV-uninfected and 178 HIV-infected), with recurrent microscopy-detectable parasitemia detected in 176 episodes by day 42. The final model was a two-compartment model with first-order absorption and an estimated age effect on bioavailability. Systemic lumefantrine exposure was highest with lopinavir-ritonavir, lowest with efavirenz, and equivalent with nevirapine and HIV-uninfected children. HIV status and lumefantrine concentration were significant factors associated with recurrence risk. Significant selection was demonstrated for pfmdr1 N86 and pfcrt K76 in recurrent infections, with no evidence of selection for pfmdr1 Y184F. Less sensitive parasites were able to tolerate lumefantrine concentrations ~ 3.5-fold higher than more sensitive parasites. This is the first population PK model of lumefantrine in HIV-infected children and demonstrates selection for reduced lumefantrine susceptibility, a concern as we confront the threat to ACTs posed by emerging artemisinin resistance in Africa.
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Affiliation(s)
- Katherine Kay
- Metrum Research Group, Tariffville, Connecticut, USA
| | - Justin Goodwin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Hanna Ehrlich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joyce Ou
- Yale University, New Haven, Connecticut, USA
| | | | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Martina Wade
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Liusheng Huang
- University of California, San Francisco, San Francisco, California, USA
| | - Francesca Aweeka
- University of California, San Francisco, San Francisco, California, USA
| | - Norah Mwebaza
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Matthew Riggs
- Metrum Research Group, Tariffville, Connecticut, USA
| | | | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
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Grisic A, Venkatakrishnan K, French J, Khandelwal A. Variable or variate? A conundrum in pharmacometrics exposure-response models. CPT Pharmacometrics Syst Pharmacol 2022; 12:144-147. [PMID: 36537836 PMCID: PMC9931432 DOI: 10.1002/psp4.12905] [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] [Received: 09/28/2022] [Revised: 11/15/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Key elements of scientific writing-consistency and clarity-can be compromised in case of inaccurate use of methodological terms, especially in complex and multidisciplinary scientific fields. Such is the case in reports of pharmacometrics exposure-response analyses with the use of the terms univariate/multivariate and univariable/multivariable. This perspective outlines the issues in the use of these terms, clarifies their definitions, provides examples, and makes recommendations for authors, reviewers, and journals in the fields of clinical pharmacology and pharmacometrics.
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Assiotis A, French J, Edwards G, McCann PA, Chalk N, Amirfeyz R. Distal biceps repair through a single incision with the use of a knotless cortical button device: Mid-term results. Shoulder Elbow 2022; 14:677-681. [PMID: 36479012 PMCID: PMC9720876 DOI: 10.1177/17585732211060356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
Background Distal biceps rupture presents with an increasing incidence and evidence suggests that although a surgical repair is not mandatory, it results in superior functional outcomes when compared to non-operative management. As implant technology has advanced, several devices have been utilised and studied in managing this pathology. We present our single-centre experience with the use of the ToggleLoc Ziploop reattachment device, a knotless cortical button implant, using a single-incision technique. Methods Retrospective series of 70 consecutive distal biceps tendon repairs, at a mean follow-up of 45.6 months after surgery, using a standardised single implant, single-incision technique, and post-operative rehabilitation programme. Results There was one (1.4%) re-rupture in our patient cohort. The range of motion was complete in all patients except for one patient who had symptomatic heterotopic ossification, causing limitation in pronation. Complications were minor with the commonest being transient neuropraxia of the lateral cutaneous nerve of the forearm. The mean Oxford elbow score was 46.9 out of 48, and the patient global impression of change scale was 7 out of 7 in 77% of cases. Conclusion Our data support this technique and implant combination when dealing with acute and chronic distal biceps tendon rupture.
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Affiliation(s)
- Angelos Assiotis
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan French
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gray Edwards
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Philip A McCann
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Naomi Chalk
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rouin Amirfeyz
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Goteti K, French J, Garcia R, Li Y, Casset‐Semanaz F, Aydemir A, Townsend R, Mateo CV, Studham M, Guenther O, Kao A, Gastonguay M, Girard P, Benincosa L, Venkatakrishnan K. Disease trajectory of SLE clinical endpoints and covariates affecting disease severity and probability of response: Analysis of pooled patient-level placebo (Standard-of-Care) data to enable model-informed drug development. CPT Pharmacometrics Syst Pharmacol 2022; 12:180-195. [PMID: 36350330 PMCID: PMC9931431 DOI: 10.1002/psp4.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems. Many investigational agents have failed or shown only modest effects when added to standard of care (SoC) therapy in placebo-controlled trials, and only two therapies have been approved for SLE in the last 60 years. Clinical trial outcomes have shown discordance in drug effects between clinical endpoints. Herein, we characterized longitudinal disease activity in the SLE population and the sources of variability by developing a latent disease trajectory model for SLE component endpoints (Systemic Lupus Erythematosus Disease Activity Index [SLEDAI], Physician's Global Assessment [PGA], British Isles Lupus Assessment Group Index [BILAG]) and composite endpoints (Systemic Lupus Erythematosus Responder Index [SRI], BILAG-based Composite Lupus Assessment [BICLA], and Lupus Low Disease Activity State [LLDAS]) using patient-level historical SoC data from nine phase II and III studies. Across all endpoints, in predictions up to 52 weeks from the final disease trajectory model, the following baseline covariates were associated with a greater decrease in SLE disease activity and higher response to placebo + SoC: Hispanic ethnicity from Central/South America, absence of hypocomplementemia, recent SLE diagnosis, and high baseline disease activity score using SLEDAI and BILAG separately. No discernible differences were observed in the trajectory of response to placebo + SoC across different SoC medications (antimalarial and immunosuppressant such as mycophenolate, methotrexate, and azathioprine). Across all endpoints, disease trajectory showed no difference in Asian versus non-Asian patients, supporting Asia-inclusive global SLE drug development. These results describe the first population approach to support a model-informed drug development framework in SLE.
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Affiliation(s)
- Kosalaram Goteti
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | | | - Ying Li
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Florence Casset‐Semanaz
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Aida Aydemir
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Robert Townsend
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Cristina Vazquez Mateo
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Matthew Studham
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | - Amy Kao
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | - Pascal Girard
- Merck Institute of PharmacometricsLausanneSwitzerland
| | - Lisa Benincosa
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Karthik Venkatakrishnan
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
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Ellul T, Mukhtar B, Manolidis T, French J, Izegbu V. An uncommon diagnosis of non-Hodgkin lymphoma on prostatic biopsy. Journal of Clinical Urology 2022. [DOI: 10.1177/2051415819876510] [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: 11/15/2022]
Affiliation(s)
- T Ellul
- Department of Urology, Royal Glamorgan Hospital, Cwm Taf University Healthboard, UK
| | - B Mukhtar
- Department of Urology, Royal Glamorgan Hospital, Cwm Taf University Healthboard, UK
| | - T Manolidis
- Department of Urology, Royal Glamorgan Hospital, Cwm Taf University Healthboard, UK
| | - J French
- Department of Urology, Royal Glamorgan Hospital, Cwm Taf University Healthboard, UK
| | - V Izegbu
- Department of Urology, Royal Glamorgan Hospital, Cwm Taf University Healthboard, UK
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Manderino LM, Preszler J, French J, Kegel N, Blaney N, Collins MW, Kontos AP. A-29 Consistency of Clinical Profiles Across Repeat Concussions. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose: To evaluate the association between concussion profiles within individual patients across repeat concussions. Methods: Retrospective chart review of 100 adolescents (57.3% male) aged 10–21 years presenting to a concussion clinic within 30 days of injury for two separate injuries between 2011 and 2021. Clinicians conducted multidomain assessments including vestibular/ocular motor screening, neurocognitive testing, symptoms and medical/injury history to adjudicate the following concussion clinical profiles: vestibular, ocular, post-traumatic migraine, cognitive fatigue, and anxiety/mood. Chi-square tests with odds ratios (OR) and 95% confidence intervals (CI) were conducted to examine the association of each profile from the first to the second concussion. Results: Chi-square analyses supported associations between the first and second concussions (time between injuries = 667.1 ± 529.2 days) for the vestibular (χ2 = 10.08, p < 0.01, OR = 3.75, 95% CI = 1.63–8.62), ocular (χ2 = 6.51, p < 0.05, OR = 3.51, 95% CI = 1.30–9.46), and migraine (χ2 = 11.056, p < 0.001, OR = 4.01, 95% CI = 1.73–9.29) profiles, such that having that profile at first concussion was associated with increased likelihood of having the same profile at second concussion. Chi-square analyses for cognitive fatigue and anxiety/mood were not significant. Conclusions: Vestibular, ocular, and migraine profiles at first injury predicted their presence at second injury, which may reflect consistent underlying risk factors (e.g., sex migraine history) for these profiles. Conversely, no association was supported for anxiety/mood and cognitive fatigue profiles across injuries. The present findings are the first to demonstrate that certain profiles are likely to recur after repeat concussion. This information can be used by clinicians to inform earlier, targeted treatment recommendations for associated profiles.
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Khandelwal A, Grisic AM, French J, Venkatakrishnan K. Pharmacometrics Golems: Exposure-Response Models in Oncology. Clin Pharmacol Ther 2022; 112:941-945. [PMID: 35286713 DOI: 10.1002/cpt.2564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
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Hall AJ, Clement ND, Ojeda-Thies C, MacLullich AMJ, Toro G, Johansen A, White TO, Duckworth AD, Abdul-Jabar H, Abu-Rajab R, Abugarja A, Adam K, Aguado Hernández HJ, Améstica Lazcano G, Anderson S, Ansar M, Antrobus J, Aragón Achig EJ, Archunan M, Arrieta Salinas M, Ashford-Wilson S, Assens Gibert C, Athanasopoulou K, Awadelkarim M, Baird S, Bajada S, Balakrishnan S, Balasubramanian S, Ballantyne JA, Bárcena Goitiandia L, Barkham B, Barmpagianni C, Barres-Carsi M, Barrett S, Baskaran D, Bell J, Bell K, Bell S, Bellelli G, Benchimol JA, Boietti BR, Boswell S, Braile A, Brennan C, Brent L, Brooke B, Bruno G, Burahee A, Burns S, Calabrò G, Campbell L, Carabelli GS, Carnegie C, Carretero Cristobal G, Caruana E, Cassinello Ogea MC, Castellanos Robles J, Castillon P, Chakrabarti A, Cecere AB, Chen P, Clarke JV, Collins G, Corrales Cardenal JE, Corsi M, Cózar Adelantado GM, Craxford S, Crooks M, Cuarental-García J, Cuthbert R, Dall G, Daskalakis I, De Cicco A, Diana DLFDD, Demaria P, Dereix J, Díaz Jiménez J, Dinamarca Montecinos JL, Do Le HP, Donoso Coppa JP, Drosos G, Duffy A, East J, Eastwood D, Elbahari H, Elias de Molins Peña C, Elmamoun M, Emmerson B, Escobar Sánchez D, Faimali M, Farré-Mercadé MV, Farrow L, Fayez A, Fell A, Fenner C, Ferguson D, Finlayson L, Flores Gómez A, Freeman N, French J, Gabardo Calvo S, Gagliardo N, Garcia Albiñana J, García Cruz G, García de Cortázar Antolín U, García Virto V, Gealy S, Gil Caballero SM, Gill M, González González MS, Gopireddy R, Guntley D, Gurung B, Guzmán Rosales G, Haddad N, Hafeez M, Haller P, Halligan E, Hardie J, Hawker I, Helal A, Herrera Cruz M, Herreros Ruiz-Valdepeñas R, Horton J, Howells S, Howieson A, Hughes L, Hünicken Torrez FL, Hurtado Ortega A, Huxley P, Hamid HK, Ilahi N, Iliadis A, Inman D, Jadhao P, Jandoo R, Jawad L, Jayatilaka MLT, Jenkins PJ, Jeyapalan R, Johnson D, Johnston A, Joseph S, Kapoor S, Karagiannidis G, Karanam KS, Kattakayam F, Konarski A, Kontakis G, Labrador Hernández G, Lancaster V, Landi G, Le B, Liew I, Logishetty K, Lopez Marquez ACD, Lopez J, Lum J, Macpherson GJ, Madan S, Mahroof S, Malik-Tabassum K, Mallina R, Maqsood A, Marson B, Martin Legorburo MJ, Martin-Perez E, Martínez Jiménez T, Martinez Martin J, Mayne A, Mayor A, McAlinden G, McLean L, McDonald L, McIntyre J, McKay P, McKean G, McShane H, Medici A, Meeke C, Meldrum E, Mendez M, Mercer S, Merino Perez J, Mesa-Lampré MP, Mighton S, Milne K, Mohamed Yaseen M, Moppett I, Mora J, Morales-Zumel S, Moreno Fenoll IB, Mousa A, Murray AW, Murray EV, Nair R, Neary F, Negri G, Negus O, Newham-Harvey F, Ng N, Nightingale J, Noor Mohamed Anver S, Nunag P, O'Hare M, Ollivere B, Ortés Gómez R, Owens A, Page S, Palloni V, Panagiotopoulos A, Panagiotopoulos E, Panesar P, Papadopoulos A, Spyridon P, Pareja Sierra T, Park C, Parwaiz H, Paterson-Byrne P, Patton S, Pearce J, Porter M, Pellegrino A, Pèrez Cuellar A, Pezzella R, Phadnis A, Pinder C, Piper D, Powell-Bowns M, Prieto Martín R, Probert A, Ramesh A, Ramírez de Arellano MVM, Renton D, Rickman S, Robertson A, Roche Albero A, Rodrigo Verguizas JA, Rodríguez Couso M, Rooney J, Sáez-López P, Saldaña-Díaz A, Santulli A, Sanz Pérez MI, Sarraf KM, Scarsbrook C, Scott CE, Scott J, Shah S, Sharaf S, Sharma S, Shirley D, Siano A, Simpson J, Singh A, Singh A, Sinnett T, Sisodia G, Smith P, Sophena Bert E, Steel M, Stewart A, Stewart C, Sugand K, Sullivan N, Sweeting L, Symes M, Tan DJH, Tancredi F, Tatani I, Thomas P, Thomson F, Toner NS, Tong A, Toro A, Tosounidis T, Tottas S, Trinidad Leo A, Tucker D, Vemulapalli K, Ventura Garces D, Vernon OK, Viveros Garcia JC, Ward A, Ward K, Watson K, Weerasuriya T, Wickramanayake U, Wilkinson H, Windley J, Wood J, Wynell-Mayow W, Zatti G, Zeiton M, Zurrón Lobato M. IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic. Surgeon 2022; 20:e429-e446. [PMID: 35430111 PMCID: PMC8958101 DOI: 10.1016/j.surge.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
Aims This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. Methods A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. Results A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. Conclusion The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.
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Terranova N, French J, Dai H, Wiens M, Khandelwal A, Ruiz‐Garcia A, Manitz J, Heydebreck A, Ruisi M, Chin K, Girard P, Venkatakrishnan K. Pharmacometric modeling and machine learning analyses of prognostic and predictive factors in the JAVELIN Gastric 100 phase III trial of avelumab. CPT Pharmacometrics Syst Pharmacol 2022; 11:333-347. [PMID: 34971492 PMCID: PMC8923733 DOI: 10.1002/psp4.12754] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/23/2022] Open
Abstract
Avelumab (anti–PD‐L1) is an approved anticancer treatment for several indications. The JAVELIN Gastric 100 phase III trial did not meet its primary objective of demonstrating superior overall survival (OS) with avelumab maintenance versus continued chemotherapy in patients with advanced gastric cancer/gastroesophageal junction cancer; however, the OS rate was numerically higher with avelumab at timepoints after 12 months. Machine learning (random forests, SIDEScreen, and variable‐importance assessments) was used to build models to identify prognostic/predictive factors associated with long‐term OS and tumor growth dynamics (TGDs). Baseline, re‐baseline, and longitudinal variables were evaluated as covariates in a parametric time‐to‐event model for OS and Gompertzian population model for TGD. The final OS model incorporated a treatment effect on the log‐logistic shape parameter but did not identify a treatment effect on OS or TGD. Variables identified as prognostic for longer OS included older age; higher gamma‐glutamyl transferase (GGT) or albumin; absence of peritoneal carcinomatosis; lower neutrophil‐lymphocyte ratio, lactate dehydrogenase, or C‐reactive protein (CRP); response to induction chemotherapy; and Eastern Cooperative Oncology Group performance status of 0. Among baseline and time‐varying covariates, the largest effects were found for GGT and CRP, respectively. Liver metastasis at re‐baseline predicted higher tumor growth. Tumor size after induction chemotherapy was associated with number of metastatic sites and stable disease (vs. response). Asian region did not impact OS or TGD. Overall, an innovative workflow supporting pharmacometric modeling of OS and TGD was established. Consistent with the primary trial analysis, no treatment effect was identified. However, potential prognostic factors were identified.
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Affiliation(s)
- Nadia Terranova
- Merck Institute of Pharmacometrics (an affiliate of Merck KGaA, Darmstadt, Germany) Lausanne Switzerland
| | | | | | | | | | | | | | | | | | | | - Pascal Girard
- Merck Institute of Pharmacometrics (an affiliate of Merck KGaA, Darmstadt, Germany) Lausanne Switzerland
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kadappu K, Gibbs O, Kachwalla K, Nguyen P, Hopkins A, Lo S. Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.130] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions.
Purpose
Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes.
Methods
All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded.
Results
67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI. IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion.
Conclusion
Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI
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Affiliation(s)
- J Leung
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - J French
- Liverpool Hospital, Liverpool, Australia
| | - D Leung
- Liverpool Hospital, Liverpool, Australia
| | - C Mussap
- Liverpool Hospital, Liverpool, Australia
| | - K Asrress
- Liverpool Hospital, Liverpool, Australia
| | - D Taylor
- Liverpool Hospital, Liverpool, Australia
| | | | - K Kadappu
- Liverpool Hospital, Liverpool, Australia
| | - O Gibbs
- Liverpool Hospital, Liverpool, Australia
| | | | - P Nguyen
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kaddapu K, Xu J, Kachwalla H, Hopkins A, Gibbs O, Lo S. Intravascular Lithotripsy versus Rotational Atherectomy Cutting Balloon on Stent Expansion for Heavily Calcified Coronary Lesions. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jamal J, O’Loughlin A, Juergens C, Mussap C, French J. Reperfusion Strategy and Late Clinical Outcomes of Patients With ST-Elevation Myocardial Infarction (STEMI) Without Standard Modifiable Risk Factors (SMuRFs). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jayanti S, Juergens C, Makris A, Hennessy A, Lo S, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Rajaratnam R, French J, Leung D, Nguyen P. Ultrasound Guidance Facilitates Ideal Femoral Puncture for Coronary Angiography. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pohl O, Baron K, Riggs M, French J, Garcia R, Gotteland JP. A model-based analysis to guide gonadotropin-releasing hormone receptor antagonist use for management of endometriosis. Br J Clin Pharmacol 2021; 88:2359-2371. [PMID: 34904270 PMCID: PMC9306723 DOI: 10.1111/bcp.15171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/25/2021] [Accepted: 11/21/2021] [Indexed: 12/05/2022] Open
Abstract
Aims To identify linzagolix doses, an oral GnRH receptor antagonist, that effectively lower oestradiol (E2) to relieve endometriosis‐related pelvic pain without compromising bone health. Methods Integrated statistical, pharmacokinetic–pharmacodynamic and systems pharmacology models were developed from Phase 1 and 2 clinical trial data in healthy volunteers and patients, receiving linzagolix 25–200 mg daily or placebo, and analysed simultaneously. The main outcome measures were pelvic pain scores for dysmenorrhoea, nonmenstrual pelvic pain (NMPP), uterine bleeding and lumbar spine bone mineral density (BMD). Results Linzagolix pharmacokinetics were described by a 2‐compartment model with sequential zero/first‐order absorption process (CL/F: 0.422 L/h). E2 changes over time were well described as a function of linzagolix 24‐hour AUC (AUC50: 1.68 × 105 ng h/mL). For a Caucasian reference patient, a change in E2 from 50–20 pg/mL at 24 weeks increased the odds of relief of dysmenorrhoea 1.33‐fold and NMPP 1.07‐fold (95% CI: 1.22–1.47 and 1.02–1.12, respectively) and decreased bleeding days by 1.55 (95% CI: 1.39–1.72). A previously validated quantitative systems pharmacology BMD model was adjusted to the clinical data. The mean week 24 lumbar spine BMD change from baseline ranged from −0.092% in the 50 mg dose, −1.30% in the 100 mg dose group and −2.67% in the 200 mg dose group. Discussion The previously‐reported E2 target range (20–50 pg/mL) to balance efficacy and safety endpoints was confirmed. Linzagolix once daily doses between 75–125 mg daily were expected to meet endometriosis‐associated pain, efficacy, and BMD loss targets in Caucasian patients.
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Yin O, Zahir H, French J, Polhamus D, Wang X, van de Sande M, Tap WD, Gelderblom H, Wagner AJ, Healey JH, Greenberg J, Shuster D, Stacchiotti S. Exposure-response analysis of efficacy and safety for pexidartinib in patients with tenosynovial giant cell tumor. CPT Pharmacometrics Syst Pharmacol 2021; 10:1422-1432. [PMID: 34585528 PMCID: PMC8592513 DOI: 10.1002/psp4.12712] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
This analysis was conducted to assess exposure–response relationships for efficacy and safety of pexidartinib in patients with tenosynovial giant cell tumor. Efficacy was assessed categorically by overall response rate (ORR) with Response Evaluation Criteria in Solid Tumors version 1.1 and longitudinally (changes in tumor size and volume). Safety included hepatic parameters (i.e., alanine aminotransferase [ALT], aspartate aminotransferase [AST], and total bilirubin). Average pexidartinib concentration (Cavg) was identified as the primary exposure parameter correlated with response. In categorical and longitudinal analyses, higher Cavg coincided with greater ORR and tumor size reduction, respectively, with smaller joint size having a greater impact. For safety, a significant relationship was observed between Cavg and incidence of ALT‐related and AST‐related adverse events (AEs). With increased exposure, an increase in efficacy was predicted with near maximum effect at 800 mg/day. Higher initial dose (1000 mg/day) during the first 2 weeks did not improve efficacy. Higher doses were associated with an increased risk of ALT‐related and AST‐related AEs. These results support the US Food and Drug Administration–approved dose (400 mg two times/day without initial loading dose).
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Affiliation(s)
- Ophelia Yin
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | - Hamim Zahir
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | | | | | - Xiaoning Wang
- Metrum Research Group, Tariffville, Connecticut, USA
| | - Michiel van de Sande
- Department of Orthopedics, Leiden University Medical Center, Leiden, Netherlands
| | - William D Tap
- Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hans Gelderblom
- Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John H Healey
- Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonathan Greenberg
- Global Oncology R&D, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | - Dale Shuster
- Global Oncology R&D, Daiichi Sankyo, Inc., Basking Ridge, New Jersey, USA
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
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Rowland Yeo K, Hennig S, Krishnaswami S, Strydom N, Ayyar VS, French J, Sinha V, Sobie E, Zhao P, Friberg LE, Mentré F. CPT: Pharmacometrics & Systems Pharmacology - Inception, Maturation, and Future Vision. CPT Pharmacometrics Syst Pharmacol 2021; 10:649-657. [PMID: 34298582 PMCID: PMC8302238 DOI: 10.1002/psp4.12680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | - Natasha Strydom
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | | | | | | | - Eric Sobie
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ping Zhao
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lena E Friberg
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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French J, Mentré F. Welcome to the statistics and pharmacometrics themed issue. CPT Pharmacometrics Syst Pharmacol 2021; 10:273-274. [PMID: 33951754 PMCID: PMC8099442 DOI: 10.1002/psp4.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/19/2022] Open
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Xu J, Juergens C, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Leung D, Lo S. Ticagrelor is Superior to Clopidogrel in Preserving Vasodilatory Capacity of the Coronary Microcirculation After Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sharma L, Faour A, Nguyen T, Burgess S, Juergens C, French J. Simple Indices of Infarct Size Post ST-Elevation Myocardial Infarction (STEMI) Provides Similar Risk Stratification to Cardiac MRI. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib BT, Kaddapu K, Gibbs O, Kachwalla H, Nguyen P, Hopkins A, Lo S. Initial Experience with Intravascular Lithotripsy with Shockwave Balloon for Calcified Coronary Lesions During Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Brachial Artery Flow-Mediated Vasodilation is Related to the Coronary Index of Microcirculatory Resistance in Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Femia G, Ramachandran J, Poon J, Hopkins A, Mussap C, Rajaratnam R, French J, Leung D, Lo S, Juergens C. The Impact of COVID-19 on ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [PMCID: PMC8324111 DOI: 10.1016/j.hlc.2021.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Redfern J, Hyun K, Brieger D, Chew D, French J, Astley C, Gallagher R, Ellis C, Carr B, Lefkovits J, Nallaiah K, Lintern K, Neubeck L, Briffa T. Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3108] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.
Purpose
To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.
Methods
SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.
Results
In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees.
Conclusions
Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation
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Affiliation(s)
- J Redfern
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - K Hyun
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - D Brieger
- ANZAC Research Institute, Sydney, Australia
| | - D Chew
- Flinders University, Adelaide, Australia
| | - J French
- University of New South Wales, Sydney, Australia
| | - C Astley
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - C Ellis
- Auckland City Hospital, Auckland, New Zealand
| | - B Carr
- NSW Agency for Clinical Innovation, Sydney, Australia
| | | | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - K Lintern
- South Western Sydney Local Health District, Sydney, Australia
| | - L Neubeck
- Napier University, Edinburgh, United Kingdom
| | - T Briffa
- University of Western Australia, Perth, Australia
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Hyun K, Brieger D, Briffa T, Chew D, Horsfall M, French J, Ellis C, Hammett C, Nallaiah K, Redfern J. The impact of socioeconomic status on secondary prevention of the acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2970] [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
Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover.
Purpose
The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia.
Methods
Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked.
Results
Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups.
Conclusion
This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - D Brieger
- Concord General Repatriation Hospital, Department of Cardiology, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | | | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - C Ellis
- Auckland Heart Group, Auckland, New Zealand
| | - C Hammett
- Royal Brisbane and Women's Hospital, Department of Cardiology, Brisbane, Australia
| | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
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Sherry N, Ernst N, French J, Kontos AP, Collins MW. A-40 Predictors of Failed Effort Testing at Initial Clinic Visit for Concussion Rehabilitation and Outcomes. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
Neuropsychological evaluation of concussion typically includes performance validity testing to assess effort. The aim of this study was to explore the usefulness of effort testing as part of initial screening for concussion rehabilitation, including determining the factors that predict effort testing and evaluate outcomes between “good effort” and “failed effort” groups.
Method
Records of 76 patients aged 16–66 years old (M = 40.58 years, SD = 14.18) seen for rehabilitation of non-sport concussion from 2018–2019 were reviewed. Patients completed clinical interview, neurocognitive screening (ImPACT), effort testing (Word Memory Test), vestibular/oculomotor screening (VOMS), and the post-concussion symptom scale (PCSS). A logistic regression (LR) was conducted to predict effort, with predictors including mental health history, secondary gain, work injury, days post-injury, and PCSS. A series of one-way ANOVAs evaluated outcomes from concussion rehabilitation between the good and failed effort groups.
Results
Failed effort occurred in 42% of cases. The LR accurately classified 81.8% of individuals, with mental health history (p = .01) and PCSS (p = .02) as the only significant predictors of effort. There were no differences in recovery time (p = .56) between effort groups, but the failed effort group took longer to return to work (p = .03). Half of individuals who failed effort were seen until discharge, and 69% of them reported no symptoms/mild symptoms at discharge.
Conclusions
Failure of effort testing was predicted by a history of mental health and high symptom burden. Individuals who fail effort testing at initial visit for concussion rehabilitation take longer to return to functional activity but are capable of achieving recovery with compliance and appropriate rehabilitation.
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Kontos AP, Jorgensen-Wagers K, Trbovich AM, Ernst N, Emami K, Gillie B, French J, Holland C, Elbin RJ, Collins MW. Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion. JAMA Neurol 2020; 77:435-440. [PMID: 31904763 DOI: 10.1001/jamaneurol.2019.4552] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care. Objective To investigate the association of time since injury with initiation of clinical care on recovery time following concussion. Design, Setting, and Participants This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days of the injury (late). Data were analyzed between June 2019 and August 2019. Exposures Time from injury (concussion) to initiation of clinical care. Main Outcomes and Measures Recovery time; testing with the Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening instruments; demographic factors, medical history, and injury information. Results A total of 416 individuals were eligible, and 254 (61.1%) were excluded, leaving 162 (38.9%) in analyses. The early group (98 patients) and late group (64 patients) did not differ in age (mean [SD] age, early, 15.3 [1.6] years; late, 15.4 [1.6] years), number of female patients (early, 51 of 98 [52.0%]; late, 40 of 64 [62.5%]), or other demographic, medical history, or injury information. The groups also were similar on symptom severity, cognitive, ocular, and vestibular outcomes at the first clinic visit. Results from a logistical regression supported being in the late group (adjusted odds ratio, 5.8 [95% CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95% CI, 1.1-18.0]; P = .04) as factors significantly associated with recovery time. Conclusions and Relevance Findings suggest that earlier initiation of clinical care is associated with faster recovery after concussion. Other factors may also influence recovery time. Further research is needed to determine the role of active rehabilitation and treatment strategies, as well as demographic factors, medical history, and injury characteristics on the current findings.
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Affiliation(s)
- Anthony P Kontos
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kendra Jorgensen-Wagers
- Landstuhl Regional Medical Center, Landstuhl, Germany.,Defense and Veterans Brain Injury Center, Silver Spring, Maryland
| | - Alicia M Trbovich
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nathan Ernst
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kouros Emami
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brandon Gillie
- UPMC Sports Medicine Concussion Program, Altoona, Pennsylvania
| | - Jonathan French
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cyndi Holland
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R J Elbin
- Office for Sport Concussion Research, Department of Health, Human Performance, & Recreation, University of Arkansas, Fayetteville
| | - Michael W Collins
- UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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French J, Agius LM, Sandiford NA. Managing the multiply injured patient: the impact of multidisciplinary teams. Br J Hosp Med (Lond) 2020; 80:703-706. [PMID: 31822166 DOI: 10.12968/hmed.2019.80.12.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.
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Affiliation(s)
- Jonathan French
- Registrar, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
| | - Lewis M Agius
- Registrar, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
| | - Nemandra A Sandiford
- Consultant, Joint Reconstruction Unit, Southland Teaching Hospital, Southern District Health Board, Invercargill, New Zealand
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Kontos AP, Elbin RJ, Trbovich A, Womble M, Said A, Sumrok VF, French J, Kegel N, Puskar A, Sherry N, Holland C, Collins M. Concussion Clinical Profiles Screening (CP Screen) Tool: Preliminary Evidence to Inform a Multidisciplinary Approach. Neurosurgery 2020; 87:348-356. [DOI: 10.1093/neuros/nyz545] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Current concussion symptom inventories emphasize total number or symptoms and severity and overlap with other conditions, such as mental health disorders, which may limit their specificity and clinical utility.
OBJECTIVE
To develop and test the reliability and validity of a new Concussion Clinical Profiles Screening tool (CP Screen) in both healthy controls and concussed.
METHODS
CP Screen is a 29-item self-report, clinical profile-based symptom inventory that measures the following 5 concussion clinical profiles: 1) anxiety/mood, 2) cognitive/fatigue, 3) migraine, 4) ocular, and 5) vestibular; and the following 2 modifying factors: 1) sleep and 2) neck. Post-Concussion Symptom Scale (PCSS), vestibular/ocular motor screening (VOMS) tool, and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) were conducted. CP Screen was administered in community a concussion surveillance program and 2 sports medicine concussion clinics. Responses include 248 athletes, 121 concussed, and 127 controls, enrolled between 2018 and 2019.
RESULTS
Internal consistency of the CP Screen in the control (Cronbach's alpha = .87) and concussed (Cronbach's alpha = .93) samples was high. Moderate to high correlations among the CP Screen factors and PCSS factors and VOMS items, supporting concurrent validity. ROC curve analysis for identifying concussed from controls was significant (P < .001) for all CP Screen factor and modifier scores with excellent AUCs for migraine (.93), ocular (.88), vestibular (.85), and cognitive (.81) factors, demonstrating predictive validity.
CONCLUSION
The CP Screen demonstrated strong reliability, concurrent validity with commonly used concussion assessment (ie, PCSS, VOMS, and ImPACT), and predictive validity for identifying concussion. The CP Screen extends current symptom inventories by evaluating more specific symptoms that may reflect clinical profiles and inform better clinical care.
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Affiliation(s)
- Anthony P Kontos
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R J Elbin
- University of Arkansas, Fayetteville, Arkansas
| | - Alicia Trbovich
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melissa Womble
- INOVA Medical Group, Department of Orthopedics and Sports Medicine, INOVA Sports Medicine Concussion Program, Fairfax, Virginia
| | - Azkya Said
- University of Arkansas, Fayetteville, Arkansas
| | - Vanessa Fazio Sumrok
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan French
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nathan Kegel
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alicia Puskar
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie Sherry
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cyndi Holland
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Collins
- UPMC Sports Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. 805 Clopidogrel Versus Ticagrelor on Coronary Microvascular and Peripheral Endothelial Function After Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS): Results of a Randomised Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Song N, Kwok A, Getta B, Motum P, Harvey M, French J, Jansz P, Muller D. 128 Intravascular Haemolysis – A Rare Complication of the MitraClip. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Burgess S, Juergens C, Nguyen T, Leung M, Robledo K, Thomas L, Mussap C, Zaman S, Lo S, French J. 886 ST-Elevation Myocardial Infarction, Incomplete Revascularization and Gender. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Redwood E, Hyun K, French J, Kritharides L, Ryan M, D'Sousa M, Brieger D. 559 The Association Between Mode of Transport, Management and Outcomes of Patients Presenting With STEMI. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.566] [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: 10/23/2022]
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37
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Jeyaprakash P, Khor L, Madan K, Sivapathan S, Hill L, Robledo K, Hallani H, Roy P, Ellenberger K, Jepson N, Roy J, Pressley L, Patal S, Thomas L, French J, Burgess S. 887 STEMI in the Time of COVID-19: NSW Data. Heart Lung Circ 2020. [PMCID: PMC8435296 DOI: 10.1016/j.hlc.2020.09.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mentré F, Friberg LE, Duffull S, French J, Lauffenburger DA, Li L, Mager DE, Sinha V, Sobie E, Zhao P. Pharmacometrics and Systems Pharmacology 2030. Clin Pharmacol Ther 2019; 107:76-78. [DOI: 10.1002/cpt.1683] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lena E. Friberg
- Department of Pharmaceutical Biosciences Uppsala University Uppsala Sweden
| | | | | | | | - Lang Li
- The Ohio State University Columbus Ohio USA
| | - Donald E. Mager
- University at BuffaloState University of New York (UB) Buffalo New York USA
| | | | - Eric Sobie
- Icahn School of Medicine at Mount Sinai New York New York USA
| | - Ping Zhao
- Bill & Melinda Gates Foundation Seattle Washington USA
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French J, Huber P, McShane J, Holland CL, Elbin RJ, Kontos AP. Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance. Am J Sports Med 2019; 47:3263-3269. [PMID: 31609635 DOI: 10.1177/0363546519875137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/31/2023]
Abstract
BACKGROUND Baseline computerized testing is a common component of concussion assessments, and the testing environment has been suggested to influence test performance and validity. PURPOSE To compare concussion baseline computerized neurocognitive test performance and validity among adolescent athletes based on testing environment (group, individual), age group (10-12, 13-15, 16-18 years), sex (male, female), and sport type (collision/combat, contact, noncontact). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Through a concussion community outreach program, participants completed baseline computerized neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 2845 athletes aged 10 to 18 years completed the baseline assessment. A total of 2241 (79%) athletes completed baseline testing in a group environment, and 604 (21%) completed testing in an individual environment. A random subsample of 500 athletes from each group was selected for statistical comparison. RESULTS No significant differences were supported in baseline computerized neurocognitive test performance between the group and individual administration environments. Test validity was statistically similar across testing environment, age group, and sex. However, patients of older age (16-18 years), female sex, and collision/combat and contact sports performed better on ImPACT. There were differences in total symptom severity scores (t = 2.19, df = 998, P = .03), with participants in the group testing environment reporting lower total symptom severity scores than those in the individual testing environment. The rates of invalid tests were low across all age groups, averaging from 4.0% in the 10- to 12-year age group to 4.8% in the 13- to 15-year age group. CONCLUSION The findings indicated that concussion baseline neurocognitive test performance is similar when administered in group and individual testing environments. However, differences based on age group, sex, and sport type should be considered when interpreting baseline computerized neurocognitive test scores. The finding of higher symptom scores in older adolescents in the individual testing environment suggests that they may be less forthcoming about symptoms in a group setting.
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Affiliation(s)
- Jonathan French
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Patrick Huber
- UPMC Telehealth Program, Pittsburgh, Pennsylvania, USA
| | - Joseph McShane
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Cyndi L Holland
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert J Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
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Vo T, Nguyen T, Chen A, French J, Otton J, Mussap C, Richards D, Dimitri H, Thomas L. 4938Left ventricular global longitudinal strain recovery predicts scar size reduction and systolic remodelling post ST-elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0008] [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
Left ventricular (LV) strain has prognostic utility following ST-elevation myocardial infarction (STEMI); however, serial changes in LV strain has not been evaluated post-infarct. We sought to determine the relationship between post-STEMI transthoracic echocardiographic (TTE) LV global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) imaging derived scar size and LV systolic remodelling.
Methods
Following revascularisation, 172 first STEMI patients (85% male, 56.9±10.7 years) had paired TTE for GLS, and CMR to evaluate scar size and LV systolic function at baseline (2–7 days) and follow-up (8–10 weeks). Patients were divided into 3 groups according to absolute baseline GLS: group 1 (GLS ≥16%), group 2 (12%< GLS <16%), group 3 (GLS ≤12%). GLS recovery was defined as ≥10% increase in GLS at follow-up, excluding patients with normal baseline GLS. LV systolic adverse remodelling was defined as ≥15% increase in LVESV. LV systolic reverse remodelling was defined as ≥15% decrease in LVESV. Scar reduction was defined as ≥30% decrease in scar size.
Results
Group 1 and 2 had smaller follow-up scar size and higher LVEF compared to group 3 (p<0.0001 for both, see table). There was no difference in scar size reduction or systolic reverse remodeling among the baseline GLS groups (p>0.05 for both). Importantly, no patients from group 1 demonstrated systolic adverse remodelling. Relative change in GLS is significantly correlated with changes in LVEF (r=0.354, p<0.0001) and scar size (r=−0.262, p<0.0001), see figure. On multivariate binary logistic analysis, patients who demonstrated GLS recovery had greater reduction in scar size (OR=2.77 (1.09–7.01), p=0.032) and LV systolic reverse remodelling (OR=9.63 (1.21–76.41), p=0.032).
Follow-up parameters within GLS groups All patients (n=172) Group 1 (n=47) Group 2 (n=72) Group 3 (n=53) Follow-up GLS, % 16.02±3.44 19.38±1.90 16.36±2.09 12.57±2.69 GLS recovery, n 110 (64%) 19 (40%) 53 (74%) 38 (72%) Follow-up scar size, % 7.67±5.40 5.01±3.38 6.27±3.73 12.02±6.24 Follow-up LVEF, % 51.80±10.20 57.83±6.95 54.14±8.02 43.26±9.83 Data presented as mean ± SD or n (%).
Correlation graphs for change in GLS
Conclusion
Stratification of STEMI patients by baseline GLS was a determinant of CMR scar size as well as LV systolic function. However, the evaluation of GLS recovery could provide additional insights into reduction in scar size and LV systolic remodelling, both important prognostic markers. Thus, echocardiographic serial GLS evaluation may be a relevant non-invasive parameter, that is cheaper and more widely available for monitoring STEMI patients and guiding therapy.
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Affiliation(s)
- T Vo
- Liverpool Hospital, Sydney, Australia
| | - T Nguyen
- Liverpool Hospital, Sydney, Australia
| | - A Chen
- Liverpool Hospital, Sydney, Australia
| | - J French
- Liverpool Hospital, Sydney, Australia
| | - J Otton
- Liverpool Hospital, Sydney, Australia
| | - C Mussap
- Liverpool Hospital, Sydney, Australia
| | - D Richards
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | - H Dimitri
- Liverpool Hospital, Sydney, Australia
| | - L Thomas
- Westmead Hospital, Sydney, Australia
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Hyun K, Redfern J, Briffa T, Chew D, French J, Brieger D. P4343Reconciling acute coronary syndrome diagnoses between linked administrative data and hospital medical records in medical research. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0751] [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: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Administrative data incorporating the International Classification of Diseases 10th Revision (ICD-10) is commonly used in cardiac research. Using patient records, diagnoses are systematically coded by trained coders who have limited/no clinical experience. Therefore, it is important to understand how systematically coded cardiac diagnoses compare with clinically assessed diagnoses to better analyse and interpret studies that have used linked administrative data to adjudicate patient's diagnosis.
Purpose
To assess the agreement between the acute coronary syndrome (ACS) diagnoses according to linked data compared to those extracted from hospital medical records by clinicians participating in a national registry and determine the factors associated with diagnoses disagreement.
Methods
The rate of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) obtained from the medical records, from admission to discharge, for the nationwide SNAPSHOT ACS audit in 2012 were compared to the corresponding ICD-10 Australian Modification (ICD-10-AM) codes using linked data from 6 jurisdictions covering all Australian states (6) and territories (2). The proportions of the overall agreement (OA), the positive agreement (PA) and the Cohen's weighted kappa and the 95% confidence interval (CI) were derived using both data sources for STEMI, NSTEMI and UA individually, where kappa≥0.8 confers strong agreement and 0.6≤kappa<0.8 moderate agreement. The factors associated with the diagnostic disagreement were explored using multilevel multivariable logistic regression model (backward selection method), accounting for the hospital clustering effect.
Results
Overall, 3130 patients had both medical records and linked data available for comparison. The degree of agreement was greatest for STEMI and lowest for UA (STEMI: OA=97%, PA=85%, kappa (95% CI)=0.84 (0.81, 0.87); NSTEMI: OA=91%, PA=81%, kappa (95% CI)=0.76 (0.73,0.79); UA: OA = 81%, PA=53%, kappa (95% CI)=0.41 (0.38, 0.45)). Further, the independent factors associated with the disagreement between the medical records and the linked data were the diagnosis of UA (UA vs. STEMI (odds ratio (95% CI)): 6.85 (4.12, 11.40)), not receiving revascularisation (2.27 (1.69, 3.03)), and the state where the ICD-10-AM was coded (p=0.007) (see Figure).
Figure 1
Conclusion
This study suggests that the agreement between the systematically coded diagnoses from linked administrative data and the diagnosis from the clinical assessment is greater in patients who received revascularisation and worse in those with UA. Also, the degree of agreement varies between states. As the linked data and the ICD codes are being used more often in research to support the evidence-based policies and practice, more attention is needed in testing and improving the accuracy of the ICD-10 codes as well as the ICD-11 codes that are soon to be introduced.
Acknowledgement/Funding
KH is funded by Heart Foundation Postdoctoral Fellowship. SNAPSHOT data linkage project was funded by the NSW Heart Foundation CVRN Project Grant
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - D Brieger
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. P2708Clopidogrel versus ticagrelor on coronary microvascular and peripheral endothelial function after non-ST elevation acute coronary syndrome: a randomised trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1025] [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: 11/14/2022] Open
Abstract
Abstract
Background
Ticagrelor has been shown to reduce microvascular injury and improve peripheral endothelial function compared to clopidogrel in ST-elevation myocardial infarction and stable patients. However, comparable data is lacking in non-ST elevation acute coronary syndromes (NSTE-ACS).
Purpose
To investigate the effects of clopidogrel versus ticagrelor on coronary microvascular function and peripheral endothelial function in NSTE-ACS patients.
Methods
Patients hospitalised for NSTE-ACS were prospectively randomised 1:1 to clopidogrel (300mg loading then 75mg daily) or ticagrelor (180mg loading then 90mg twice-daily). Coronary microvascular function was assessed with index of microcirculatory resistance (IMR) in the infarct related artery (IRA) and non-IRA before and after percutaneous coronary intervention (PCI) using a standard pressure-temperature coronary wire. Peripheral endothelial function was assessed with flow-mediated vasodilation (FMD) of the brachial artery, performed on admission prior to antiplatelet loading and again before discharge, using a pneumatic cuff and 10MHz linear ultrasound transducer.
Results
A total of 40 patients were included for analysis (Figure 1). Median age was 53.5 (IQR 49.0–61.5) years, 35 (87.5%) were male, 11 (27.5%) had diabetes, 19 (47.5%) were smokers. Median peak troponin T was 527 (175–1006.5) ng/L, median GRACE score 91.5 (78.3–103.3) and median SYNTAX score 13 (6–20). Baseline characteristics were similar between both groups. There was no significant difference in the median baseline IMR between the 2 groups in both the IRA (clopidogrel 14.4 [IQR 12.2–18.6] vs ticagrelor 20.8 [11.3–27.4], p=0.22) and non-IRA (14.0 [11.0–22.0] vs 14.0 [10.0–29.5] respectively, p=0.74). 28 patients underwent PCI to the IRA (12 clopidogrel, 16 ticagrelor). There was no significant difference in the median post-PCI IMR between the 2 groups (19.5 [14.5–24.5] vs 29.0 [19.0–35.6] respectively, p=0.11). However, there was significant worsening of post-PCI compared with pre-PCI IMR (19.5 vs 15.0, p=0.049) in the clopidogrel group but not in the ticagrelor group (29.0 vs 25.4, p=0.47). FMD was performed in 23 patients (9 clopidogrel, 14 ticagrelor). Admission median %FMD (change in post-stimulus diameter as a percentage of the baseline diameter) was similar between the 2 groups (13.2% [10.1–17.6] vs 12.2% [10.2–15.8] respectively, p=0.41). There was a trend towards higher median pre-discharge %FMD in the ticagrelor group (12.8% [12.2–18.0]) compared to the clopidogrel group (10.4% [9.5–11.2], p=0.09). There was a trend towards lower pre-discharge %FMD compared to admission in the clopidogrel group (10.4% vs 13.2%, p=0.05) but not the ticagrelor group (12.8% vs 12.2%, p=0.43).
Figure 1
Conclusions
In our NSTE-ACS patients undergoing PCI, ticagrelor resulted in less disruption of coronary microvascular function and may also have beneficial effects on peripheral endothelial function compared to clopidogrel.
Acknowledgement/Funding
Dr. James Xu is funded by a post-graduate scholarship from the Australian Government Research Training Program (RTP)
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Affiliation(s)
- J Xu
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - S Lo
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - C Mussap
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - R Rajaratnam
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - K Kadappu
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - U Premawardhana
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - P Nguyen
- Campbelltown Hospital, Department of Cardiology, Sydney, Australia
| | - C Juergens
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - D Leung
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
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Vo T, Nguyen T, Chen A, French J, Otton J, Mussap C, Richards D, Dimitri H, Thomas L. P1483Serial changes in peak left atrial strain predicts diastolic remodelling following percutaneous revascularisation for ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0248] [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: 11/14/2022] Open
Abstract
Abstract
Background
Echocardiographic 2D speckle tracking peak left atrial (LA) strain reflects LA reservoir function. Limited studies have reported the relationship between peak LA strain and diastolic dysfunction. In addition, adverse diastolic remodeling (ADR) has been reported, to have better prognostic value than single diastolic function assessment following ST-elevation myocardial infarction (STEMI).
Purpose
We examined the relationship between serial changes in echocardiographic peak LA strain and diastolic function in STEMI patients.
Methods
186 percutaneously revascularized first presentation STEMI patients (87% male, 56.9±10.6 years) underwent serial TTE at baseline (2–7 days) and at follow-up (8–10 weeks) post-STEMI. Peak LA reservoir strain measurements were analysed from apical 2-, 3- and 4- chamber views. Diastolic function was graded as per 2016 guidelines: normal, grade 1, grade 2 and grade 3. ADR was defined as worsening of diastolic function grade (≥1) from baseline to follow-up, or persistent grade 3.
Results
Lower baseline peak LA strain was associated with grade 2 and grade 3 diastolic dysfunction compared to normal and grade 1 function at follow-up (p<0.05, see figure and table). Change in LA strain was less with worsening grades of diastolic function (see table). ADR was seen in 33 patients. Lower baseline peak LA strain predicted ADR (B=0.86 (0.80–0.92), p<0.0001). In addition, a reduction in peak LA strain at follow up was independently associated with ADR (B=0.91 (0.84–0.97), p=0.007) (see figure).
Diastolic function grades with LA strain Follow-up diastolic function Baseline peak LA strain (%) Follow-up peak LA strain (%) Change in peak LA strain (%) Normal (n=91) 35.70±6.38 40.97±8.10 5.26±6.07 Grade 1 (n=61) 30.70±6.97 34.54±8.77 3.84±6.32 Grade 2 (n=17) 23.95±6.11 25.49±5.93 1.54±4.70 Grade 3 (n=17) 23.66±8.07 23.49±10.64 −0.17±7.44 Data presented as mean ± SD.
Peak LA strain vs diastolic function
Conclusion
Peak LA strain is associated with diastolic function following STEMI and differentiates normal diastolic function from diastolic dysfunction. Serial changes in peak LA strain correlated with diastolic remodelling. Longer-term follow-up is required to determine the prognostic value of changes in peak LA strain, and diastolic remodelling.
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Affiliation(s)
- T Vo
- Liverpool Hospital, Sydney, Australia
| | - T Nguyen
- Liverpool Hospital, Sydney, Australia
| | - A Chen
- Liverpool Hospital, Sydney, Australia
| | - J French
- Liverpool Hospital, Sydney, Australia
| | - J Otton
- Liverpool Hospital, Sydney, Australia
| | - C Mussap
- Liverpool Hospital, Sydney, Australia
| | - D Richards
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | - H Dimitri
- Liverpool Hospital, Sydney, Australia
| | - L Thomas
- Westmead Hospital, Sydney, Australia
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Jennings S, French J, Holland C, Collins M, Kontos AP. Comparison of Clinical Outcomes Following Patients' First and Second Concussions. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
The objective of this study was to examine differences in self-reported symptoms, neurocognitive performance, and vestibular-ocular insufficiencies between patients’ first and second concussions. A secondary purpose was to explore the role of risk factors on recovery.
Methods
We conducted a retrospective medical chart review of 73 (32-M/41-F) patients aged 15.69 (SD=1.67) years from a concussion specialty clinic with two separate concussions (84.9% of 1st and 79.5% of 2nd sport-related) that occurred between August 2010 and April 2018. Clinical outcomes included the PCSS, ImPACT, and the Vestibular/Ocular Motor Screening (VOMS). A series of paired samples t-tests were used to compare clinical outcomes along with chi-square analyses for risk factor associations.
Results
Verbal memory scores were higher following the second (M=80.67, SD=15.3) (M=76.32, SD=15.65) (t[73]=–2.18, p=.03) concussion. Visual motor processing speed was faster following the second concussion (M=35.04, SD= 7.90) (M=31.35, SD=7.63) (t[73]=–5.72, p<.001). There were no other significant differences observed. Recovery time was similar for the first (61.07, SD=58.41.5) and second (67.91 SD=70.10) respectively, t(70)=–.91, p=.37. There was no relationship between any risk factors, and recovery time for either injury with the exception a significant association between gender and recovery time (>21 days) with the 1st injury for females (χ2, N=73)=10.58, p=.001.
Conclusion
Findings suggest that a second concussion does not result in more pronounced symptoms, worse neurocognitive performance, or increased deficits on vestibular/ocular performance and/or longer recovery time. The only significant risk factor to a recovery over 21 days included gender.
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Marrington R, French J, Robins A, Mackenzie F. UK NEQAS for serum indices: Three years on …. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lu D, Li C, Riggs M, Polhamus D, French J, Agarwal P, Chen SC, Vadhavkar S, Patre M, Strasak A, Quartino A, Jin JY, Girish S. Pharmacokinetics of trastuzumab emtansine (T-DM1) as a single agent or in combination with pertuzumab in HER2-positive breast cancer patients with recurrent or locally advanced metastatic breast cancer. Cancer Chemother Pharmacol 2019; 84:175-185. [PMID: 31102024 DOI: 10.1007/s00280-019-03852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/14/2018] [Accepted: 04/25/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The phase III MARIANNE study investigated single-agent trastuzumab emtansine (T-DM1) and combination T-DM1 plus pertuzumab as the first-line treatment for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). Pharmacokinetic properties of T-DM1 and pertuzumab in these patients and the potential for drug-drug interactions (DDIs) were assessed. METHODS Pharmacokinetic samples of T-DM1-related analytes (T-DM1 conjugate, total trastuzumab, DM1) and pertuzumab were analyzed. Observed pharmacokinetic data were summarized for all analytes. Historical population pharmacokinetic models for T-DM1 conjugate and pertuzumab in HER2-positive MBC were used to derive empirical Bayes estimates of pharmacokinetic parameters. RESULTS In MARIANNE (N = 375), mean ± standard deviation population pharmacokinetic model-predicted Cycle 1 Cmax for T-DM1 conjugate was 74.4 ± 10.1 µg/mL, Cycle 1 Ctrough was 1.34 ± 0.802 µg/mL, and area under the concentration-time curve from time zero to infinity after first dose (AUCinf) was 338 ± 69.5 µg*day/mL. These values were similar to other T-DM1 studies. Pharmacokinetics of T-DM1 conjugate and other analytes (total trastuzumab, DM1) were similar with or without pertuzumab. In the pertuzumab plus T-DM1 arm, mean model-predicted Cycle 1 pertuzumab Cmax, Ctrough, and AUCinf were 276 ± 50.0 µg/mL, 64.8 ± 17.9 μg/mL, and 4470 ± 1360 µg*day/mL, respectively. These values were similar to other pertuzumab studies. CONCLUSIONS Based on the population pharmacokinetic analysis of T-DM1 conjugate and pertuzumab, pharmacokinetics are similar across different lines of treatment and stages of disease including previously untreated MBC patients, and no DDIs were identified for combined use of T-DM1 and pertuzumab.
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Affiliation(s)
- Dan Lu
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
| | - Chunze Li
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Matthew Riggs
- Metrum Research Group, 2 Tunxis Rd # 112, Tariffville, CT, USA
| | - Daniel Polhamus
- Metrum Research Group, 2 Tunxis Rd # 112, Tariffville, CT, USA
| | - Jonathan French
- Metrum Research Group, 2 Tunxis Rd # 112, Tariffville, CT, USA
| | - Priya Agarwal
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Shang-Chiung Chen
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Shweta Vadhavkar
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Monika Patre
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Alexander Strasak
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Angelica Quartino
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Jin Yan Jin
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Sandhya Girish
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
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Meybodi F, Sedaghat N, French J, Elder E. Abstract P2-14-26: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Meybodi F, Sedaghat N, French J, Elder E. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-26.
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Affiliation(s)
- F Meybodi
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - N Sedaghat
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - J French
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - E Elder
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
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Xu J, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Intravascular Ultrasound (IVUS) Analysis of Intensive Plaque Modification with Rotational Atherectomy with or without Adjunctive Cutting Balloon for Extremely Calcified Coronary Lesions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Kee A, Rajaratnam R, Leung D, French J, Juergens C. Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) - A Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pender P, Faour A, Gibbs O, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Use of Mechanical Cardiac Support (MCS) for ST-elevated Myocardial Infarction with Cardiogenic Shock(STEMI-CS) in a Non-transplant Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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