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Magnetta D, Jackson L, Zeevi A, Turnquist H, Miller S, West S, Murtagh G, Feingold B. High Sensitivity Troponin-I is Associated with Acute Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.068] [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: 04/05/2023] Open
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Jackson L, Mcneeley E, Techarukpong NC, Mugeta F, Aaron K, Mudano A, Merchant J, Warren K, Foster J, Saag K, Danila M. POS1147 CHALLENGES IN CONDUCTING PRAGMATIC CARE STRATEGY STUDIES IN OSTEOPOROSIS: PATIENT PERCEPTIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2473] [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: 11/04/2022]
Abstract
BackgroundLarge pragmatic osteoporosis studies to improve outcomes are needed. Direct-to-patient studies have highest generalizability but achieving sufficient sample size is difficult; recruitment challenges represent an important consideration given limited participant eligibility and interest. The Fracture Liaison Service (FLS), a team approach to post-fracture care, is a secondary fracture prevention method that has significantly improved outcomes internationally.ObjectivesOur goal was to evaluate the interest, barriers, and lessons learned in recruiting participants for a future trial assessing remote FLS approaches for post-fracture care.MethodsWe used ICD10 fracture codes to identify patients > 50 years of age with a documented hip/pelvis, spine, humerus, or wrist fracture in the previous 1 year. We excluded patients with i) prescriptions for osteoporosis medications (e.g., bisphosphonates, parathyroid hormone analogs, denosumab, romosozumab, raloxifene) in the prior 1 year; ii) an ICD10 code for end-stage renal disease, non-osteoporotic metabolic bone disease, malignant neoplasm, or motor vehicle accident. In December 2021, research assistants reviewed electronic health records (EHR) of potentially eligible patients for evidence of additional serious illness limiting life expectancy to < 1 year or non-ambulatory status prior to fracture. Research assistants called preliminary eligible patients that met inclusion and exclusion criteria and asked them to complete a survey by phone. Interest in a FLS future clinical trial was evaluated using a Likert scale (1=“Definitely would not volunteer”, to 5=“Definitely would volunteer”). We used descriptive statistics to analyze baseline demographic, clinical characteristics, and interest. This pilot was approved by the UAB Institutional Review Board (IRB-300008310-005).ResultsWe identified 1,577 patients > 50 years of age with a fracture. After applying exclusion criteria, we identified 869 preliminary eligible patients. Over 3 weeks, we screened the medical records of a random sample of half of the preliminary eligible patient cohort (n=414), of whom we contacted 271 patients determined potentially eligible, and successfully reached 141 (52% of those contacted) by phone. A total of 108 (77% of those reached) persons, mean (SD) age 69.5 (11.5) years, 40% men, 21% Black or non-white Hispanics completed the survey. Among those contacted, 68 (63%, interest rate) said they would be very or highly interested in participating in a future clinical trial evaluating FLS approaches. Among the 40 (37%) people who said they were not sure, unlikely or very unlikely to volunteer the most common reasons cited were “I don’t want to participate in a study” (33%); “I don’t feel well enough to participate” (10%); “I don’t understand what the study is for” (3%). From this pilot, we calculated a refined eligibility/interest rate of 9.1% among those patients preliminarily identified as eligible using administrative data alone.ConclusionBased on our pilot, we estimate that approximately 9% of eligible patients with fractures will be interested in enrolling in a future comparative effectiveness study to prevent recurrent fragility fractures. We identified several potential modifiable barriers to clinical trial recruitment. Patient perceptions collected from this pilot will inform enrollment strategies, which can be incorporated early when planning direct-to-patient pragmatic osteoporosis studies to achieve recruitment goals.Disclosure of InterestsLesley Jackson: None declared, Ellen McNeeley: None declared, Norma C. Techarukpong: None declared, Faith Mugeta: None declared, Kiara Aaron: None declared, Amy Mudano: None declared, Jeanne Merchant: None declared, Kellie Warren: None declared, Jeff Foster: None declared, Kenneth Saag Grant/research support from: Amgen, Horizon, LG Chem, Radius, SOBI, Maria Danila Grant/research support from: Pfizer, Horizon
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Yokose C, Mccormick N, Lu N, Joshi A, Jackson L, Kohler M, Yinh J, Zhang Y, Saag K, Choi H. POS1171 TRIPLE THE RATE OF EMERGENCY ROOM VISITS AND HOSPITALIZATIONS FOR GOUT AMONG US BLACKS VS WHITES – 2019 NATIONWIDE ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4189] [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: 11/03/2022]
Abstract
BackgroundGout is a highly prevalent inflammatory arthritis with increasing global disease burden in recent years.1,2 Gout prevalence has been reported to be higher among Blacks compared to Whites,3 and that they are less likely to receive allopurinol in outpatient care.4 The potential nationwide impact of these racial disparities on emergency department (ED) visits and hospitalizations is unknown.ObjectivesTo examine the contemporary racial disparities in ED visits and hospitalizations with a primary discharge diagnosis of gout in the US (2019).MethodsWe compared ED visits and hospitalizations between Blacks and Whites in the latest data (2019) from the US National Emergency Department Sample (NEDS) and National Inpatient Sample (NIS). We focused on encounters for which the primary diagnosis was gout based on ICD codes (M1A.xx, M10.xx). We calculated annual population rates of ED visits and hospitalizations for gout (per 100,000 US adults) using the 2019 US census adult population (>18 years) according to race.ResultsThere were a total of 160,759 ED visits and 9,560 hospitalizations among White and Blacks with a gout diagnosis in the US in 2019. The mean age (58.2 years vs. 56.5 years) and male proportion (78.0% vs. 74.8%) tended to be higher among Whites, while more Blacks tended to live in the South (40.7% vs. 66.5%) and reported a median household income of < $50,000 (30.7% vs. 57.1%). Compared to Whites, Blacks had 2.7- and 3.2-fold higher rates of gout ED visits and hospitalizations, respectively, after adjusting for age, sex, payer, region, and household income (Table 1 & Figure 1). Black women, in particular, had 3.4- and 4.0-fold higher rates of ED visits and hospitalizations compared to White women, while the corresponding rate ratios for men were 2.5 and 2.8, respectively. The mean costs per gout ED visit were similar for Blacks compared to Whites (adjusted difference, -$7.6 [95% CI, -25.4 to 1.0]), while hospitalizations were more costly (adjusted difference, $1,055.3 [95% CI, 553.1 to 1557.5]). The duration of ED visits and hospitalizations was also higher among Blacks than Whites (adjusted difference of 0.41 days [95% CI, 0.19 to 0.63] and 0.59 days [95% CI, 0.25 to 0.94], respectively).Table 1.Racial Disparities in Emergency Department Visits and Hospitalizations with Primary Diagnosis of Gout in 2019Emergency Department VisitsHospitalizationsRaceWhiteBlackWhiteBlackAll6801196524521330198510434519150Visits, N888107194962003360Rate per 100,000130.6293.431.274.4Rate Ratio (95% CI)*1.0 (ref)2.81 (2.63, 3.00)1.0 (ref)3.08 (2.79, 3.40)Rate Ratio (95% CI)**1.0 (ref)2.66 (2.50, 2.82)1.0 (ref)3.17 (2.86, 3.50)Women3785136914363031110390932647105Visits, N195671816317701145Rate per 100,00051.7126.516.043.3Rate Ratio (95% CI)*1.0 (ref)3.68 (3.39, 3.99)1.0 (ref)4.01 (3.40, 4.73)Rate Ratio (95% CI)**1.0 (ref)3.36 (3.11, 3.62)1.0 (ref)4.02 (3.39, 4.78)Men301561011015657388098151871620Visits, N692285378344302215Rate per 100,000229.6529.550.3118.3Rate Ratio (95% CI)*1.0 (ref)2.59 (2.42, 2.78)1.0 (ref)2.66 (2.36, 3.00)Rate Ratio (95% CI)**1.0 (ref)2.47 (2.32, 2.64)1.0 (ref)2.77 (2.45, 3.14)*Adjusted for age and sex for all, adjusted for age for sex-specific rate ratios**Adjusted for age, sex, payment, region, and household incomeConclusionThese latest national data indicate that ED visits and hospitalization due to gout are both 3 times higher among Blacks than Whites; this disparity was particularly prominent among women with gout. Higher risk of developing gout3 and suboptimal care4 both translate to these avoidable costly healthcare utilizations, calling for improved primary prevention and gout care.References[1]Safiri et al., PMID 32755051[2]Xia et al., PMID 31624843[3]Chen-Xu et al., PMID 30618180[4]Krishnan et al., PMID 18260174Disclosure of InterestsChio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Lesley Jackson: None declared, Minna Kohler Speakers bureau: Lilly, Consultant of: Mymee, Novartis, Grant/research support from: Setpoint Medical, Janeth Yinh: None declared, Yuqing Zhang: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon
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Gilsenan A, Harris D, Reynolds M, McSorley D, Midkiff K, Jackson L, Muldavin B, Kellier-Steele N, Andrews E. Long-term cancer surveillance: results from the Forteo Patient Registry Surveillance Study. Osteoporos Int 2021; 32:645-651. [PMID: 33151378 PMCID: PMC8026426 DOI: 10.1007/s00198-020-05718-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Forteo Patient Registry estimated the incidence of osteosarcoma in US patients treated with teriparatide and enrolled in the study between 2009 and 2019. No incident cases of osteosarcoma were identified among patients registered, and the crude incidence rate was 0 (95% confidence interval [CI], 0-10.2) cases per million person-years. PURPOSE The prospective, voluntary Forteo Patient Registry was established to estimate the incidence of osteosarcoma in patients who have received treatment with teriparatide (Forteo). METHODS Information on US adults prescribed teriparatide and enrolled in the Forteo Patient Registry 2009-2019 was linked with data from participating state cancer registries annually (2010-2019) to identify incident osteosarcoma cases using a standardized linkage algorithm. Teriparatide exposure was ascertained from self-reported data that included teriparatide initiation and demographics necessary to complete linkage. Osteosarcoma cases diagnosed on or after January 1, 2009, were identified by participating state cancer registries. The crude incidence rate (IR) and standardized incidence ratio (SIR) of observed cases to the expected number of cases adjusted to the background rate (3 per million person-years) and corresponding 95% CIs for the occurrence of osteosarcoma were calculated whereby the cumulative amount of person-time observed was adjusted for mortality. RESULTS Data for 75,247 enrolled patients (representing 361,763 cumulative person-years) were linked to each of 42 participating state cancer registries (covering 93% of the US population), which included information on 6180 cases of osteosarcoma. No matches with incident cases of osteosarcoma following registry enrollment were found. The crude IR was 0 (95% CI, 0-10.2) cases per million person-years and the SIR was 0 (95% CI, 0-3.0). CONCLUSIONS The ability to draw conclusions about the incidence of osteosarcoma among patients participating in the registry was limited due to the smaller than expected amount of patient follow-up time and the fact that no cases were identified.
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Affiliation(s)
- A Gilsenan
- RTI Health Solutions, Research Triangle Park, NC, USA.
| | - D Harris
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - M Reynolds
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - D McSorley
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - K Midkiff
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - L Jackson
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - B Muldavin
- RTI International, Research Triangle Park, NC, USA
| | | | - E Andrews
- RTI Health Solutions, Research Triangle Park, NC, USA
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Jackson L, Saund J, Donnelly G. 70 Improving the Documentation of DNACPR Decisions Following the Transition to Electronic Record Keeping. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This quality improvement project was based at The Royal Bolton Hospital across our four Complex Care wards.
Introduction
We have recently transferred to electronic record keeping. At these points of transition there may be an adverse impact on the quality of patient care and safety. We recognised on our own ward there were inaccuracies between the required paper form and electronic documentation of DNACPR decisions. Consequently, we wanted to review and improve the accuracy of our DNACPR documentation to ensure safe and effective patient care.
Methods
To gauge the scope of the problem we audited 87 patient’s electronic and paper notes, with no exclusion criteria. We reviewed whether each patient had a formal resuscitation decision, and if a DNACPR decision had been made whether we met our hospital policy by having:
93% of the 87 patient’s had an active decision regarding resuscitation, with a DNACPR decision documented for 50 patients. Of these 50 patients only 11 had all three forms of documentation. More worryingly, there were discrepancies in the documented DNACPR decisions for 11 patients across paper and electronic records.
Interventions
We escalated our concerns to the Clinical Governance team who sent out a trust wide SBAR highlighting this as an urgent clinical issue. On a directorate level we incorporated DNACPR decision documentation into our afternoon safety huddle and arranged informal teaching for medical, nursing and administrative staff.
Results
Reassuringly, the subsequent re-audit of 90 patient’s notes showed only one patient to have a discrepancy between paper and electronic documentation. We saw an improvement to 98% having paper forms in the right bedside notes and 100% having a documented electronic DNACPR decision.
Conclusion
Through local education and trust-wide dissemination of our expected standards we have seen some improvement. We recognise the importance of maintaining this, and importantly that there is still work to be done. The electronic “Resuscitation and treatment escalation plan” is still rarely completed and provides important information on escalation of care and thus will be the focus of a further educational intervention.
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Affiliation(s)
- L Jackson
- Geriatric Medicine, The Royal Bolton Hospital
| | - J Saund
- Geriatric Medicine, The Royal Bolton Hospital
| | - G Donnelly
- Geriatric Medicine, The Royal Bolton Hospital
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Laharwani H, Manucha V, Jefferson G, Jackson L. Utilization of P16 in Head and Neck Cytology and Surgical Specimens After the Release of CAP Guidelines. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
HPV-positive oropharyngeal squamous cell carcinoma is biologically and clinically unique and has a survival advantage over other head and neck squamous cell carcinomas. In December 2017 College of American Pathologist published guidelines for testing HPV status in head and neck cancer. It was recommended that pathologists perform HR-HPV testing on head and neck squamous cell carcinomas from all patients with known oropharyngeal SCC not previously tested for HR-HPV, with suspected oropharyngeal SCC, or with metastatic SCC of unknown primary. The aim of this study was to determine the compliance of pathologists following the CAP guidelines.
Methods
Cases that underwent HPV testing using p16 immunohistochemistry for the years 2017 and 2019 were retrieved. Based on the guidelines, p16 testing was designated as “indicated” or “not indicated”.
Results
There were 196 cases in which p16 testing was performed in a period of 3 consecutive years. Of these, 175 were FNA/ biopsies and 21 were surgical resections. In 69 cases (56 FNAs and 13 biopsies) the biopsy was performed on neck masses with unknown primary. The compliance for p16 testing in OPC and Lymph nodes with metastatic SCC of unknown primary was 100%. In 34 (17.3%) cases p16 testing was not indicated, the most common reason being wrong site (85%) including the larynx, oral tongue, the floor of the mouth, buccal mucosa, and nasal mass. Of the unindicated p16s, 20 (58%) were received in consultation for continuity of care.
Conclusion
Not being clear about the site of the tumor is the most common reason for unindicated p16 testing. A clear designation of biopsy site and proper communication between pathologist and surgeon can improve utilization of p16 testing in head and neck carcinomas.
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Affiliation(s)
- H Laharwani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - V Manucha
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - G Jefferson
- University of Mississippi Medical Center, Jackson, Mississippi
| | - L Jackson
- University of Mississippi Medical Center, Jackson, Mississippi
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8
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Vikulova D, Trinder M, Brown C, Jackson L, Pimstone S, Brunham L. GENETICALLY CONFIRMED FAMILIAL HYPERCHOLESTEROLEMIA IN PATIENTS WITH PREMATURE CORONARY ARTERY DISEASE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.055] [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] Open
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9
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Hayatigolkhatmi K, Padroni G, Su W, Fang L, Gómez-Castañeda E, Hsieh YC, Jackson L, Pellicano F, Burley GA, Jørgensen HG. An investigation of targeted inhibition of transcription factor activity with pyrrole imidazole polyamide (PA) in chronic myeloid leukemia (CML) blast crisis cells. Bioorg Med Chem Lett 2019; 29:2622-2625. [PMID: 31378570 DOI: 10.1016/j.bmcl.2019.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/28/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
Tyrosine kinase inhibitor (TKI) therapy is the standard treatment for chronic phase (CP)-chronic myeloid leukemia (CML), yet patients in blast crisis (BC) phase of CML are unlikely to respond to TKI therapy. The transcription factor E2F1 is a down-stream target of the tyrosine kinase BCR-ABL1 and is up-regulated in TKI-resistant leukemia stem cells (LSC). Pyrrole imidazole polyamides (PA) are minor groove binders which can be programmed to target DNA sequences in a gene-selective manner. This manuscript describes such an approach with a PA designed to down-regulate E2F1 controlled gene expression by targeting a DNA sequence within 100 base pairs (bp) upstream of the E2F1 consensus sequence. Human BC-CML KCL22 cells were assessed after treatment with PA, TKI or their combination. Our PA inhibited BC-CML cell expansion based on cell density analysis compared to an untreated control after a 48-hour time-course of PA treatment. However, no evidence of cell cycle arrest was observed among BC-CML cells treated with PA, with respect to their no drug control counterparts. Thus, this work demonstrates that PAs are effective in inhibiting E2F1 TF activity which results in a temporal reduction in BC-CML cell number. We envisage that PAs could be used in the future to map genes under E2F1 control in CML LSCs.
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MESH Headings
- Antineoplastic Agents/chemical synthesis
- Antineoplastic Agents/chemistry
- Antineoplastic Agents/pharmacology
- Blast Crisis/drug therapy
- Blast Crisis/metabolism
- Blast Crisis/pathology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Dose-Response Relationship, Drug
- Drug Screening Assays, Antitumor
- E2F1 Transcription Factor/antagonists & inhibitors
- E2F1 Transcription Factor/genetics
- E2F1 Transcription Factor/metabolism
- Humans
- Imidazoles/chemistry
- Imidazoles/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Molecular Structure
- Nylons/chemistry
- Nylons/pharmacology
- Protein Kinase Inhibitors/chemical synthesis
- Protein Kinase Inhibitors/chemistry
- Protein Kinase Inhibitors/pharmacology
- Pyrroles/chemistry
- Pyrroles/pharmacology
- Structure-Activity Relationship
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Affiliation(s)
- K Hayatigolkhatmi
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - G Padroni
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow, UK
| | - W Su
- Guangdong Key Laboratory of Nanomedicine, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, PR China
| | - L Fang
- Guangdong Key Laboratory of Nanomedicine, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, PR China
| | - E Gómez-Castañeda
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Y C Hsieh
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - L Jackson
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - F Pellicano
- Drug Discovery Program, Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, UK
| | - G A Burley
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow, UK
| | - H G Jørgensen
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
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10
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Trinder M, Li X, DeCastro M, Cermakova L, Sadananda S, Jackson L, Azizi H, Mancini G, Francis G, Frohlich J, Brunham L. Monogenic Familial Hypercholesterolemia, Polygenic Hypercholesterolemia, And The Risk Of Premature Atherosclerotic Cardiovascular Disease. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Dowsett L, Porras AR, Kruszka P, Davis B, Hu T, Honey E, Badoe E, Thong MK, Leon E, Girisha KM, Shukla A, Nayak SS, Shotelersuk V, Megarbane A, Phadke S, Sirisena ND, Dissanayake VHW, Ferreira CR, Kisling MS, Tanpaiboon P, Uwineza A, Mutesa L, Tekendo-Ngongang C, Wonkam A, Fieggen K, Batista LC, Moretti-Ferreira D, Stevenson RE, Prijoles EJ, Everman D, Clarkson K, Worthington J, Kimonis V, Hisama F, Crowe C, Wong P, Johnson K, Clark RD, Bird L, Masser-Frye D, McDonald M, Willems P, Roeder E, Saitta S, Anyane-Yeoba K, Demmer L, Hamajima N, Stark Z, Gillies G, Hudgins L, Dave U, Shalev S, Siu V, Ades A, Dubbs H, Raible S, Kaur M, Salzano E, Jackson L, Deardorff M, Kline A, Summar M, Muenke M, Linguraru MG, Krantz ID. Cornelia de Lange syndrome in diverse populations. Am J Med Genet A 2019; 179:150-158. [PMID: 30614194 DOI: 10.1002/ajmg.a.61033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 01/22/2023]
Abstract
Cornelia de Lange syndrome (CdLS) is a dominant multisystemic malformation syndrome due to mutations in five genes-NIPBL, SMC1A, HDAC8, SMC3, and RAD21. The characteristic facial dysmorphisms include microcephaly, arched eyebrows, synophrys, short nose with depressed bridge and anteverted nares, long philtrum, thin lips, micrognathia, and hypertrichosis. Most affected individuals have intellectual disability, growth deficiency, and upper limb anomalies. This study looked at individuals from diverse populations with both clinical and molecularly confirmed diagnoses of CdLS by facial analysis technology. Clinical data and images from 246 individuals with CdLS were obtained from 15 countries. This cohort included 49% female patients and ages ranged from infancy to 37 years. Individuals were grouped into ancestry categories of African descent, Asian, Latin American, Middle Eastern, and Caucasian. Across these populations, 14 features showed a statistically significant difference. The most common facial features found in all ancestry groups included synophrys, short nose with anteverted nares, and a long philtrum with thin vermillion of the upper lip. Using facial analysis technology we compared 246 individuals with CdLS to 246 gender/age matched controls and found that sensitivity was equal or greater than 95% for all groups. Specificity was equal or greater than 91%. In conclusion, we present consistent clinical findings from global populations with CdLS while demonstrating how facial analysis technology can be a tool to support accurate diagnoses in the clinical setting. This work, along with prior studies in this arena, will assist in earlier detection, recognition, and treatment of CdLS worldwide.
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Affiliation(s)
- Leah Dowsett
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawai'i.,Kapi'olani Medical Specialists, Honolulu, Hawai'i
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia
| | - Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Brandon Davis
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Tommy Hu
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Engela Honey
- Department of Genetics, University of Pretoria, Pretoria, South Africa
| | - Eben Badoe
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Meow-Keong Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eyby Leon
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Shalini S Nayak
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Shubha Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nirmala D Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Carlos R Ferreira
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Monisha S Kisling
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Pranoot Tanpaiboon
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Annette Uwineza
- Center for Human Genetics, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Leon Mutesa
- Center for Human Genetics, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Karen Fieggen
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Leticia Cassimiro Batista
- Department of Genetics, Institute of Biosciences, São Paulo State University-UNESP, São Paulo, Brazil
| | - Danilo Moretti-Ferreira
- Department of Genetics, Institute of Biosciences, São Paulo State University-UNESP, São Paulo, Brazil
| | | | | | | | | | | | - Virginia Kimonis
- Department of Pediatrics, Division of Genetics and Genomic Medicine, University of California, Irvine, California
| | - Fuki Hisama
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Carol Crowe
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Paul Wong
- Department of Pediatrics, Rush University Medical College, Chicago, Illinois
| | - Kisha Johnson
- Department of Pediatrics, Rush University Medical College, Chicago, Illinois
| | - Robin D Clark
- Division of Medical Genetics, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Lynne Bird
- Department of Pediatrics, University of California Sand Diego, San Diego, California.,Department of Genetics, Rady Children's Hospital, San Diego, California
| | - Diane Masser-Frye
- Department of Genetics, Rady Children's Hospital, San Diego, California
| | - Marie McDonald
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, North Carolina
| | | | - Elizabeth Roeder
- Department of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Sulgana Saitta
- Division of Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Medical Genetics Institute, Los Angeles, California
| | - Kwame Anyane-Yeoba
- Division of Clinical Genetics, Columbia University Medical College, New York, New York
| | - Laurie Demmer
- Department of Pediatrics, Carolinas Medical Center, Charlotte, North Carolina
| | - Naoki Hamajima
- Department of Pediatrics, Nagoya City Jouhoku Hospital, Nagoya, Japan
| | - Zornitza Stark
- Murdoch Children's Research Institute, Victorian Clinical Genetics Services, Melbourne, Australia
| | - Greta Gillies
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Louanne Hudgins
- Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, Palo Alto, California
| | - Usha Dave
- Haffkine Institute, MILS International India, Mumbai, India
| | - Stavit Shalev
- Ha'emek Medical Center, The Genetic Institute, Hafia, Israel
| | - Victoria Siu
- Medical Genetics Program, London Health Sciences Centre, Ontario, Canada
| | - Ann Ades
- The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly Dubbs
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Raible
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maninder Kaur
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emanuela Salzano
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laird Jackson
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthew Deardorff
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Antonie Kline
- Department of Pediatrics, Greater Baltimore Medical Center, Harvey Institute for Human Genetics, Baltimore, Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia
| | - Ian D Krantz
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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12
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Shah N, Jackson L, Phelan J, Corton M. 16: Anterior and medial thigh anatomy in female cadavers: Clinical applications to transobturator tape sling excision. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.200] [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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13
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Vears DF, Sénécal K, Clarke AJ, Jackson L, Laberge AM, Lovrecic L, Piton A, Van Gassen KLI, Yntema HG, Knoppers BM, Borry P. Points to consider for laboratories reporting results from diagnostic genomic sequencing. Eur J Hum Genet 2018; 26:36-43. [PMID: 29184171 PMCID: PMC5839050 DOI: 10.1038/s41431-017-0043-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 07/04/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022] Open
Abstract
Although NGS technologies are well-embedded in the clinical setting for identification of genetic causes of disease, guidelines issued by professional bodies are inconsistent regarding some aspects of reporting results. Most recommendations do not give detailed guidance about whether variants of uncertain significance (VUS) should be reported by laboratory personnel to clinicians, and give conflicting messages regarding whether unsolicited findings (UF) should be reported. There are also differences both in their recommendations regarding whether actively searching for secondary findings (SF) is appropriate, and in the extent to which they address the duty (or lack thereof) to reanalyse variants when new information arises. An interdisciplinary working group considered the current guidelines, their own experiences, and data from a recent qualitative study to develop a set of points to consider for laboratories reporting results from diagnostic NGS. These points to consider fall under six categories: (i) Testing approaches and technologies used, (ii) Approaches for VUS; (iii) Approaches for reporting UF, (iv) Approaches regarding SF; (v) Reanalysis of data & re-contact; and vi) Minors. While it is unclear whether uniformity in reporting across all laboratories is desirable, we hope these points to consider will be useful to diagnostic laboratories as they develop their processes for making decisions about reporting VUS and UF from NGS in the diagnostic context.
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Affiliation(s)
- D F Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Leuven Institute for Human Genetics and Society, Leuven, Belgium.
| | - K Sénécal
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - A J Clarke
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - L Jackson
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - A M Laberge
- Department of Pediatrics, Université de Montréal, Medical Genetics, CHU Sainte-Justine; CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - L Lovrecic
- Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - A Piton
- Molecular diagnostic laboratory, Strasbourg University Hospitals, Strasbourg, France
| | - K L I Van Gassen
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H G Yntema
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B M Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - P Borry
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Leuven Institute for Human Genetics and Society, Leuven, Belgium
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14
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Kølvraa S, Singh R, Normand EA, Qdaisat S, van den Veyver IB, Jackson L, Hatt L, Schelde P, Uldbjerg N, Vestergaard EM, Zhao L, Chen R, Shaw CA, Breman AM, Beaudet AL. Genome-wide copy number analysis on DNA from fetal cells isolated from the blood of pregnant women. Prenat Diagn 2016; 36:1127-1134. [PMID: 27761919 DOI: 10.1002/pd.4948] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/13/2016] [Accepted: 10/15/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Non-invasive prenatal testing (NIPT) based on fetal cells in maternal blood has the advantage over NIPT based on circulating cell-free fetal DNA in that there is no contamination with maternal DNA. This will most likely result in better detection of chromosomal aberrations including subchromosomal defects. The objective of this study was to test whether fetal cells enriched from maternal blood can be used for cell-based NIPT. METHODS We present a method for enriching fetal cells from maternal blood, subsequent amplification of the fetal genome and detection of chromosomal and subchromosomal variations in the genome. RESULTS An average of 12.8 fetal cells from 30 mL of maternal blood were recovered using our method. Subsequently, whole genome amplification on fetal cells resulted in amplified fetal DNA in amounts and quality high enough to generate array comparative genomic hybridization as well as next-generation sequencing profiles. From one to two fetal cells, we were able to demonstrate copy number differences of whole chromosomes (21, X-, and Y) as well as subchromosomal aberrations (ring X). CONCLUSION Intact fetal cells can be isolated from every maternal blood sample. Amplified DNA from isolated fetal cells enabled genetic analysis by array comparative genomic hybridization and next-generation sequencing. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Elizabeth A Normand
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sadeem Qdaisat
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ignatia B van den Veyver
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Laird Jackson
- Department of OB-Gyn, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Li Zhao
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Rui Chen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chad A Shaw
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Amy M Breman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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15
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Breman AM, Chow JC, U'Ren L, Normand EA, Qdaisat S, Zhao L, Henke DM, Chen R, Shaw CA, Jackson L, Yang Y, Vossaert L, Needham RHV, Chang EJ, Campton D, Werbin JL, Seubert RC, Van den Veyver IB, Stilwell JL, Kaldjian EP, Beaudet AL. Evidence for feasibility of fetal trophoblastic cell-based noninvasive prenatal testing. Prenat Diagn 2016; 36:1009-1019. [PMID: 27616633 PMCID: PMC5129580 DOI: 10.1002/pd.4924] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/09/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
Objective The goal was to develop methods for detection of chromosomal and subchromosomal abnormalities in fetal cells in the mother's circulation at 10–16 weeks' gestation using analysis by array comparative genomic hybridization (CGH) and/or next‐generation sequencing (NGS). Method Nucleated cells from 30 mL of blood collected at 10–16 weeks' gestation were separated from red cells by density fractionation and then immunostained to identify cytokeratin positive and CD45 negative trophoblasts. Individual cells were picked and subjected to whole genome amplification, genotyping, and analysis by array CGH and NGS. Results Fetal cells were recovered from most samples as documented by Y chromosome PCR, short tandem repeat analysis, array CGH, and NGS including over 30 normal male cells, one 47,XXY cell from an affected fetus, one trisomy 18 cell from an affected fetus, nine cells from a trisomy 21 case, three normal cells and one trisomy 13 cell from a case with confined placental mosaicism, and two chromosome 15 deletion cells from a case known by CVS to have a 2.7 Mb de novo deletion. Conclusion We believe that this is the first report of using array CGH and NGS whole genome sequencing to detect chromosomal abnormalities in fetal trophoblastic cells from maternal blood. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?
Analysis of cell‐free DNA for noninvasive prenatal testing (NIPT) is widely practiced, and the frequency of amniocentesis and CVS has decreased. However, cell‐free NIPT is not adequate for detecting smaller deletions and duplications with high specificity, sensitivity, and positive predictive value. Although fetal nucleated red blood cells and trophoblastic cells are known to be present in the maternal circulation, it has not been possible to develop a reliable cytogenetic cell‐based form of NIPT.
What does this study add?
Fetal cytotrophoblasts were successfully recovered from maternal blood. Although a clinical test has not been validated, for the first time, the feasibility of using array comparative genomic hybridization and next generation sequencing to detect chromosomal and subchromosomal abnormalities is demonstrated. The results suggest the possibility of developing a cell‐based form of NIPT with ability to detect abnormalities with a similar accuracy as can currently be obtained with amniocentesis and CVS.
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Affiliation(s)
- Amy M Breman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Elizabeth A Normand
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sadeem Qdaisat
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Li Zhao
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - David M Henke
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Rui Chen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chad A Shaw
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Laird Jackson
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Liesbeth Vossaert
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | - Ignatia B Van den Veyver
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | | | | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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16
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Petrylak D, Heath E, Sonpavde G, George S, Morgans A, Eigl B, Picus J, Cheng S, Hotte S, Gartner E, Vincent M, Chu R, Anand B, Morrison K, Jackson L, Melhem-Bertrandt A, Yu E. Interim analysis of a phase I dose escalation trial of the antibody drug conjugate (ADC) AGS15E (ASG-15ME) in patients (Pts) with metastatic urothelial cancer (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mehta D, Vergano SAS, Deardorff M, Aggarwal S, Barot A, Johnson DM, Miller NF, Noon SE, Kaur M, Jackson L, Krantz ID. Characterization of limb differences in children with Cornelia de Lange Syndrome. Am J Med Genet C Semin Med Genet 2016; 172:155-62. [PMID: 27120260 DOI: 10.1002/ajmg.c.31498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cornelia de Lange syndrome (CdLS) is a well-described multisystem developmental disorder characterized by dysmorphic facial features, growth and behavioral deficits, and cardiac, gastrointestinal, and limb anomalies. The limb defects seen in CdLS can be mild, with small feet or hands only, or can be severe, with variable deficiency defects involving primarily the ulnar structures and ranging from mild hypoplasia of the fifth digit to complete absence of the forearm. Interestingly, the upper limbs are typically much more involved than the lower extremities that generally manifest with small feet and 2-3 syndactyly of the toes and shortened fourth metatarsal. The upper limbs often manifest asymmetric involvement. The limb findings in our cohort of 378 individuals with CdLS demonstrate a consistent pattern of laterality and symmetry involvement (with increased severity of right-sided limb in individuals with asymmetric limb defects) and a correlation of more significant limb defects with an increased risk of other structural anomalies, and more severe behavioral outcomes. Additionally, we found that individuals with mutations in NIPBL were most likely to have limb defects compared to mutations in other genes with nonsense, exonic deletion, and frameshift mutations being most prevalent in those with limb defects. Characterization of the limb differences in children with CdLS may provide a tool to assist in genetic counseling and determining prognosis. This paper will review the limb involvement in a large cohort of individuals with CdLS assessing the correlation with molecular etiologies, symmetry, additional structural birth defects, and cognitive outcomes. © 2016 Wiley Periodicals, Inc.
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Maldonado P, Jackson L, Florian-Rodriguez M, Wai C. 51: Comparisons of functional support with sacrohysteropexy versus sacrocolpopexy: A cadaveric study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.082] [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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Hodgetts J, Flint L, Davey C, Forde S, Jackson L, Harju V, Skelton A, Fox A. Identification of ‘
Candidatus
Phytoplasma fragariae’ (16Sr XII‐E) infecting
Corylus avellana
(hazel) in the United Kingdom. ACTA ACUST UNITED AC 2015. [DOI: 10.5197/j.2044-0588.2015.032.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J. Hodgetts
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - L.J. Flint
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - C. Davey
- Animal and Plant Health AgencyPlant Health and Seeds InspectorateRoom 6 Timberham House, World Cargo CentreGatwick AirportWest SussexRH6 0EY
| | - S. Forde
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - L. Jackson
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - V. Harju
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - A. Skelton
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - A. Fox
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
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Urquhart R, Grunfeld E, Jackson L, Sargeant J, Porter G. Cross-disciplinary research in cancer: an opportunity to narrow the knowledge-practice gap. Curr Oncol 2013; 20:e512-21. [PMID: 24311951 PMCID: PMC3851347 DOI: 10.3747/co.20.1487] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Health services researchers have consistently identified a gap between what is identified as "best practice" and what actually happens in clinical care. Despite nearly two decades of a growing evidence-based practice movement, narrowing the knowledge-practice gap continues to be a slow, complex, and poorly understood process. Here, we contend that cross-disciplinary research is increasingly relevant and important to reducing that gap, particularly research that encompasses the notion of transdisciplinarity, wherein multiple academic disciplines and non-academic individuals and groups are integrated into the research process. The assimilation of diverse perspectives, research approaches, and types of knowledge is potentially effective in helping research teams tackle real-world patient care issues, create more practice-based evidence, and translate the results to clinical and community care settings. The goals of this paper are to present and discuss cross-disciplinary approaches to health research and to provide two examples of how engaging in such research may optimize the use of research in cancer care.
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Affiliation(s)
- R. Urquhart
- Department of Surgery, Department of Community Health and Epidemiology, and Division of Medical Education, Dalhousie University, Halifax, NS
| | - E. Grunfeld
- Ontario Institute for Cancer Research, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - L. Jackson
- School of Health and Human Performance, Dalhousie University; and Atlantic Health Promotion Research Centre, Dalhousie University, Halifax, NS
| | - J. Sargeant
- Continuing Medical Education, Dalhousie University; and Division of Medical Education, Dalhousie University, Halifax, NS
| | - G.A. Porter
- Department of Surgery, Dalhousie University; and Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
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Wolpin BM, O'Reilly EM, Ko YJ, Blaszkowsky LS, Rarick M, Rocha-Lima CM, Ritch P, Chan E, Spratlin J, Macarulla T, McWhirter E, Pezet D, Lichinitser M, Roman L, Hartford A, Morrison K, Jackson L, Vincent M, Reyno L, Hidalgo M. Global, multicenter, randomized, phase II trial of gemcitabine and gemcitabine plus AGS-1C4D4 in patients with previously untreated, metastatic pancreatic cancer. Ann Oncol 2013; 24:1792-1801. [PMID: 23448807 PMCID: PMC3716216 DOI: 10.1093/annonc/mdt066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/08/2012] [Accepted: 01/28/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We evaluated AGS-1C4D4, a fully human monoclonal antibody to prostate stem cell antigen (PSCA), with gemcitabine in a randomized, phase II study of metastatic pancreatic cancer. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and previously untreated, metastatic pancreatic adenocarcinoma were randomly assigned 1:2 to gemcitabine (1000 mg/m(2) weekly seven times, 1 week rest, weekly three times q4weeks) or gemcitabine plus AGS-1C4D4 (48 mg/kg loading dose, then 24 mg/kg q3weeks IV). The primary end point was 6-month survival rate (SR). Archived tumor samples were collected for pre-planned analyses by PSCA expression. RESULTS Between April 2009 and May 2010, 196 patients were randomly assigned to gemcitabine (n = 63) or gemcitabine plus AGS-1C4D4 (n = 133). The 6-month SR was 44.4% (95% CI, 31.9-57.5) in the gemcitabine arm and 60.9% (95% CI, 52.1-69.2) in the gemcitabine plus AGS-1C4D4 arm (P = 0.03), while the median survival was 5.5 versus 7.6 months and the response rate was 13.1% versus 21.6% in the two arms, respectively. The 6-month SR was 57.1% in the gemcitabine arm versus 79.5% in the gemcitabine plus AGS-1C4D4 arm among the PSCA-positive subgroup and 31.6% versus 46.2% among the PSCA-negative subgroup. CONCLUSIONS This randomized, phase II study achieved its primary end point, demonstrating an improved 6-month SR with addition of AGS-1C4D4 to gemcitabine among patients with previously untreated, metastatic pancreatic adenocarcinoma. ClinicalTrials.gov identifier: NCT00902291.
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Affiliation(s)
| | - E M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Y J Ko
- Sunnybrook Health Science Center, Toronto, Canada
| | | | - M Rarick
- Kaiser Permanente Northwest Region Oncology Hematology, Portland
| | - C M Rocha-Lima
- Sylvester Comprehensive Cancer Center, University of Miami, Miami
| | - P Ritch
- Medical College of Wisconsin, Milwaukee
| | - E Chan
- Vanderbilt University Medical Center, Nashville, USA
| | - J Spratlin
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - T Macarulla
- Hospital Vall d'Hebrón, Servicio de Oncología, Barcelona, Spain
| | - E McWhirter
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - D Pezet
- Inserm U1071, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - M Lichinitser
- State Institution 'Blokhin Cancer Research Centre RAMS', Moscow
| | - L Roman
- State Healthcare Institution 'Leningrad Regional Oncologic Dispensary', Saint Petersburg, Russia
| | | | | | | | | | - L Reyno
- Agensys, Inc., Santa Monica, USA
| | - M Hidalgo
- Centro Integral Oncológico 'Clara Campal', Madrid; Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
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Sellars M, Silvester W, Fullam R, Sjanta R, Jackson L, Mawren D, Mountjoy R. CPR POLICY AND PRACTICE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES (RACFS). BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wapner RJ, Martin CL, Levy B, Ballif BC, Eng CM, Zachary JM, Savage M, Platt LD, Saltzman D, Grobman WA, Klugman S, Scholl T, Simpson JL, McCall K, Aggarwal VS, Bunke B, Nahum O, Patel A, Lamb AN, Thom EA, Beaudet AL, Ledbetter DH, Shaffer LG, Jackson L. Chromosomal microarray versus karyotyping for prenatal diagnosis. N Engl J Med 2012; 367:2175-84. [PMID: 23215555 PMCID: PMC3549418 DOI: 10.1056/nejmoa1203382] [Citation(s) in RCA: 862] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chromosomal microarray analysis has emerged as a primary diagnostic tool for the evaluation of developmental delay and structural malformations in children. We aimed to evaluate the accuracy, efficacy, and incremental yield of chromosomal microarray analysis as compared with karyotyping for routine prenatal diagnosis. METHODS Samples from women undergoing prenatal diagnosis at 29 centers were sent to a central karyotyping laboratory. Each sample was split in two; standard karyotyping was performed on one portion and the other was sent to one of four laboratories for chromosomal microarray. RESULTS We enrolled a total of 4406 women. Indications for prenatal diagnosis were advanced maternal age (46.6%), abnormal result on Down's syndrome screening (18.8%), structural anomalies on ultrasonography (25.2%), and other indications (9.4%). In 4340 (98.8%) of the fetal samples, microarray analysis was successful; 87.9% of samples could be used without tissue culture. Microarray analysis of the 4282 nonmosaic samples identified all the aneuploidies and unbalanced rearrangements identified on karyotyping but did not identify balanced translocations and fetal triploidy. In samples with a normal karyotype, microarray analysis revealed clinically relevant deletions or duplications in 6.0% with a structural anomaly and in 1.7% of those whose indications were advanced maternal age or positive screening results. CONCLUSIONS In the context of prenatal diagnostic testing, chromosomal microarray analysis identified additional, clinically significant cytogenetic information as compared with karyotyping and was equally efficacious in identifying aneuploidies and unbalanced rearrangements but did not identify balanced translocations and triploidies. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT01279733.).
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Affiliation(s)
- Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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25
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Sjanta R, Jackson L, Fullam R, Lewis V, Silvester W. Final evaluation of the “Making Health Choices” advance care planning in aged care project. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000250.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, Baggs J, Weinmann S, Baxter R, Nordin J, Daley MF, Jackson L, Jacobsen SJ. Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study. J Intern Med 2012; 271:510-20. [PMID: 22026504 DOI: 10.1111/j.1365-2796.2011.02474.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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: 10/16/2022]
Abstract
OBJECTIVES The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention. DESIGN Two self-comparison approaches, including a case-centred approach and a self-controlled case series (SCCS) analysis were used. SETTING Eight managed-care organizations participating in the Vaccine Safety Datalink project in the United States. SUBJECTS A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included. MAIN OUTCOME MEASURES Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. RESULTS The risk of allergic reaction was significantly increased within 1-7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87-2.40 by case-centred method and relative rate = 2.32, 95% CI: 1.85-2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy. CONCLUSIONS The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well-tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination.
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Affiliation(s)
- H F Tseng
- Kaiser Permanente, Southern California, Pasadena, CA 91101, USA
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Skirton H, Goldsmith L, Jackson L, O'Connor A. Direct to consumer genetic testing: a systematic review of position statements, policies and recommendations. Clin Genet 2012; 82:210-8. [PMID: 22372614 DOI: 10.1111/j.1399-0004.2012.01863.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In healthcare settings, genetic tests to determine whether an individual had inherited a genetic mutation are ordered by a health professional, and the results are interpreted and conveyed to the patient by that person. However, direct to consumer genetic testing (DTCGT) has enabled individuals to purchase genetic tests and receive results without the intervention of a health professional. To inform a set of guidelines for consumers and health professionals, we undertook a systematic review of position statements, policies and recommendations on the use of DTCGT. We performed a search of seven databases and the Internet for relevant documents. The search terms were 'direct to consumer' and 'genetic test', and documents in English published from 2002 to 2011 were included. The search retrieved 314 items, of which 14 were eligible for review. Five themes were derived from thematic analysis: motivation for use, potential benefits, potential harms, recommendations to guide consumers and need for research. The authors of these documents described more potential harms than benefits, but, although some stated that direct to consumer testing should be actively discouraged, others supported consumer rights to make autonomous choices. Further research into the impact of direct to consumer testing on health services and consumers is required to inform policies.
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Affiliation(s)
- H Skirton
- Faculty of Health, Education and Society, Plymouth University, Plymouth, United Kingdom.
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Riggs ER, Jackson L, Miller DT, Van Vooren S. Phenotypic information in genomic variant databases enhances clinical care and research: the International Standards for Cytogenomic Arrays Consortium experience. Hum Mutat 2012; 33:787-96. [PMID: 22331816 DOI: 10.1002/humu.22052] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/22/2012] [Indexed: 11/06/2022]
Abstract
Whole-genome analysis, now including whole-genome sequencing, is moving rapidly into the clinical setting, leading to detection of human variation on a broader scale than ever before. Interpreting this information will depend on the availability of thorough and accurate phenotype information, and the ability to curate, store, and access data on genotype-phenotype relationships. This idea has already been demonstrated within the context of chromosomal microarray (CMA) testing. The International Standards for Cytogenomic Arrays (ISCA) Consortium promotes standardization of variant interpretation for this technology through its initiatives, including the formation of a publicly available database housing clinical CMA data. Recognizing that phenotypic data are essential for the interpretation of genomic variants, the ISCA Consortium has developed tools to facilitate the collection of these data and its deposition in a standardized structured format within the ISCA Consortium database. This rich source of phenotypic data can also be used within broader applications such as developing phenotypic profiles of emerging genomic disorders, identification of candidate regions for particular phenotypes, or creation of tools for use in clinical practice. We summarize the ISCA experience as a model for ongoing efforts incorporating phenotype data with genotype data to improve the quality of research and clinical care in human genetics.
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Affiliation(s)
- Erin Rooney Riggs
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.
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Parker J, Jackson L, Dykeman M, Gahagan J, Karabanow J. Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs. Health Place 2012; 18:152-62. [DOI: 10.1016/j.healthplace.2011.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/22/2011] [Accepted: 08/25/2011] [Indexed: 11/28/2022]
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Gersh B, Edenfield T, Jackson L. P-853 - Inpatient psychiatric management of the bariatric surgery patient: complexities and considerations. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Eiermann W, Jackson L, Murray A, Chapman CJ, Peek LJ, Widschwendter P, Allen J, Graham H, Robertson JF. P4-08-03: Serum Autoantibodies to Breast Cancer Associated Antigens Reflect Tumor Biology: An Opportunity for Early Detection & Prevention? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-08-03] [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
Autoantibodies (AABs) are produced as an immune response to abnormal ('non-self') cancer antigens. Previous studies have reported that AABs can be measured in the blood long before cancers are presently diagnosed, e.g., up to 4 years before screening mammography identified breast cancers and up to 5 years before screening CT detected lung cancers. EarlyCDT™-Lung is currently available as an aid to early detection of lung cancer in high risk patients and measures a panel of seven AABs to general cancer antigens and also lung cancer (LC) specific antigens. These AABs have previously been reported to be associated with the two main types of LC i.e., non-small cell and small cell LC. This study looked at AABs to 4 general cancer antigens to evaluate whether their levels reflected different biology in primary breast tumors.
Methods
770 patients presented with primary breast cancer to three centers (Nottingham, UK n=323; Munich, Germany n=320; Oklahoma, USA n=127); the median ages and ranges were 61 (26-82), 61 (20-88) & 65 (54-84) years, respectively. All had serum samples taken post-diagnosis and pre-treatment. The tumors were well characterized for histological grade, estrogen receptor (ER), progesterone receptor (PgR) and HER2 status. Serum samples were tested for AABs to four generic cancer antigens(Ags) (p53, SOX2, NY-ESO-1 and Annexin1) originally included as part of Oncimmune's EarlyCDT™-Lung assay. The AABs were measured by ELISA on the Oncimmune platform, and the EarlyCDT™-Lung cutoffs were used to determine positivity.
Results
131/770 (17%) of primary breast cancers showed elevated AAB levels to one or more of the limited panel of four generic antigens. Positivity for each AAB was correlated with histological grade, ER, PgR and HER2 status. The results, which were similar for each of the three centres, were combined, and the results are shown in Table 1 below.
p53 AAB positive cancers tended to be hormone receptor negative and HER2 positive. NY-ESO-1 positive tumors were almost all higher grade with the majority hormone receptor and HER2 negative. SOX2 positive cancers tended to have a hormone sensitive phenotype (i.e., hormone receptor positive and HER2 negative). Annexin 1 positive cancers also tended to have a hormone sensitive phenotype as well as HER2 negative. The pattern was statistically different for the four AABs (p<0.001). The autoantibody profile for ER positive tumours was not statistically different from PgR positive tumors.
Conclusions
These data show that specific AABs measured in the serum reflected the biology of the breast cancers. Confirmation of this finding could, in the future, lead to using immuno-biomarkers such as these to guide early therapeutic intervention (e.g. prevention) in a targeted group of women.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-08-03.
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Affiliation(s)
- W Eiermann
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - L Jackson
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - A Murray
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - CJ Chapman
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - LJ Peek
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - P Widschwendter
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - J Allen
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - H Graham
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
| | - JF Robertson
- 1Fauenklinik vom Roten, Munich, Germany; University of Nottingham, Nottingham, United Kingdom; Oncimmune Ltd, Nottingham, United Kingdom; Oncimmune LLC, De Soto, KS
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Campbell LA, Jackson L, Bassett R, Bowes MJ, Donahue M, Cartwright J, Kisely S. Can we use medical examiners’ records for suicide surveillance and prevention research in Nova Scotia? ACTA ACUST UNITED AC 2011. [DOI: 10.24095/hpcdp.31.4.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction
Medical examiners’ records can contribute to our understanding of the extent of suicide in a population, as well as associated sociodemographic and other factors.
Methods
Using a mixed methods approach, the key objective of this pilot study was to determine the sources and types of information found in the Nova Scotia Medical Examiner Service (NSMES) records that might inform suicide surveillance and targeted prevention efforts. A secondary objective was to describe the one-year cohort of 108 individuals who died by suicide in 2006 in terms of available sociodemographic information and health care use in the year prior to death.
Results
Data extraction revealed inconsistencies both across and within files in terms of the types and amounts of sociodemographic and other data collected, preventing correlational analyses. However, linkage of the records to administrative databases revealed frequent health care use in the month prior to death.
Conclusion
The introduction of systematic data collection to NSMES investigations may yield a comprehensive dataset useful for policy development and population level research.
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Affiliation(s)
- LA Campbell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - L Jackson
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- Atlantic Health Promotion Research Centre Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Bassett
- Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - MJ Bowes
- Nova Scotia Medical Examiner Service, Halifax, Nova Scotia, Canada
| | - M Donahue
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - J Cartwright
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Kisely
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Health LinQ, University of Queensland, Queensland, Australia
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Campbell LA, Jackson L, Bassett R, Bowes MJ, Donahue M, Cartwright J, Kisely S. Can we use medical examiners' records for suicide surveillance and prevention research in Nova Scotia? Chronic Dis Inj Can 2011; 31:165-171. [PMID: 21978640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Medical examiners' records can contribute to our understanding of the extent of suicide in a population, as well as associated sociodemographic and other factors. METHODS Using a mixed methods approach, the key objective of this pilot study was to determine the sources and types of information found in the Nova Scotia Medical Examiner Service (NSMES) records that might inform suicide surveillance and targeted prevention efforts. A secondary objective was to describe the one-year cohort of 108 individuals who died by suicide in 2006 in terms of available sociodemographic information and health care use in the year prior to death. RESULTS Data extraction revealed inconsistencies both across and within files in terms of the types and amounts of sociodemographic and other data collected, preventing correlational analyses. However, linkage of the records to administrative databases revealed frequent health care use in the month prior to death. CONCLUSION The introduction of systematic data collection to NSMES investigations may yield a comprehensive dataset useful for policy development and population level research.
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Affiliation(s)
- L A Campbell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Jackson L, Detering K, Silvester W, Hancock A. The evolution of Austin health's 'Statement of Choices'. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jackson L, Sjanta R, Fullam R, Silvester W. Making health choices; Part 1. Advance Care planning in aged care project. Setting the scene. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sjanta R, Jackson L, Fullam R, Silvester W. Making health choices: advance care planning in aged care. Perception versus reality. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shih KC, Infante JR, Papadopoulos KP, Bendell JC, Tolcher AW, Burris HA, Beeram M, Jackson L, Arcos R, Westin EH, Farrington D, McGlothlin A, Hynes S, Leohr J, Brandt JT, Nasir A, Patnaik A. A phase I dose-escalation study of LY2523355, an Eg5 inhibitor, administered either on days 1, 5, and 9; days 1 and 8; or days 1 and 5 with pegfilgrastim (peg) every 21 days (NCT01214642). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wolpin BM, O'Reilly EM, Ko Y, Blaszkowsky LS, Rarick MU, Rocha Lima CMS, Ritch PS, Chan E, Spratlin JL, Macarulla T, McWhirter E, Pezet D, Lichinitser M, Roman LD, Hartford A, Jackson L, Vincent M, Reyno LM, Hidalgo M. Global, multicenter, open-label, randomized phase II trial comparing gemcitabine (G) with. G plus AGS-1C4D4 (A) in patients (pts) with metastatic pancreatic cancer (mPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Two recent studies published in Science Translational Medicine (Lo et al., 2010; Bell et al., 2011) demonstrate the potential of applying the latest genome-sequencing technologies to preconception carrier testing and noninvasive prenatal genetic diagnosis. These studies shine new light on old ethical, legal, and social concerns associated with genetic technology and deserve careful discussion.
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Affiliation(s)
- Laird Jackson
- Department of Obstetrics and Gynecology, Drexel University College of Medicine and Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19102, USA.
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Jackson L. Using the latest genome sequencing technologies to develop new carrier and prenatal genetic tests. Interview by Orla Smith. Sci Transl Med 2011; 3:65pc1. [PMID: 21284236 DOI: 10.1126/scitranslmed.3002122] [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: 11/02/2022]
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Prosser JD, Bhatt N, Coleman T, Jackson L. Case Report of Periocular Merkel Cell Carcinoma Treated with Primary Concomitant Chemotherapy and Radiation, and Review of the Literature Regarding Its Use. Laryngoscope 2011; 120 Suppl 4:S177. [DOI: 10.1002/lary.21641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sommer JR, Jackson L, Simpson S, Collins EB, Piedrahita J, Petters RM. 336 TRANSGENIC Stra8-EYFP PIGS: A MODEL FOR DEVELOPING MALE GERM CELL TECHNOLOGIES. Reprod Fertil Dev 2011. [DOI: 10.1071/rdv23n1ab336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Stimulated by retinoic acid 8 (STRA8) is a protein that is required for meiotic initiation in both male and female gametes in vertebrates. It is also expressed in embryonic germ cells and neonatal male germ cells of mice. The utility of using the Stra8 promoter to recognise and isolate pre-meiotic male germ cells has been reported by others in the mouse. In order to mark germ cells in male pigs, we cloned 1.6 kb of the mouse Stra8 promoter and used it to develop a reporter plasmid using mitochondrial-localised enhanced yellow fluorescent protein (mEYFP). The Stra8-mEYFP transgenic male pigs were produced using somatic cell nuclear transfer. The mEYFP reporter was expressed and easily detectable in the live germ cells of the mature animals and could be observed during tissue culture. The mitochondrial-localised expression of the EYFP reporter was helpful in observing the size and stage of the germ cell. The mEYPF protein was found to be expressed only in the testis of the transgenic pigs using Western blot analysis, whereas endogenous STRA8 protein was also detected in the lung and brain. Fluorescent immunohistochemistry of testicular sections of the transgenic pigs indicated a similar expression pattern to that of the endogenous STRA8 protein. There was an overlap in the expression of the mEYFP and the endogenous STRA8 protein; however, it was observed that the mEYFP protein was present at an earlier stage of spermatogenesis than the STRA8 protein. Immunocytochemistry performed on plated tubules similarly showed varying intensity in expression between the mEYFP transgene and the endogenous STRA8. The difference in the timing of protein expression may be due to the model created or the use of the mouse Stra8 promoter for the expression of mEYFP. Alternatively, the lag in expression between that of the endogenous STRA8 and mEYFP protein may be due to attenuated translation of the Stra8 mRNA. This transgenic model should be useful for the study of reproduction, development, transplantation, biotechnology, and culture of the pig male germ line.
Supported by North Carolina Agricultural Research Service 02234.
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Armstrong DK, Herzog TJ, Reyno LM, Vincent M, Jackson L, Sabbatini P. A phase I dose escalation study of AGS-8M4 (ASP6183), an anti-AGS-8 fully human antibody, in advanced ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miller DT, Adam MP, Aradhya S, Biesecker LG, Brothman AR, Carter NP, Church DM, Crolla JA, Eichler EE, Epstein CJ, Faucett WA, Feuk L, Friedman JM, Hamosh A, Jackson L, Kaminsky EB, Kok K, Krantz ID, Kuhn RM, Lee C, Ostell JM, Rosenberg C, Scherer SW, Spinner NB, Stavropoulos DJ, Tepperberg JH, Thorland EC, Vermeesch JR, Waggoner DJ, Watson MS, Martin CL, Ledbetter DH. Consensus statement: chromosomal microarray is a first-tier clinical diagnostic test for individuals with developmental disabilities or congenital anomalies. Am J Hum Genet 2010; 86:749-64. [PMID: 20466091 PMCID: PMC2869000 DOI: 10.1016/j.ajhg.2010.04.006] [Citation(s) in RCA: 1798] [Impact Index Per Article: 128.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/12/2010] [Accepted: 04/19/2010] [Indexed: 12/11/2022] Open
Abstract
Chromosomal microarray (CMA) is increasingly utilized for genetic testing of individuals with unexplained developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), or multiple congenital anomalies (MCA). Performing CMA and G-banded karyotyping on every patient substantially increases the total cost of genetic testing. The International Standard Cytogenomic Array (ISCA) Consortium held two international workshops and conducted a literature review of 33 studies, including 21,698 patients tested by CMA. We provide an evidence-based summary of clinical cytogenetic testing comparing CMA to G-banded karyotyping with respect to technical advantages and limitations, diagnostic yield for various types of chromosomal aberrations, and issues that affect test interpretation. CMA offers a much higher diagnostic yield (15%-20%) for genetic testing of individuals with unexplained DD/ID, ASD, or MCA than a G-banded karyotype ( approximately 3%, excluding Down syndrome and other recognizable chromosomal syndromes), primarily because of its higher sensitivity for submicroscopic deletions and duplications. Truly balanced rearrangements and low-level mosaicism are generally not detectable by arrays, but these are relatively infrequent causes of abnormal phenotypes in this population (<1%). Available evidence strongly supports the use of CMA in place of G-banded karyotyping as the first-tier cytogenetic diagnostic test for patients with DD/ID, ASD, or MCA. G-banded karyotype analysis should be reserved for patients with obvious chromosomal syndromes (e.g., Down syndrome), a family history of chromosomal rearrangement, or a history of multiple miscarriages.
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Affiliation(s)
- David T. Miller
- Division of Genetics and Department of Laboratory Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Margaret P. Adam
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Leslie G. Biesecker
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arthur R. Brothman
- Department of Pediatrics, Human Genetics, Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Deanna M. Church
- National Center for Biotechnology Information, Bethesda, MD, USA
| | - John A. Crolla
- National Genetics Reference Laboratory (Wessex), Salisbury UK
| | - Evan E. Eichler
- Department of Genome Sciences and Howard Hughes Medical Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Charles J. Epstein
- Institute for Human Genetics and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - W. Andrew Faucett
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lars Feuk
- Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Jan M. Friedman
- Department of Medical Genetics, University of British Columbia, and Child & Family Research Institute, Vancouver, British Columbia, Canada
| | - Ada Hamosh
- Department of Pediatrics and McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laird Jackson
- Department of Obstetrics and Gynecology, Drexel University College of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin B. Kaminsky
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Klaas Kok
- Department of Genetics, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Ian D. Krantz
- Department of Pediatrics/Human Genetics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Robert M. Kuhn
- Center for Biomolecular Science and Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Charles Lee
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James M. Ostell
- National Center for Biotechnology Information, Bethesda, MD, USA
| | - Carla Rosenberg
- Department of Genetics and Evolutionary Biology, University Sao Paulo, Brazil
| | - Stephen W. Scherer
- The Centre for Applied Genomics and Program in Genetics and Genetic Biology, The Hospital for Sick Children and Department of Molecular Genetics, University of Toronto, Ontario, Canada
| | - Nancy B. Spinner
- Department of Pediatrics/Human Genetics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Dimitri J. Stavropoulos
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Erik C. Thorland
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Darrel J. Waggoner
- Department of Human Genetics and Pediatrics, University of Chicago, Chicago, IL, USA
| | | | - Christa Lese Martin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - David H. Ledbetter
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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Shin Y, Takeda K, Jia Y, Jackson L, Wright A, Carter L, Zuzack J, Gross S, Robinson J, Hicken E, Munson M, Gelfand E. The Effects of a Pim Kinase Inhibitor on Allergen-Induced Airway Hyperresponsiveness (AHR) and Inflammation. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sikora A, Zimmermann BG, Rusterholz C, Birri D, Kolla V, Lapaire O, Hoesli I, Kiefer V, Jackson L, Hahn S. Detection of Increased Amounts of Cell-Free Fetal DNA with Short PCR Amplicons. Clin Chem 2010; 56:136-8. [DOI: 10.1373/clinchem.2009.132951] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim: A digital PCR approach has recently been suggested to detect greater amounts of cell-free fetal DNA in maternal plasma than conventional real-time quantitative PCR (qPCR). Because the digital qPCR approach uses shorter PCR amplicons than the real-time qPCR assay, we investigated whether a real-time qPCR assay appropriately modified for such short amplicons would improve the detection of cell-free fetal DNA.
Method: We developed a novel universal-template (UT) real-time qPCR assay that was specific for the DYS14 sequence on Y chromosome and had a short amplicon size of 50 bp. We examined this “short” assay with 50 maternal plasma samples and compared the results with those for a conventional real-time qPCR assay of the same locus but with a longer amplicon (84 bp).
Results: Qualitatively, both assays detected male cell-free fetal DNA with the same specificity and detection capability. Quantitatively, however, the new UT real-time qPCR assay for shorter amplicons detected, on average, almost 1.6-fold more cell-free fetal DNA than the conventional real-time qPCR assay with longer amplicons.
Conclusions: The use of short PCR amplicons improves the detection of cell-free fetal DNA. This feature may prove useful in attempts to detect cell-free fetal DNA under conditions in which the amount of template is low, such as in samples obtained early in pregnancy.
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Affiliation(s)
- Aleksandra Sikora
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | | | - Corinne Rusterholz
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Daniella Birri
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Varaprasad Kolla
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Olav Lapaire
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Irene Hoesli
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Vivian Kiefer
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
| | - Laird Jackson
- Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, PA
| | - Sinuhe Hahn
- University Women’s Hospital, Department of Biomedicine, Basel, Switzerland
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Jackson L, Shaheen M, Heslin K, Pan D. Racial/Ethnic Differences in the Prevalence of Childhood Caries and Parental Perception of Need for Dental Treatment and Preventive Services. Ann Epidemiol 2009. [DOI: 10.1016/j.annepidem.2009.07.063] [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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Romanuk T, Beisner B, Hayward A, Jackson L, Post J, McCauley E. Processes governing riverine fish species richness are scale-independent. COMMUNITY ECOL 2009. [DOI: 10.1556/comec.10.2009.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Social identity theory proposes that a threatened social identity can impact on self-concept and well-being. As a low-status minority group, mental health service users face the possibility of a threatened social identity compounding existing mental health problems. This may be further complicated by an inpatient admission where the context in which social identity is maintained has changed from a community setting. We use a qualitative approach to explore the salient social identity of mental health inpatient service users using semi-structured interviews. Analysis showed that the salient in-groups and out-groups mainly centred around the inpatient context but were somewhat influenced by non-mental health service group membership. Participants also talked of their unique characteristics as group members. How these findings relate to social identity theory and, particularly how they relate to mental health service users within changing contexts is explored.
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Affiliation(s)
- L Jackson
- Psychosocial Interventions Team, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.
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