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Montaldo P, Cirillo M, Burgod C, Caredda E, Ascione S, Carpentieri M, Puzone S, D'Amico A, Garegrat R, Lanza M, Moreno Morales M, Atreja G, Shivamurthappa V, Kariholu U, Aladangady N, Fleming P, Mathews A, Palanisami B, Windrow J, Harvey K, Soe A, Pattnayak S, Sashikumar P, Harigopal S, Pressler R, Wilson M, De Vita E, Shankaran S, Thayyil S. Whole-Body Hypothermia vs Targeted Normothermia for Neonates With Mild Encephalopathy: A Multicenter Pilot Randomized Clinical Trial. JAMA Netw Open 2024; 7:e249119. [PMID: 38709535 DOI: 10.1001/jamanetworkopen.2024.9119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Importance Although whole-body hypothermia is widely used after mild neonatal hypoxic-ischemic encephalopathy (HIE), safety and efficacy have not been evaluated in randomized clinical trials (RCTs), to our knowledge. Objective To examine the effect of 48 and 72 hours of whole-body hypothermia after mild HIE on cerebral magnetic resonance (MR) biomarkers. Design, Setting, and Participants This open-label, 3-arm RCT was conducted between October 31, 2019, and April 28, 2023, with masked outcome analysis. Participants were neonates at 6 tertiary neonatal intensive care units in the UK and Italy born at or after 36 weeks' gestation with severe birth acidosis, requiring continued resuscitation, or with an Apgar score less than 6 at 10 minutes after birth and with evidence of mild HIE on modified Sarnat staging. Statistical analysis was per intention to treat. Interventions Random allocation to 1 of 3 groups (1:1:1) based on age: neonates younger than 6 hours were randomized to normothermia or 72-hour hypothermia (33.5 °C), and those 6 hours or older and already receiving whole-body hypothermia were randomized to rewarming after 48 or 72 hours of hypothermia. Main Outcomes and Measures Thalamic N-acetyl aspartate (NAA) concentration (mmol/kg wet weight), assessed by cerebral MR imaging and thalamic spectroscopy between 4 and 7 days after birth using harmonized sequences. Results Of 225 eligible neonates, 101 were recruited (54 males [53.5%]); 48 (47.5%) were younger than 6 hours and 53 (52.5%) were 6 hours or older at randomization. Mean (SD) gestational age and birth weight were 39.5 (1.1) weeks and 3378 (380) grams in the normothermia group (n = 34), 38.7 (0.5) weeks and 3017 (338) grams in the 48-hour hypothermia group (n = 31), and 39.0 (1.1) weeks and 3293 (252) grams in the 72-hour hypothermia group (n = 36). More neonates in the 48-hour (14 of 31 [45.2%]) and 72-hour (13 of 36 [36.1%]) groups required intubation at birth than in the normothermic group (3 of 34 [8.8%]). Ninety-nine neonates (98.0%) had MR imaging data and 87 (86.1%), NAA data. Injury scores on conventional MR biomarkers were similar across groups. The mean (SD) NAA level in the normothermia group was 10.98 (0.92) mmol/kg wet weight vs 8.36 (1.23) mmol/kg wet weight (mean difference [MD], -2.62 [95% CI, -3.34 to -1.89] mmol/kg wet weight) in the 48-hour and 9.02 (1.79) mmol/kg wet weight (MD, -1.96 [95% CI, -2.66 to -1.26] mmol/kg wet weight) in the 72-hour hypothermia group. Seizures occurred beyond 6 hours after birth in 4 neonates: 1 (2.9%) in the normothermia group, 1 (3.2%) in the 48-hour hypothermia group, and 2 (5.6%) in the 72-hour hypothermia group. Conclusions and Relevance In this pilot RCT, whole-body hypothermia did not improve cerebral MR biomarkers after mild HIE, although neonates in the hypothermia groups were sicker at baseline. Safety and efficacy of whole-body hypothermia should be evaluated in RCTs. Trial Registration ClinicalTrials.gov Identifier: NCT03409770.
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Affiliation(s)
- Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Constance Burgod
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Elisabetta Caredda
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Serena Ascione
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Mauro Carpentieri
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Simona Puzone
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Reema Garegrat
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Marianna Lanza
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Maria Moreno Morales
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Gaurav Atreja
- Neonatal Unit, Imperial Health Care NHS Trust, London, United Kingdom
| | | | - Ujwal Kariholu
- Neonatal Unit, Imperial Health Care NHS Trust, London, United Kingdom
| | - Narendra Aladangady
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Paul Fleming
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Asha Mathews
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | | | - Joanne Windrow
- Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom
| | - Karen Harvey
- Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom
| | - Aung Soe
- Oliver Fisher Neonatal Intensive Care Unit, Medway Maritime Hospital, Medway NHS Foundation Trust, Kent, United Kingdom
| | - Santosh Pattnayak
- Oliver Fisher Neonatal Intensive Care Unit, Medway Maritime Hospital, Medway NHS Foundation Trust, Kent, United Kingdom
| | - Palaniappan Sashikumar
- Oliver Fisher Neonatal Intensive Care Unit, Medway Maritime Hospital, Medway NHS Foundation Trust, Kent, United Kingdom
| | - Sundeep Harigopal
- Neonatal Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Ronit Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, United Kingdom
| | - Martin Wilson
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Enrico De Vita
- MRI Physics, Radiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Seetha Shankaran
- Department of Neonatal-Perinatal Medicine, Wayne State University, Detroit, Michigan
- Department of Pediatrics, The University of Texas at Austin, Dell Children's Hospital, Austin, Texas
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Yuan JM, Nugent C, Wilson A, Verlander NQ, Alexander E, Fleming P, Modi N, Oughham K, Ratnaraja N, Wan Y, Thorn L, Felgate H, Webber MA, Ogundipe E, Brown CS, Paranthaman K, Demirjian A. Clinical outcomes of Staphylococcus capitis isolation from neonates, England, 2015-2021: a retrospective case-control study. Arch Dis Child Fetal Neonatal Ed 2024; 109:128-134. [PMID: 37751992 DOI: 10.1136/archdischild-2023-325887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Staphylococcus capitis, a coagulase-negative staphylococci (CoNS) species, has been increasingly detected from UK sterile site samples and has caused neonatal unit outbreaks worldwide. We compared survival to discharge and 30-day mortality for the detection of S. capitis versus other CoNS species. METHODS In this retrospective case-control study, we included hospitalised infants with any CoNS species detected from a normally sterile body site up to 90 days of age. We linked English laboratory reports from the Second Generation Surveillance System database, mortality data from the Personal Demographics Service, and neonatal unit admissions from the National Neonatal Research Database. In primary analysis, multivariable logistic regression was used, with two co-primary outcomes: survival to discharge and death within 30 days of positive specimen date. Sensitivity analyses using multiply imputed datasets followed. RESULTS We identified 16 636 CoNS episodes relating to 13 745 infants. CoNS episodes were highest among infants born extremely preterm (22-27 weeks) and with extremely low birth weight (400-999 g). In primary analysis, there were no differences in survival to discharge (p=0.71) or 30-day mortality (p=0.77) between CoNS species. In sensitivity analyses, there were no differences in outcomes between infection with four of the most common CoNS species (Staphylococcus epidermidis, S. capitis, Staphylococcus haemolyticus and Staphylococcus warneri) but the remaining CoNS species were at higher risk of adverse outcomes when treated in aggregate. CONCLUSION Infants with S. capitis detected from sterile site samples did not experience significant differences in either survival to discharge or 30-day mortality compared with infants with detection of other common CoNS species.
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Affiliation(s)
- Jin-Min Yuan
- Field Service, UK Health Security Agency, London, UK
| | - Christopher Nugent
- UK Field Epidemiology Training Programme, UK Health Security Agency, Belfast, UK
| | | | - Neville Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | | | - Paul Fleming
- Homerton Healthcare NHS Foundation Trust, London, UK
- Queen Mary University of London, London, UK
| | - Neena Modi
- Section of Neonatal Medicine, Imperial College London, London, UK
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Kayleigh Oughham
- Section of Neonatal Medicine, Imperial College London, London, UK
| | - Natasha Ratnaraja
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yu Wan
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Louise Thorn
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
| | | | | | - Enitan Ogundipe
- Chelsea and Westminster Healthcare NHS Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Colin S Brown
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | | | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Jenkinson A, Aladangady N, Wellmann S, Eaton S, Bührer C, Fleming P, Roehr C. Pancreatic Insufficiency, Digestive Enzyme Supplementation, and Postnatal Growth in Preterm Babies. Neonatology 2024:1-5. [PMID: 38246160 DOI: 10.1159/000535964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Optimising postnatal growth facilitates better long-term neonatal neurodevelopmental outcomes. Early postnatal growth is often hindered by a variety of factors unique to the extrauterine environment and digestive immaturity both contributing to reduced enteral feed tolerance during the first few days and weeks after birth. Preterm infants display varying levels of pancreatic insufficiency that are related to gestational age and providing digestive enzyme supplementation, may be one way in which to improve postnatal growth in enterally fed preterm babies. SUMMARY In this review, we explore which exocrine pancreatic enzymes are deficient in preterm babies, the methods by which exocrine pancreatic function is measured, potential avenues by which digestive enzyme replacement might improve postnatal growth failure, and which babies might benefit most from this intervention. KEY MESSAGES Pancreatic exocrine function exhibits developmental immaturity in extremely preterm infants and may contribute to postnatal growth failure. Stool elastase is a simple, non-invasive method of assessing pancreatic function in preterm infants. Available evidence does not currently support routine use of digestive enzyme supplementation in preterm infants.
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Affiliation(s)
- Allan Jenkinson
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Narendra Aladangady
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Fleming
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charles Roehr
- National Perinatal Epidemiology Unit Clinical Trials Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
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Das A, Ariyakumar G, Gupta N, Kamdar S, Barugahare A, Deveson-Lucas D, Gee S, Costeloe K, Davey MS, Fleming P, Gibbons DL. Identifying immune signatures of sepsis to increase diagnostic accuracy in very preterm babies. Nat Commun 2024; 15:388. [PMID: 38195661 PMCID: PMC10776581 DOI: 10.1038/s41467-023-44387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Bacterial infections are a major cause of mortality in preterm babies, yet our understanding of early-life disease-associated immune dysregulation remains limited. Here, we combine multi-parameter flow cytometry, single-cell RNA sequencing and plasma analysis to longitudinally profile blood from very preterm babies (<32 weeks gestation) across episodes of invasive bacterial infection (sepsis). We identify a dynamically changing blood immune signature of sepsis, including lymphopenia, reduced dendritic cell frequencies and myeloid cell HLA-DR expression, which characterizes sepsis even when the common clinical marker of inflammation, C-reactive protein, is not elevated. Furthermore, single-cell RNA sequencing identifies upregulation of amphiregulin in leukocyte populations during sepsis, which we validate as a plasma analyte that correlates with clinical signs of disease, even when C-reactive protein is normal. This study provides insights into immune pathways associated with early-life sepsis and identifies immune analytes as potential diagnostic adjuncts to standard tests to guide targeted antibiotic prescribing.
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Affiliation(s)
- A Das
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK.
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK.
| | - G Ariyakumar
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - N Gupta
- Department of Neonatology, Evelina London Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S Kamdar
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - A Barugahare
- Bioinformatics Platform and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia
| | - D Deveson-Lucas
- Bioinformatics Platform and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia
| | - S Gee
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - K Costeloe
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M S Davey
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - P Fleming
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
| | - D L Gibbons
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK.
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Cole D, Fleming P, Roberts J, James D, Benetti M, Wistel K, Billingham J, Forrester S. Comparison of player perceptions to mechanical measurements of third generation synthetic turf football surfaces. Sports Eng 2023. [DOI: 10.1007/s12283-022-00398-x] [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: 01/16/2023]
Abstract
AbstractMechanical testing of synthetic turf football surfaces is considered essential to ensure player performance and safety. However, it remains unknown how well the mechanical outputs reflect player perceptions of these surfaces. The first objective of this study was to investigate the agreement between the outputs from the Rotational Traction Tester and the Advanced Artificial Athlete with player perceptions across a range of controlled third generation turf football surfaces. The second objective was to identify the modifications to the Rotational Traction Tester and the Advanced Artificial Athlete configurations and output variables that give the strongest agreement with player perceptions. An indoor test area containing ten third generation turf surfaces with controlled hardness and traction properties was constructed. Each surface was tested using the Advanced Artificial Athlete and Rotational Traction Tester in their current configuration and in several modified configurations aimed at better replicating the player–surface interaction. Using a trained panel paired comparisons technique, 18 University footballers (11 males and 7 females) identified differences in the surfaces based on four sensory attributes Movement Speed, Slip, Leg Shock and Give. Results indicated strong agreement (correlation coefficients between 0.7 and 1.0) across several Rotational Traction Tester and Advanced Artificial Athlete testing configurations and output variables with player perceptions. It is recommended that the current Rotational Traction Tester is improved through added instrumentation to allow surface stiffness to be evaluated (the rate of generation of traction resistance). It is further recommended that the Advanced Artificial Athlete adopts a new algorithm to improve the accuracy of the surface’s Vertical Deformation and Energy Restitution, and the number of drops is reduced from three to one.
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Patel N, Evans K, Berrington J, Szatkowski L, Costeloe K, Ojha S, Fleming P, Battersby C. How frequent is routine use of probiotics in UK neonatal units? BMJ Paediatr Open 2023; 7:e002012. [PMID: 37451704 PMCID: PMC10351264 DOI: 10.1136/bmjpo-2023-002012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE There is a lack of UK guidance regarding routine use of probiotics in preterm infants to prevent necrotising enterocolitis, late-onset sepsis and death. As practices can vary, we aimed to determine the current usage of probiotics within neonatal units in the UK. DESIGN AND SETTING Using NeoTRIPS, a trainee-led neonatal research network, an online survey was disseminated to neonatal units of all service levels within England, Scotland, Northern Ireland and Wales in 2022. Trainees were requested to complete one survey per unit regarding routine probiotic administration. RESULTS 161 of 188 (86%) neonatal units responded to the survey. 70 of 161 (44%) respondents routinely give probiotics to preterm infants. 45 of 70 (64%) use the probiotic product Lactobacillus acidophilus NCFM/Bifidobacterium bifidum Bb-06/B. infantis Bi-26 (Labinic™). 57 of 70 (81%) start probiotics in infants ≤32 weeks' gestation. 33 of 70 (47%) had microbiology departments that were aware of the use of probiotics and 64 of 70 (91%) had a guideline available. Commencing enteral feeds was a prerequisite to starting probiotics in 62 of 70 (89%) units. The majority would stop probiotics if enteral feeds were withheld (59 of 70; 84%) or if the infant was being treated for necrotising enterocolitis (69 of 70; 99%). 24 of 91 (26%) units that did not use probiotics at the time of the survey were planning to introduce them within the next 12 months. CONCLUSIONS More than 40% of all UK neonatal units that responded are now routinely administering probiotics, with variability in the product used. With increased probiotic usage in recent years, there is a need to establish whether this translates to improved clinical outcomes.
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Affiliation(s)
- Neaha Patel
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Katie Evans
- Neonatal Medicine, School of Public Health Faculty of Medicine, Imperial College London, London, UK
| | - Janet Berrington
- Department of Neonatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Szatkowski
- Centre for Perinatal Research, Lifespan and Population Health, School of Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Kate Costeloe
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
- Genomics and Child Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Shalini Ojha
- Centre for Perinatal Research, Lifespan and Population Health, School of Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Paul Fleming
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, UK
- Genomics and Child Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health Faculty of Medicine, Imperial College London, London, UK
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Paranthaman K, Wilson A, Verlander N, Rooney G, Macdonald N, Nsonwu O, Hope R, Fleming P, Hatcher J, Ogundipe E, Ratnaraja N, Wan Y, Pichon B, Westrop SJ, Brown CS, Demirjian A. Trends in coagulase-negative staphylococci (CoNS), England, 2010-2021. Access Microbiol 2023; 5:acmi000491.v3. [PMID: 37424540 PMCID: PMC10323795 DOI: 10.1099/acmi.0.000491.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Objective To review the epidemiology of coagulase-negative staphylococci (CoNS) in England over the recent 12 year period. Methods Laboratory-confirmed CoNS reported from sterile sites in patients in England to the UK Health Security Agency (UKHSA) between 2010 and 2021 were extracted from the national laboratory database and analysed. Results Overall, 668 857 episodes of CoNS were reported. Unspeciated CoNS accounted for 56 % (374 228) of episodes, followed by Staphylococcus epidermidis (26 %; 174 050), S. hominis (6.5 %; 43 501) and S. capitis (3.9 %; 25 773). Unspeciated CoNS increased by 8.2 % (95 % CI, 7.1-9.3) annually between 2010 and 2016, then decreased annually by 6.4 % (95 % CI: -4.8 to -7.9) until 2021. Speciated CoNS increased by 47.6 % (95 % CI, 44.5-50.9) annually between 2010 and 2016 and increased annually by 8.9 % (95 % CI: 5.1 to 12.8) until 2021. Antimicrobial susceptibility profiles differed by species. Conclusions Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years. Monitoring trends in CoNS epidemiology is crucial for development of observational and clinical intervention studies on individual species.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Fleming
- Homerton Healthcare NHS Foundation Trust, London, UK
- Queen Mary University of London, London, UK
| | - James Hatcher
- Great Ormond Street Hospital for Children, London, UK
| | - Enitan Ogundipe
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Natasha Ratnaraja
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yu Wan
- U.K. Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | | | - Colin S. Brown
- U.K. Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Alicia Demirjian
- U.K. Health Security Agency, London, UK
- Evelina London Children’s Hospital, London, UK
- King’s College London, London, UK
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Thomas S, Fleming P, O'Donoghue C, Almirall-Sanchez A. Strategies for developing preparedness and building legacy – learning from the experience of building Health System Resilience in Ireland. Eur J Public Health 2022. [PMCID: PMC9593371 DOI: 10.1093/eurpub/ckac129.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Health system resilience to shocks is perhaps the biggest global challenge facing health systems in the 21st Century. Health systems face an increasing prevalence and likelihood of a broad range of shocks (including economic crises, pandemics, climate-related events, political upheavals, mass migration, conflicts and cyberterrorism) that can each undermine the ability of a health system to function well. In particular, the twin processes of dealing with the legacy of a health system shock and preparing for the next shock are distinct but related challenges that face policy makers today. In this presentation the authors will present key findings on improving preparedness and building a constructive legacy drawing from: • the results of a recent systematic review on how health system resilience has been measured in high income countries over the last twenty years; • the results of a recent realist review exploring the legacy of the economic crisis for the resilience of the response of the health system to COVID-19, and • analysis of interviews with Irish policy makers, managers and analysts as they reflect on the different shocks encountered by the Irish system over the last fourteen years. Triangulating these findings, the authors will reflect on the merits and challenges of measuring resilience and what the focus should be moving forward. Key strategies and approaches will be outlined to best prepare a system for a shock and to leave a positive legacy for the future.
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Affiliation(s)
- S Thomas
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - P Fleming
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C O'Donoghue
- School of Medicine, Trinity College Dublin , Dublin, Ireland
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Fleming P, Pereira S, Kapellou O, Claxton A, Bamford A, Aladangady N. Possible In Utero Transmission of SARS-CoV-2 and Severe Respiratory Disease in a Preterm Infant. Pediatrics 2022; 150:186766. [PMID: 35425990 DOI: 10.1542/peds.2021-054557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infections are uncommon in newborn infants. This report describes possible in utero transmission of the B.1.1.7 (alpha) variant in a preterm infant born at 31 weeks' gestational age who presented with severe respiratory disease. The infant was treated with high-frequency oscillatory ventilation, antiviral medications, and corticosteroids and transitioned to noninvasive respiratory support on day 33. By day 63, she was off positive pressure support and breathing room air and she was discharged from the hospital on day 70. She demonstrated normal growth and development at a 6-month follow-up visit. Placental histopathology revealed placentitis characterized by loss of intervillous spaces resulting from fibrin deposition and inflammatory cell infiltration. Optimum management strategies for treating infants with severe acute respiratory syndrome coronavirus 2 infection have yet to be determined.
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Affiliation(s)
- Paul Fleming
- Neonatal Unit.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sujith Pereira
- Neonatal Unit.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Alleyna Claxton
- Department of Microbiology, Homerton University Hospital, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Narendra Aladangady
- Neonatal Unit.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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10
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Affiliation(s)
- Paul Fleming
- Neonatal Unit, Homerton University Hospital, London, UK .,Centre for Genomics and Child Health, Queen Mary University of London, London, UK
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11
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Shakya HB, Cislaghi B, Fleming P, Levtov RG, Boyce SC, Raj A, Silverman JG. Associations of attitudes and social norms with experiences of intimate partner violence among married adolescents and their husbands in rural Niger: a dyadic cross-sectional study. BMC Womens Health 2022; 22:180. [PMID: 35585589 PMCID: PMC9118706 DOI: 10.1186/s12905-022-01724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Prior cross-sectional research suggests that both men’s and women’s attitudes towards intimate partner violence (IPV) are predictive of women’s IPV experience, although this can vary greatly by context. In general, women who have experienced IPV are likely to report attitudes accepting of it. Men who perpetrate IPV may also report attitudes accepting of it, although some research has found that there is not always an association. Studies that investigate these dynamics often conflate attitudes with social norms, or use attitudes as a proxy for social norms, given that valid measures on social norms are usually lacking. Here we conduct a secondary data analysis to ask how are men’s and women’s IPV-related attitudes associated with women’s reports of IPV and how are men’s and women’s perceived social norms associated with women’s reports of IPV. Methods Dyadic data were collected from a representative sample of married adolescent girls and their husbands in 48 rural villages of the Dosso region of Niger (N = 1010). Assessments included logistic regression analyses of husbands’ and wives’ reports of individual attitudes towards IPV, and social norms based on husbands’ and wives’ perceptions of their communities’ beliefs related to gender roles and acceptability of IPV. Results Eight percent of women in this sample reported IPV. We found that, consistent with other research, wives who have reported IPV are more likely to report attitudes in support of IPV, while for husbands whose wives report IPV, that relationship is insignificant. On the other hand, husbands who report that people in their community believe there are times when a woman deserves to be beaten are more likely to have perpetrated IPV, while for wives there is no association between the community norm and IPV reporting. Finally, wives who report that people in their community hold inequitable gender norms in general are more likely to have experienced IPV, while for husbands, community gender norms are not predictive of whether their wives have reported IPV. Conclusions Our results are evidence that IPV prevention interventions focused solely on individual attitudes may be insufficient. Targeting and assessment of social norms are likely critical to advancing understanding and prevention of IPV.
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Affiliation(s)
- Holly Baker Shakya
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA.
| | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine Room, 330 LSHTM 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Paul Fleming
- Department of Health Behavior & Health Education, 3814 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | | | - Sabrina C Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
| | - Jay G Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
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12
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Abstract
Darier's disease (also known as keratosis follicularis or dyskeratosis follicularis) is an autosomal dominant inherited disorder which manifests as hyperkeratotic greasy papules in the first or second decade of life. Aside from symptom management and behavioral modifications to avoid triggers, there are currently no validated treatments for Darier's disease (DD). However, a variety of treatments have been proposed in the literature including retinoids, steroids, vitamin D analogs, photodynamic therapy, and surgical excision. The purpose of this review article is to identify therapeutic options for treating DD and to outline the evidence underlying these interventions. A search was conducted in Medline for English language articles from inception to July 4, 2020. Our search identified a total of 474 nonduplicate studies, which were screened by title and abstract. Of these, 155 full text articles were screened against inclusion/exclusion criteria, and 113 studies were included in our review. We identified Grade B evidence for the following treatments of DD: oral acitretin, oral isotretinoin, systemic Vitamin A, topical tretinoin, topical isotretinoin, topical adapalene gel, topical 5-flououracil, topical calciptriol and tacalcitol (with sunscreen), grenz ray radiation, and x-ray radiation. All other evidence for treatments of DD consisted of case reports or case series, which is considered grade C evidence. Considering the quality and quantity of evidence, clinicians may consider initiating a trial of select topical or oral retinoids first in patients with localized or generalized DD, respectively.
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Affiliation(s)
- N Hanna
- 6363 Faculty of Medicine, University of Ottawa, ON, Canada
| | - M Lam
- 12362 Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - P Fleming
- 7938 Division of Dermatology, University of Toronto, ON, Canada
| | - C Lynde
- 7938 Division of Dermatology, University of Toronto, ON, Canada.,Lynde Institute of Dermatology, Markham, ON, Canada
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13
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Fleming P. Risankizumab vs. fumaric acid esters: a direct comparison. Br J Dermatol 2021; 186:4-5. [PMID: 34726768 DOI: 10.1111/bjd.20813] [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] [Received: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- P Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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14
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Lim Y, Beebeejaun S, Claxton A, Fleming P, Prakash R. Assessing the impact of introducing a satellite blood culture incubator within a tertiary neonatal unit on length of hospital stay. Arch Dis Child Fetal Neonatal Ed 2020; 105:570. [PMID: 32033963 DOI: 10.1136/archdischild-2019-317773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Yinru Lim
- Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Shirin Beebeejaun
- Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alleyna Claxton
- Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Paul Fleming
- Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Ravi Prakash
- Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
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15
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Kamdar S, Hutchinson R, Laing A, Stacey F, Ansbro K, Millar MR, Costeloe K, Wade WG, Fleming P, Gibbons DL. Perinatal inflammation influences but does not arrest rapid immune development in preterm babies. Nat Commun 2020; 11:1284. [PMID: 32152273 PMCID: PMC7062833 DOI: 10.1038/s41467-020-14923-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
Infection and infection-related complications are important causes of death and morbidity following preterm birth. Despite this risk, there is limited understanding of the development of the immune system in those born prematurely, and of how this development is influenced by perinatal factors. Here we prospectively and longitudinally follow a cohort of babies born before 32 weeks of gestation. We demonstrate that preterm babies, including those born extremely prematurely (<28 weeks), are capable of rapidly acquiring some adult levels of immune functionality, in which immune maturation occurs independently of the developing heterogeneous microbiome. By contrast, we observe a reduced percentage of CXCL8-producing T cells, but comparable levels of TNF-producing T cells, from babies exposed to in utero or postnatal infection, which precedes an unstable post-natal clinical course. These data show that rapid immune development is possible in preterm babies, but distinct identifiable differences in functionality may predict subsequent infection mediated outcomes.
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Affiliation(s)
- S Kamdar
- Peter Gorer Department of Immunobiology, King's College London, London, SE1 9RT, UK
| | - R Hutchinson
- Department of Neonatology, Homerton University Hospital, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Laing
- Peter Gorer Department of Immunobiology, King's College London, London, SE1 9RT, UK
| | - F Stacey
- Department of Neonatology, Homerton University Hospital, London, UK
| | - K Ansbro
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- University of Sheffield, Sheffield, UK
| | - M R Millar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K Costeloe
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - W G Wade
- Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - P Fleming
- Department of Neonatology, Homerton University Hospital, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D L Gibbons
- Peter Gorer Department of Immunobiology, King's College London, London, SE1 9RT, UK.
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Affiliation(s)
- A Muntyanu
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - W P Gulliver
- Department of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - P Fleming
- Lynde Institute for Dermatology (Private Practice), Markham, ON, Canada.,Division of Dermatology, University of Toronto, Toronto, ON, Canada
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17
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Abstract
Over the last few decades, numerous studies have evaluated probiotic use for the prevention of necrotising enterocolitis in preterm babies. Early 'proof of concept' studies evaluating whether probiotics are capable of colonising the preterm gut have translated into multiple observational studies, small and large randomised controlled trials. Some show evidence of benefit while others have produced disappointing results. In this paper, we review the history of probiotic use in preterm babies for NEC prevention in an attempt to explain why uncertainty exists and why this intervention has not been universally adopted into routine neonatal practice.
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Affiliation(s)
- Prudence Jarrett
- Homerton University Hospital, NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.
| | - Andras Meczner
- Homerton University Hospital, NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Kate Costeloe
- Barts and the London School of Medicine and Dentistry, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul Fleming
- Homerton University Hospital, NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland; Barts and the London School of Medicine and Dentistry, London, United Kingdom of Great Britain and Northern Ireland
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18
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Affiliation(s)
- P Fleming
- Lynde Institute for Dermatology, 5 Washington St, Markham, ON, L3P 2R3, Canada
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19
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Fleming P, Fung K, Chan A. 194 Dermatologic assessment is associated with improved melanoma outcomes: population-based cohort study. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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MacFarlane M, Thompson JMD, Zuccollo J, McDonald G, Elder D, Stewart AW, Lawton B, Percival T, Baker N, Schlaud M, Fleming P, Taylor B, Mitchell EA. Smoking in pregnancy is a key factor for sudden infant death among Māori. Acta Paediatr 2018; 107:1924-1931. [PMID: 29869345 DOI: 10.1111/apa.14431] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To examine the sudden unexpected death in infancy (SUDI) disparity between Māori and non-Māori in New Zealand. METHODS A nationwide prospective case-control study ran from March 2012 to February 2015. Exposure to established SUDI risk factors was analysed to investigate the disparity experienced by Māori. Infant ethnicity was based on mother's ethnicity. Māori ethnicity was prioritised. Non-Māori includes Pacific, Asian, NZ European and Other. RESULTS There were 137 cases and 649 controls. The Māori SUDI rate was 1.41/1000 live births compared to 0.53/1000 for non-Māori. Parents/caregivers of 132 cases (96%) and 258 controls (40%) were interviewed. Smoking in pregnancy was associated with an equally increased SUDI risk for Māori (adjusted OR = 8.11, 95% CI = 2.64, 24.93) and non-Māori (aOR = 5.09, 95% CI = 1.79, 14.47), as was bed-sharing (aOR = 3.66, 95% CI = 1.49, 9.00 vs aOR = 11.20, 95% CI = 3.46, 36.29). Bed-sharing prevalence was similar; however, more Māori controls smoked during pregnancy (46.7%) than non-Māori (22.8%). The main contributor relating to increased SUDI risk for Māori/non-Māori infants is the combination of smoking in pregnancy and bed sharing. CONCLUSION The association between known SUDI risk factors, including bed sharing and/or smoking in pregnancy and SUDI risk, is the same regardless of ethnicity. Māori infants are exposed more frequently to both behaviours because of the higher Māori smoking rate.
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Affiliation(s)
- M MacFarlane
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J M D Thompson
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J Zuccollo
- University of Otago; Wellington New Zealand
| | - G McDonald
- University of Otago; Dunedin New Zealand
| | - D Elder
- University of Otago; Wellington New Zealand
| | - A W Stewart
- University of Auckland; Auckland New Zealand
| | - B Lawton
- Centre for Women's Health Research; Victoria University of Wellington; Wellington New Zealand
| | - T Percival
- University of Auckland; Auckland New Zealand
| | - N Baker
- Nelson Hospital; Nelson New Zealand
| | - M Schlaud
- Robert Koch University; Berlin Germany
| | | | - B Taylor
- University of Otago; Dunedin New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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21
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Huggett C, Birtel MD, Awenat YF, Fleming P, Wilkes S, Williams S, Haddock G. A qualitative study: experiences of stigma by people with mental health problems. Psychol Psychother 2018; 91:380-397. [PMID: 29345416 DOI: 10.1111/papt.12167] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prior research has examined various components involved in the impact of public and internalized stigma on people with mental health problems. However, studies have not previously investigated the subjective experiences of mental health stigma by those affected in a non-statutory treatment-seeking population. DESIGN An in-depth qualitative study was conducted using thematic analysis to investigate the experiences of stigma in people with mental health problems. METHODS Eligible participants were recruited through a local mental health charity in the North West of England. The topic of stigma was examined using two focus groups of thirteen people with experience of mental health problems and stigma. RESULTS Two main themes and five subthemes were identified. Participants believed that (1) the 'hierarchy of labels' has a profound cyclical impact on several levels of society: people who experience mental health problems, their friends and family, and institutional stigma. Furthermore, participants suggested (2) ways in which they have developed psychological resilience towards mental health stigma. CONCLUSIONS It is essential to utilize the views and experiences gained in this study to aid understanding and, therefore, develop ways to reduce the negative impact of public and internal stigma. PRACTITIONER POINTS People referred to their mental health diagnosis as a label and associated that label with stigmatizing views. Promote awareness and develop improved strategies (e.g., training) to tackle the cyclical impact of the 'hierarchy of labels' on people with mental health problems, their friends and family, and institutional stigma. Ensure the implementation of clinical guidelines in providing peer support to help people to combat feeling stigmatized. Talking about mental health in psychological therapy or health care professional training helped people to take control and develop psychological resilience.
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Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Stockport and District Mind, UK
| | - Michèle D Birtel
- Department of Psychology, Social Work and Counselling, University of Greenwich, London, UK
| | - Yvonne F Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Stockport and District Mind, UK
| | - Paul Fleming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Sophie Wilkes
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | | | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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23
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Igaki K, Komoike Y, Nakamura Y, Watanabe T, Yamasaki M, Fleming P, Yang L, Soler D, Fedyk E, Tsuchimori N. MLN3126, an antagonist of the chemokine receptor CCR9, ameliorates inflammation in a T cell mediated mouse colitis model. Int Immunopharmacol 2018; 60:160-169. [DOI: 10.1016/j.intimp.2018.04.049] [Citation(s) in RCA: 11] [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] [Received: 02/08/2018] [Revised: 04/04/2018] [Accepted: 04/30/2018] [Indexed: 12/18/2022]
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Partridge ACR, Bai JW, Rosen CF, Walsh SR, Gulliver WP, Fleming P. Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials. Br J Dermatol 2018; 179:290-295. [PMID: 29478243 DOI: 10.1111/bjd.16485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold-standard treatments. OBJECTIVES To review the effectiveness of systemic therapy for PG. METHODS We searched six databases for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time to healing and adverse effects. RESULTS We found 3326 citations and 375 articles underwent full-text review; 41 studies met the inclusion criteria. There were 704 participants in 26 retrospective cohort studies, three prospective cohort studies, seven case series, one case-control study, two open-label trials and two randomized controlled trials (RCTs). Systemic corticosteroids were the most studied (32 studies), followed by ciclosporin (21 studies), biologics (16 studies) and oral dapsone (11 studies). One RCT (STOP-GAP, n = 121) showed that prednisolone and ciclosporin were similar: 15-20% of patients showed complete healing at 6 weeks and 47% at 6 months. Another RCT (n = 30) found that infliximab was superior to placebo at 2 weeks (46% vs. 6% response), with a 21% complete healing rate at 6 weeks. Two uncontrolled trials showed 60% and 37% healing within 4 months for canakinumab and infliximab, respectively; other data suggest that patients with concurrent inflammatory bowel disease may benefit from biologics. The remaining studies were poor quality and had small sample sizes but supported the use of corticosteroids, ciclosporin and biologics. CONCLUSIONS Systemic corticosteroids, ciclosporin, infliximab and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.
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Affiliation(s)
- A C R Partridge
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J W Bai
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - C F Rosen
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
| | - S R Walsh
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - W P Gulliver
- Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - P Fleming
- Division of Dermatology, University of Toronto, Toronto, Canada
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25
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Carrasco MA, Wilkinson J, Kasdan B, Fleming P. Systematic review of barriers and facilitators to voluntary medical male circumcision in priority countries and programmatic implications for service uptake. Glob Public Health 2018; 14:91-111. [PMID: 29695201 DOI: 10.1080/17441692.2018.1465108] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/21/2022]
Abstract
Voluntary medical male circumcision (VMMC) is an effective biomedical HIV prevention strategy. There is a need to identify key barriers and facilitators to VMMC uptake in priority countries to improve uptake. In this paper, we report findings from a systematic review of the barriers and facilitators of VMMC uptake, comparing them across countries in order to provide programmers critical information to design effective VMMC uptake interventions. Our review followed PRISMA protocol. Twenty three articles from 10 of the 14 priority countries were included. The top three barriers cited were: MC negatively perceived as being practiced by other or foreign cultures and religions, fear of pain caused by the procedure, and perceptions of VMMC as not helpful/needed. The top four facilitators cited in most countries were: Belief that VMMC reduces health risks and improves hygiene, family and peer support of MC, and enhanced sexual performance and satisfaction. The barriers and facilitators highlighted in this paper can help inform programmatic strategies in these countries. More research is needed to ensure that all sub-populations are being adequately reached. By applying this information to new research and programming, these countries can achieve greater VMMC uptake - and thus reductions in HIV transmission and prevalence.
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Affiliation(s)
- Maria A Carrasco
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA.,b Office of HIV/AIDS, United States Agency for International Development , Washington, DC , USA
| | - Jessica Wilkinson
- b Office of HIV/AIDS, United States Agency for International Development , Washington, DC , USA
| | - Benjamin Kasdan
- b Office of HIV/AIDS, United States Agency for International Development , Washington, DC , USA
| | - Paul Fleming
- c Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , USA
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Subbiah V, Gainor JF, Rahal R, Brubaker JD, Kim JL, Maynard M, Hu W, Cao Q, Sheets MP, Wilson D, Wilson KJ, DiPietro L, Fleming P, Palmer M, Hu MI, Wirth L, Brose MS, Ou SHI, Taylor M, Garralda E, Miller S, Wolf B, Lengauer C, Guzi T, Evans EK. Precision Targeted Therapy with BLU-667 for RET-Driven Cancers. Cancer Discov 2018; 8:836-849. [DOI: 10.1158/2159-8290.cd-18-0338] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
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27
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Affiliation(s)
- P. Fleming
- Division of Dermatology; University of Toronto; Sunnybrook Health Sciences Centre (M1-722), 2075 Bayview Avenue Toronto ON Canada M4N 3M5
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28
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Hyer ML, Milhollen MA, Ciavarri J, Fleming P, Traore T, Sappal D, Huck J, Shi J, Gavin J, Brownell J, Yang Y, Stringer B, Griffin R, Bruzzese F, Soucy T, Duffy J, Rabino C, Riceberg J, Hoar K, Lublinsky A, Menon S, Sintchak M, Bump N, Pulukuri SM, Langston S, Tirrell S, Kuranda M, Veiby P, Newcomb J, Li P, Wu JT, Powe J, Dick LR, Greenspan P, Galvin K, Manfredi M, Claiborne C, Amidon BS, Bence NF. A small-molecule inhibitor of the ubiquitin activating enzyme for cancer treatment. Nat Med 2018; 24:186-193. [DOI: 10.1038/nm.4474] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/19/2017] [Indexed: 12/18/2022]
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29
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Fleming P, Daly D. In memoriam: Billy Fenlon. Eur Arch Paediatr Dent 2017. [DOI: 10.1007/s40368-017-0319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
To reach HIV epidemic control it is important to ensure that those who have never been tested access HIV testing and counseling (HTC) particularly in the context of a generalized HIV epidemic. Using data from the 2014 Lesotho Demographic Health Survey bivariate and multivariate logistic regressions were conducted to determine the associations between never tested for HIV and key socio-cognitive characteristics by sex. Marginal probabilities at the means were calculated for the socio-cognitive variables for men and women to ascertain the magnitude of the differences in the likelihood of never being tested by sex. We stratified by gender and controlled for age, education, religion, marital status, place of residence, and years circumcised (for men only). Results indicate that more men than women have never been tested (χ2 = 461.16, p < 0.001); and, among men, acceptance of gender based violence (Odds ratio [OR]: 1.44, p < 0.001), holding discriminatory attitudes (OR: 1.50, p < 0.001), and not having basic HIV prevention knowledge (OR: 1.53, p < 0.001) were significantly associated with never being tested. The likelihood of never being tested among those who had these three socio-cognitive characteristics was much higher among men (0.56, p < 0.001) than women (0.20, p < 0.001). Given the strong sex differential, there is an urgent need for strategies specifically targeting men in order to effectively promote HTC uptake among them. Additionally, results suggest that those strategies should integrate strategies to address GBV acceptance, HIV prevention knowledge, and HIV discrimination or link men to programs addressing these.
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Affiliation(s)
| | - Paul Fleming
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Jocelyn Wagman
- a United States Agency for International Development , Washington , DC , USA
| | - Vincent Wong
- a United States Agency for International Development , Washington , DC , USA
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Fleming P, Annoni J, Scholbrock A, Quon E, Dana S, Schreck S, Raach S, Haizmann F, Schlipf D. Full-Scale Field Test of Wake Steering. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/854/1/012013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Drucker A, Fleming P. 282 Risk of skin infections with dupilumab for atopic dermatitis: Systematic review and meta-analysis of randomized controlled trials. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shakya HB, Fleming P, Saggurti N, Donta B, Silverman J, Raj A. Longitudinal associations of intimate partner violence attitudes and perpetration: Dyadic couples data from a randomized controlled trial in rural India. Soc Sci Med 2017; 179:97-105. [PMID: 28260640 DOI: 10.1016/j.socscimed.2017.02.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/09/2017] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
Abstract
We conducted longitudinal analyses examining the associations between intimate partner violence (IPV) attitudes and women's reported IPV in couples (N = 762) using 3 waves of data from a randomized controlled trial in Maharashtra, India. We found that, between Waves 1 and 2, men's and women's acceptance of IPV in the overall population decreased significantly while reports of IPV increased. These changes, we hypothesize, are evidence of an exogenous shock, possibly a high profile rape in Delhi in December 2012, that may have impacted the entire population. Cross-sectional associations between men's attitudes towards IPV and reported IPV were not significant in Wave 1, while positively and significantly associated in Waves 2 and 3. Longitudinal analysis showed that reduction in men's acceptance of IPV between Waves 1 and 2 was associated with a lower likelihood of reported IPV in Wave 3. Women's Wave 1 acceptance of IPV was positively associated with reported IPV in the Wave 1 cross-sectional analysis, while Wave 2 and Wave 3 measures of IPV acceptance were negatively associated with reported IPV in Waves 2 and 3 respectively. Longitudinal analyses of the change in women's attitudes towards IPV from Wave 1 to 2 and reported IPV in Wave 3 were insignificant. However, When women first reported IPV in Waves 2 or 3 they were less likely to report acceptance of IPV in that same wave. Findings suggest that changes in husbands' IPV acceptance is predictive of subsequent IPV, while newly experienced IPV predicts decreased IPV acceptance for women. Wave 2 and Wave 3 results were significant for the control group only, evidence that the intervention affected those associations, potentially changing attitudes more quickly than behavior. We recommend interventions that expose community opposition to IPV as a new social norm, and analysis of how the 2012 Delhi rape case may have affected these norms.
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Affiliation(s)
- Holly B Shakya
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California San Diego, UCSD Department of Medicine, Division of Global Public Health, 9500 Gilman Drive, #0507, La Jolla, CA 92093-0507, USA; Center on Global Justice, University of California San Diego, USA.
| | - Paul Fleming
- University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Room 3814, Ann Arbor, MI 48109-2029, USA.
| | | | - Balaiah Donta
- National Institute for Research in Reproductive Health (NIRRH), Mumbai, India.
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California San Diego, UCSD Department of Medicine, Division of Global Public Health, 9500 Gilman Drive, #0507, La Jolla, CA 92093-0507, USA.
| | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California San Diego, UCSD Department of Medicine, Division of Global Public Health, 9500 Gilman Drive, #0507, La Jolla, CA 92093-0507, USA.
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Rees CM, Hall NJ, Fleming P, Eaton S. Probiotics for the prevention of surgical necrotising enterocolitis: systematic review and meta-analysis. BMJ Paediatr Open 2017; 1:e000066. [PMID: 29637113 PMCID: PMC5862194 DOI: 10.1136/bmjpo-2017-000066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/22/2017] [Accepted: 05/30/2017] [Indexed: 12/29/2022] Open
Abstract
AIM OF THE STUDY Probiotic administration to preterm infants has the potential to prevent necrotising enterocolitis (NEC). Data from randomised controlled trials (RCT) are conflicting but meta-analyses seem to support this intervention. To date, these analyses have not focused on surgical NEC. We aimed to determine the effect of probiotic administration to preterm infants on prevention of surgical NEC. METHODS A systematic review of RCTs of probiotic administration to preterm infants was performed. Studies were included if RCT outcomes included any of (1) Bell's stage 3 NEC; (2) surgery for NEC; and (3) deaths attributable to NEC. Article selection and data extraction were performed independently by two authors; conflicts were adjudicated by a third author. Data were meta-analysed using Review Manager V.5.3. A random effects model was decided on a priori because of the heterogeneity of study design; data are risk ratio (RR) with 95% CI. MAIN RESULTS Thirty-five RCTs reported NEC as an outcome. Seventeen reported surgical NEC; all RCTs were included. A variety of probiotic products was administered across studies. Description of surgical NEC in most studies was poor. Only 6/16 specifically reported incidence of surgery for NEC, 12/17 Bell's stage 3 and 13/17 NEC-associated mortality. Although there was a trend towards probiotic administration reducing stage 3 NEC, this was not significant (RR 0.74 (0.52-1.05), p=0.09). There was no effect of probiotics on the RR of surgery for NEC (RR 0.84 (0.56-1.25), p=0.38). Probiotics did, however, reduce the risk of NEC-associated mortality (RR 0.56 (0.34-0.93), p=0.03). CONCLUSION Despite 35 RCTs on probiotic prevention of NEC, evidence for prevention of surgical NEC is not strong, partly due to poor reporting. In studies included in this meta-analysis, probiotic administration was associated with a reduction in NEC-related mortality.
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Affiliation(s)
- Clare M Rees
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Fleming
- London School of Medicine and Dentistry, Homerton University Hospital and Barts, London, UK
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK
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Champney F, Maddock L, Welford J, Kemp J, Allan V, Persidskikh Y, Orini M, Ang R, Workman A, Wong L, Honarbakhsh S, Leong K, Silberbauer J, O'Nunain S, Gomes J, McCready J, Bostock J, Shaw K, McKenna C, Bailey J, Honarbakhsh S, Casas J, Wallace J, Hunter R, Schilling R, Perel P, Morley K, Banerjee A, Hemingway H, Mrochak A, Ilyina T, Goncharik D, Chasnoits A, Plashinskaya L, Taggart P, Hayward M, Lambiase P, Hosford P, Kasparov S, Lambiase P, Tinker A, Gourine A, Kettlewell S, Dempster J, Colman M, Rankin A, Myles R, Smith G, Tester D, Jaye A, FitzPatrick D, Evans M, Fleming P, Jeffrey I, Cohen M, Simpson M, Ackerman M, Behr E, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter RJ, Finlay M, Schilling RJ, Lambiase PD, Ng F, Tomlinson L, Nuthoo S, Cajilog E, Lefroy D, Qureshi N, Koa-Wing M, Whinnett Z, Linton N, Davies D, Lim P, Peters N, Kanagaratnam P, Varnava A. ORAL ABSTRACTS (1)Allied Professionals7CRYOABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION - IS AN EP LAB REQUIRED?8A PATHWAY TO SAFETY - ANTICOAGULATION COMPLIANCE IN CIED PATIENTS WITH AF9UNDERSTANDING THE WAYS IN WHICH OCCUPATION IS AFFECTED BY POSTURAL TACHYCARDIA SYNDROME: A UK OCCUPATIONAL THERAPY PERSPECTIVE10DEVELOPMENT OF AN INTERGRATED SUPPORT PATHWAY FOR PATIENTS FULFILLING NICE CRITERIA FOR AN INTERNAL CARDIOVASCULAR DEBRIBRILLATOR (ICD) IN A DISTRICT GENERAL HOSPITAL11ARE CARDIOVASCULAR RISK FACTORS ALSO ASSOCIATED WITH THE INCIDENCE OF ATRIAL FIBRILLATION? A SYSTEMATIC REVIEW AND FIELD SYNOPSIS OF 23 FACTORS IN 32 INITIALLY HEALTHY COHORTS OF 20 MILLION PARTICIPANTS12BRAIN MRI FINDINGS IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CARDIOVERSIONBasic Science/Sudden Cardiac Death13PRELIMINARY ASSESSMENT OF THE “RE-ENTRY VULNERABILITY INDEX” AS A MARKER OF CARDIAC INSTABILITY IN THE HUMAN HEART USING WHOLE-HEART CONTACT EPICARDIAL MAPPING14OPTOGENETIC STIMULATION OF BRAINSTEM'S VAGAL PREGANGLIONIC NEURONES IS ASSOCIATED WITH NEURONAL NITRIC OXIDE SYNTHASE-DEPENDENT PROLONGATION OF VENTRICULAR EFFECTIVE REFRACTORY PERIOD15A DYNAMIC-CLAMP STUDY OF L-TYPE Ca2+ CURRENT IN RABBIT AND HUMAN ATRIAL MYOCYTES: THE CONTRIBUTION OF WINDOW ICaL TO EARLY AFTERDEPOLARISATIONS16WHOLE EXOME SEQUENCING IN SUDDEN INFANT DEATH SYNDROME17MEDIUM TERM SURVIVAL AND FAMILY SCREENING OUTCOMES IN AN IDIOPATHIC VENTRICULAR FIBRILLATION COHORT - A MULTICENTRE EXPERIENCE18CLINICAL CHARACTERISTICS OF SCD SURVIVORS WITH BRUGADA SYNDROME:- ARE SPONSANEOUS TYPE I ECG AND PREVIOUS SYNCOPE REALLY ASSOCIATED WITH HIGH RISK? Europace 2016. [DOI: 10.1093/europace/euw270] [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: 11/14/2022] Open
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Fleming P, Churchfield M, Scholbrock A, Clifton A, Schreck S, Johnson K, Wright A, Gebraad P, Annoni J, Naughton B, Berg J, Herges T, White J, Mikkelsen T, Sjöholm M, Angelou N. Detailed field test of yaw-based wake steering. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/753/5/052003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fleming P, Bai J, Pratt M, Sibbald C, Lynde C, Gulliver W. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol 2016; 31:798-807. [DOI: 10.1111/jdv.13891] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- P. Fleming
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - J.W. Bai
- MD Program; Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - M. Pratt
- Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
| | - C. Sibbald
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - C. Lynde
- Division of Dermatology; University of Toronto; Toronto ON Canada
- Lynde Dermatology (Private Practice); Markham ON Canada
| | - W.P. Gulliver
- Department of Medicine; Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
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Fleming P, Bai J, Pratt M, Sibbald C, Lynde C, Gulliver W. 010 The prevalence of anxiety in patients with psoriasis: A systematic review of observational studies and clinical trials. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Csizmadia V, Hales P, Tsu C, Ma J, Chen J, Shah P, Fleming P, Senn JJ, Kadambi VJ, Dick L, Wolenski FS. Proteasome inhibitors bortezomib and carfilzomib used for the treatment of multiple myeloma do not inhibit the serine protease HtrA2/Omi. Toxicol Res (Camb) 2016; 5:1619-1628. [PMID: 30090462 PMCID: PMC6062231 DOI: 10.1039/c6tx00220j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/19/2016] [Accepted: 08/23/2016] [Indexed: 12/26/2022] Open
Abstract
The proteasome inhibitor bortezomib is associated with the development of peripheral neuropathy in patients, but the mechanism is not fully understood.
The proteasome inhibitor bortezomib is associated with the development of peripheral neuropathy in patients, but the mechanism by which bortezomib can induce peripheral neuropathy is not fully understood. One study suggested that off-target inhibition of proteases other than the proteasome, particularly HtraA2/Omi, may be the underlying mechanism of the neuropathy. The same study also concluded that carfilzomib, a second proteasome inhibitor that is associated with less peripheral neuropathy in patients than bortezomib, showed no inhibition of HtrA2/Omi. The goal of the work described here was to determine whether either proteasome inhibitors truly affected HtrA2/Omi activity. A variety of methods were used to test the effects of both bortezomib and carfilzomib on HtrA2/Omi activity that included in vitro recombinant enzyme assays, and studies with the human neuroblastoma SH-SY5Y cell line and HtrA2/Omi-knockout mouse embryonic fibroblasts. The compound ucf-101 was used to assess the effects of specific HtrA2/Omi inhibition. In contrast to previously published data, our results clearly demonstrated that neither bortezomib nor carfilzomib inhibited HtrA2/Omi activity in recombinant enzyme assays at concentrations up to 100 μM, while the specific inhibitor ucf-101 did inhibit the enzyme. The proteasome inhibitors did not inhibit HtrA2/Omi activity in either SH-SY5Y cells or mouse embryonic fibroblasts, as determined by expression of the HtrA2/Omi substrates eIF4G1 and UCH-L1. Based on our biochemical and cell-based assays, we conclude that neither bortezomib nor carfilzomib inhibited HtrA2/Omi activity. Therefore, it is unlikely that bortezomib associated peripheral neuropathy is a direct result of off-target inhibition of HtrA2/Omi.
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Affiliation(s)
- Vilmos Csizmadia
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Paul Hales
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Christopher Tsu
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Jingya Ma
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Jiejin Chen
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Pooja Shah
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Paul Fleming
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Joseph J Senn
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Vivek J Kadambi
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Larry Dick
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
| | - Francis S Wolenski
- Millennium Pharmaceuticals , Inc (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited) , Cambridge , MA 02139 , USA . ; ; Tel: +1 617-551-3620
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Abstract
The occurrence of skin friction related injuries is an issue for artificial turf sports pitches and remains a barrier to their acceptance. The purpose of this study was to evaluate the current industry standard Securisport® Sports Surface Tester that measures skin surface related frictional behaviour of artificial turf. Little research has been published about the device and its efficacy, despite its widespread use as a standard FIFA test instrument. To achieve a range of frictional behaviours, several "third generation" (3G) carpet and infill combinations were investigated; friction time profiles throughout the Securisport rotations were assessed in combination with independent measurements of skin roughness before and after friction testing via 3D surface scanning. The results indicated that carpets without infill had greatest friction (coefficients of friction 0.97-1.20) while those completely filled with sand or rubber had similar and lower values independent of carpet type (coefficient of friction (COF) ≈0.57). Surface roughness of a silicone skin (s-skin) decreased after friction testing, with the largest change on sand infilled surfaces, indicating an "abrasive" polishing effect. The combined data show that the s-skin is damaged in a surface-specific manner, thus the Securisport COF values appear to be a poor measure of the potential for skin abrasion. It is proposed that the change in s-skin roughness improves assessment of the potential for skin damage when players slide on artificial turf.
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Affiliation(s)
- Sock Peng Tay
- a Institute for Sports Research , Nanyang Technological University , Singapore , Singapore.,b School of Materials Science & Engineering , Nanyang Technological University , Singapore , Singapore.,c School of Civil and Building Engineering , Loughborough University , Loughborough , UK
| | - Paul Fleming
- a Institute for Sports Research , Nanyang Technological University , Singapore , Singapore.,c School of Civil and Building Engineering , Loughborough University , Loughborough , UK
| | - Xiao Hu
- a Institute for Sports Research , Nanyang Technological University , Singapore , Singapore.,b School of Materials Science & Engineering , Nanyang Technological University , Singapore , Singapore
| | - Steph Forrester
- a Institute for Sports Research , Nanyang Technological University , Singapore , Singapore.,d Wolfson School of Mechanical, Electrical and Manufacturing Engineering , Loughborough University , Loughborough , UK
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Bobotsis R, Gulliver WP, Monaghan K, Lynde C, Fleming P. Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies. Br J Dermatol 2016; 175:464-72. [PMID: 26991866 DOI: 10.1111/bjd.14547] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
Abstract
Psoriasis is a chronic inflammatory disorder with significant physical and psychological sequelae. The majority of individuals experience disease onset in early adult life - for women this often occurs during their reproductive years. While some autoimmune diseases have been shown to affect pregnancy outcomes adversely, such a relationship has not been well studied in psoriasis. We searched PubMed, Embase and the Cochrane database for published articles examining psoriasis and adverse pregnancy outcomes, and included observational studies and clinical trials evaluating direct measures of maternal and fetal morbidity and mortality. Four of the nine included articles reported a statistically significant increase in the risk of at least one outcome, including spontaneous abortion, caesarean delivery, low birth weight, macrosomia, large-for-gestational age, and a composite outcome consisting of both prematurity and low birth weight. However, these associations were not always consistent across studies. Overall, there was no clear evidence of increased adverse outcomes in pregnant women with psoriasis.
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Affiliation(s)
- R Bobotsis
- Schulich School of Medicine, Western University, London, ON, Canada
| | - W P Gulliver
- Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - K Monaghan
- Department of Family Medicine (Obstetrics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - C Lynde
- Lynde Dermatology (Private Practice), Markham, ON, Canada.,Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - P Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada.
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Duvall JR, VerPlank L, Ludeke B, McLeod SM, Lee MD, Vishwanathan K, Mulrooney CA, Le Quement S, Yu Q, Palmer MA, Fleming P, Fearns R, Foley MA, Scherer CA. Novel diversity-oriented synthesis-derived respiratory syncytial virus inhibitors identified via a high throughput replicon-based screen. Antiviral Res 2016; 131:19-25. [PMID: 27059228 DOI: 10.1016/j.antiviral.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 01/23/2023]
Abstract
Respiratory syncytial virus (RSV) infections affect millions of children and adults every year. Despite the significant disease burden, there are currently no safe and effective vaccines or therapeutics. We employed a replicon-based high throughput screen combined with live-virus triaging assays to identify three novel diversity-oriented synthesis-derived scaffolds with activity against RSV. One of these small molecules is shown to target the RSV polymerase (L protein) to inhibit viral replication and transcription; the mechanisms of action of the other small molecules are currently unknown. The compounds described herein may provide attractive inhibitors for lead optimization campaigns.
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Affiliation(s)
- Jeremy R Duvall
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Lynn VerPlank
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Barbara Ludeke
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States
| | - Sarah M McLeod
- AstraZeneca R&D Boston, Infection Innovative Medicines Unit, 35 Gatehouse Drive, Waltham, MA 02451, United States
| | - Maurice D Lee
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Karthick Vishwanathan
- AstraZeneca R&D Boston, Early Clinical Development, 35 Gatehouse Drive, Waltham, MA 02451, United States
| | - Carol A Mulrooney
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Sebastian Le Quement
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Qin Yu
- AstraZeneca R&D Boston, Infection Innovative Medicines Unit, 35 Gatehouse Drive, Waltham, MA 02451, United States
| | - Michelle A Palmer
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Paul Fleming
- AstraZeneca R&D Boston, Infection Innovative Medicines Unit, 35 Gatehouse Drive, Waltham, MA 02451, United States
| | - Rachel Fearns
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States
| | - Michael A Foley
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States
| | - Christina A Scherer
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA 02142, United States.
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Abstract
Zwitterionic polymer brushes were investigated for their skin-friendliness outside of the common aqueous environment, exhibiting superior lubrication and antifouling properties.
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Affiliation(s)
- S. P. Tay
- School of Materials Science and Engineering
- Nanyang Technological University
- Singapore
- Institute for Sports Research
- Nanyang Technological University
| | - P. Fleming
- School of Materials Science and Engineering
- Nanyang Technological University
- Singapore
- School of Civil and Building Engineering
- Loughborough University
| | - S. Forrester
- School of Materials Science and Engineering
- Nanyang Technological University
- Singapore
- Wolfson School of Mechanical and Manufacturing Engineering
- Loughborough University
| | - X. Hu
- School of Materials Science and Engineering
- Nanyang Technological University
- Singapore
- Institute for Sports Research
- Nanyang Technological University
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Pananookooln S, Khosla S, Lerebours L, Fleming P, Donastorg Y, Brito M. Sexual Behaviors in Dominican Men Before and After Voluntary Medical Male Circumcision for HIV Prevention. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.274] [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: 11/13/2022] Open
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Milhollen MA, Shi J, Traore T, Huck J, Sappal D, Duffy J, Lightcap E, Ishii Y, Ciavarri J, Fleming P, Bence N, Hyer ML. Abstract A164: The small molecule UAE inhibitor TAK-243 (MLN7243) prevents DNA damage repair and reduces cell viability/tumor growth when combined with radiation, carboplatin and docetaxel. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-a164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Clinical results of VELCADE® (bortezomib) For Injection have prompted evaluation of other enzymes within the ubiquitin proteasome system (UPS) as druggable targets for human cancer. We have identified a first in class investigational drug, TAK-243 (MLN7243), which targets the ubiquitin activating enzyme, UAE (UBA1), an essential cellular enzyme responsible for activating > 99% of all cellular ubiquitin. Ubiquitin is involved in multiple cellular processes including ubiquitin-dependent protein turnover, cell cycle progression, regulation of apoptosis, protein localization and response to DNA damage. Experiments combining targeted siRNA knockdown with TAK-243 identified DNA damage repair genes necessary for UAE inhibitor-induced cell death. A more focused approach revealed TAK-243 treatment blocked essential monoubiquitination events within the Translesion synthesis (TLS), Fanconi Anemia (FA) and Homologous recombination (HR) pathways. Inhibition of UAE prevented mono-ubiquitin signaling of key mediators within these pathways, including PCNA and FANCD2, by blocking formation of their specific E2-ubiquitin thioesters. In vitro cell-based assays combining TAK-243 with ultraviolet (UV) and radiation, both known to induce DNA damage, yielded inhibition of cell growth and enhanced DNA damage as observed through colony formation assays and Comet assay detection, respectively. Xenograft tumor bearing mice were treated with carboplatin or docetaxel, combined with TAK-243, to evaluate combination benefits in vivo. Synergistic and additive anti-tumor combination benefits were observed in animals treated with TAK-243 + carboplatin and TAK-243 + docetaxel. These important mechanistic in vitro and in vivo studies indicate the dependency of ubiquitination signaling in DNA damage repair and provide a mechanistic rationale for combining radiation, carboplatin or docetaxel with TAK-243 in the clinical setting. Currently, TAK-243 is being evaluated in a solid tumor phase I clinical trial evaluating safety, tolerability, pharmacokinetics, pharmacodynamics and anti-tumor activity (ClinicalTrials.gov identifier: NCT02045095).
Citation Format: Michael A. Milhollen, Judi Shi, Tary Traore, Jessica Huck, Darshan Sappal, Jennifer Duffy, Eric Lightcap, Yuko Ishii, Jeff Ciavarri, Paul Fleming, Neil Bence, Marc L. Hyer. The small molecule UAE inhibitor TAK-243 (MLN7243) prevents DNA damage repair and reduces cell viability/tumor growth when combined with radiation, carboplatin and docetaxel. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr A164.
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Affiliation(s)
| | - Judi Shi
- 1Takeda Oncology,Inc., Cambridge, MA
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Abstract
Probiotics for the prevention of necrotizing enterocolitis have attracted a huge interest. Combined data from heterogeneous randomised controlled trials suggest that probiotics may decrease the incidence of NEC. However, the individual studies use a variety of probiotic products, and the group at greatest risk of NEC, i.e., those with a birth weight of less than 1000 g, is relatively under-represented in these trials so we do not have adequate evidence of either efficacy or safety to recommend universal prophylactic administration of probiotics to premature infants. These problems have polarized neonatologists, with some taking the view that it is unethical not to universally administer probiotics to premature infants, whereas others regard the meta-analyses as flawed and that there is insufficient evidence to recommend routine probiotic administration. Another problem is that the mechanism by which probiotics might act is not clear, although some experimental evidence is starting to accumulate. This may allow development of surrogate endpoints of effectiveness, refinement of probiotic regimes, or even development of pharmacological agents that may act through the same mechanism. Hence, although routine probiotic administration is controversial, studies of probiotic effects may ultimately lead us to effective means to prevent this devastating disease.
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Affiliation(s)
- Paul Fleming
- Homerton University Hospital, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London, WC1N 1EH, UK
| | - Simon Eaton
- Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London, WC1N 1EH, UK.
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Fleming P, Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Siu S, Kraft J, Lynde C, Pope J, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B, Gulliver W. Effect of biologics on depressive symptoms in patients with psoriasis: a systematic review. J Eur Acad Dermatol Venereol 2014; 29:1063-70. [DOI: 10.1111/jdv.12909] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/05/2014] [Indexed: 01/23/2023]
Affiliation(s)
- P. Fleming
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - C. Roubille
- Notre-Dame Hospital; University of Montreal Hospital Research Center (CRCHUM); Montreal QC Canada
| | - V. Richer
- Department of Medicine; Dermatology Service; St-Luc Hospital; Montreal Canada
| | - T. Starnino
- Sacré-Coeur Hospital of Montreal; University of Montreal; Montreal QC Canada
| | - C. McCourt
- Department of Dermatology and Skin Science; University of British Columbia; Vancouver BC Canada
| | - A. McFarlane
- Division of Rheumatology; University of Alberta; Edmonton AB Canada
| | - S. Siu
- Division of Rheumatology; Department of Medicine; Western University; St. Joseph's Health Care; London ON Canada
| | - J. Kraft
- Lynde Dermatology; Markham ON Canada
| | - C. Lynde
- Lynde Dermatology; Markham ON Canada
| | - J.E. Pope
- Division of Rheumatology; Department of Medicine; Western University; St. Joseph's Health Care; London ON Canada
| | - S. Keeling
- Division of Rheumatology; University of Alberta; Edmonton AB Canada
| | - J. Dutz
- Department of Dermatology and Skin Science; University of British Columbia; Vancouver BC Canada
| | - L. Bessette
- Department of Medicine; Rheumatic Disease Unit; Centre Hospitalier Universitaire de Québec (pavillon CHUL); Quebec City QC Canada
| | | | - B. Haraoui
- Department of Medicine; Rheumatic Disease Unit; Centre Hospitalier de l'Université de Montréal (CHUM) and Institut de Rhumatologie de Montréal; Montreal QC Canada
| | - W.P. Gulliver
- Department of Medicine; Memorial University of Newfoundland; St. John's NL Canada
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48
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Sultan A, Warreth A, Fleming P, MacCarthy D. Does the dentist have a role in identifying patients with undiagnosed diabetes mellitus? J Ir Dent Assoc 2014; 60:298-303. [PMID: 25638930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
STATEMENT OF THE PROBLEM Diabetes has become an epidemic and the incidence of undiagnosed diabetes is growing at an alarming rate. Diabetes is an associated risk factor for chronic periodontitis and has several other oral symptoms including dry mouth and oral infection. Expanding the role of the dentist may prove to be an efficient method of early detection and management of diabetes. PURPOSE OF THE STUDY The aim of this paper is to critically analyse the literature and determine whether screening for undiagnosed diabetes mellitus is within the dentist's scope of practice. MATERIALS AND METHODS A PubMed/Google Scholar/Google literature search was conducted of papers published in the English language in the years 1980-2013. Over 140 articles were examined. Reference lists of key articles were also sourced and analysed. The most pertinent articles are presented in this review. RESULTS Screening for diabetes mellitus in the dental office should only be carried out for high-risk patients in order for such screenings to be cost-effective. CONCLUSIONS Dentists have an ethical obligation and a duty of care to protect the well-being of their patients. A screening procedure to detect a serious underlying, undiagnosed systemic condition does not cause any harm to the patient and is in the patient's best interests.
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49
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Milhollen M, Hyer M, Ciavarri J, Traore T, Sappal D, Huck J, Shi J, Duffy J, Gavin J, Brownell J, Yang Y, Stringer B, Ishii Y, Koenig E, Lublinsky A, Griffin R, Xia C, Powe J, Fleming P, Bence N. 561 Nonclinical characterization of the first in class investigational ubiquitin activating enzyme inhibitor MLN7243 in cellular and in vivo models of cancer in support of a phase I study. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70687-2] [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: 12/01/2022]
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50
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Hameed P S, Manjrekar P, Chinnapattu M, Humnabadkar V, Shanbhag G, Kedari C, Mudugal NV, Ambady A, de Jonge BL, Sadler C, Paul B, Sriram S, Kaur P, Guptha S, Raichurkar A, Fleming P, Eyermann CJ, McKinney DC, Sambandamurthy VK, Panda M, Ravishankar S. Pyrazolopyrimidines establish MurC as a vulnerable target in Pseudomonas aeruginosa and Escherichia coli. ACS Chem Biol 2014; 9:2274-82. [PMID: 25035921 DOI: 10.1021/cb500360c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The bacterial peptidoglycan biosynthesis pathway provides multiple targets for antibacterials, as proven by the clinical success of β-lactam and glycopeptide classes of antibiotics. The Mur ligases play an essential role in the biosynthesis of the peptidoglycan building block, N-acetyl-muramic acid-pentapeptide. MurC, the first of four Mur ligases, ligates l-alanine to UDP-N-acetylmuramic acid, initiating the synthesis of pentapeptide precursor. Therefore, inhibiting the MurC enzyme should result in bacterial cell death. Herein, we report a novel class of pyrazolopyrimidines with subnanomolar potency against both Escherichia coli and Pseudomonas aeruginosa MurC enzymes, which demonstrates a concomitant bactericidal activity against efflux-deficient strains. Radio-labeled precursor incorporation showed these compounds selectively inhibited peptidoglycan biosynthesis, and genetic studies confirmed the target of pyrazolopyrimidines to be MurC. In the presence of permeability enhancers such as colistin, pyrazolopyrimidines exhibited low micromolar MIC against the wild-type bacteria, thereby, indicating permeability and efflux as major challenges for this chemical series. Our studies provide biochemical and genetic evidence to support the essentiality of MurC and serve to validate the attractiveness of target for antibacterial discovery.
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Affiliation(s)
- Shahul Hameed P
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Praveena Manjrekar
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Murugan Chinnapattu
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Vaishali Humnabadkar
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Gajanan Shanbhag
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Chaitanyakumar Kedari
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Naina Vinay Mudugal
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Anisha Ambady
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Boudewijn L.M. de Jonge
- AstraZeneca Infection,
Innovative Medicines, 35 Gatehouse
Drive, Waltham, Massachusetts 02451, United States
| | - Claire Sadler
- Global Safety
Assessment,
AstraZeneca, Alderley Park, Mereside, Cheshire, United Kingdom
| | - Beena Paul
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Shubha Sriram
- AstraZeneca Infection,
Innovative Medicines, 35 Gatehouse
Drive, Waltham, Massachusetts 02451, United States
| | - Parvinder Kaur
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Supreeth Guptha
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Anandkumar Raichurkar
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Paul Fleming
- AstraZeneca Infection,
Innovative Medicines, 35 Gatehouse
Drive, Waltham, Massachusetts 02451, United States
| | - Charles J. Eyermann
- AstraZeneca Infection,
Innovative Medicines, 35 Gatehouse
Drive, Waltham, Massachusetts 02451, United States
| | - David C. McKinney
- AstraZeneca Infection,
Innovative Medicines, 35 Gatehouse
Drive, Waltham, Massachusetts 02451, United States
| | - Vasan K. Sambandamurthy
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Manoranjan Panda
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
| | - Sudha Ravishankar
- Innovative Medicines,
AstraZeneca India Pvt. Ltd., Bellary
Road, Hebbal, Bangalore 560024, India
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