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Andrade AQ, Widagdo I, Lim R, Kelly TL, Parfitt G, Pratt N, Bilton RL, Roughead EE. Correlation of frailty assessment metrics in one-year follow-up of aged care residents: a sub-study of a randomised controlled trial. Aging Clin Exp Res 2023; 35:2081-2087. [PMID: 37452224 PMCID: PMC10520153 DOI: 10.1007/s40520-023-02491-y] [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: 03/07/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Frailty is increasingly recognised as a dynamic syndrome, with multiple causes, dimensions and consequences. There is little understanding of how those frailty assessment metrics interact over time. The aim of this study was to describe the longitudinal correlation between five frailty metrics, namely multimorbidity, muscular strength, mood alterations, cognitive capacity, and functional capacity in a cohort study of aged care (nursing home) residents. METHODS 248 aged care residents with Frailty Index at baseline of < 0.4 and no dementia were followed for 12 months. A multimorbidity score and an activity of daily living limitation score were created using individual items of the Frailty Index. Muscular strength was measured by grip strength. Cognitive capacity was measured using the Montreal Cognitive Assessment (MoCA) test. Mood alterations were measured using the anxiety/depression screening question from EQ-5D. We analysed the inter-individual correlation at baseline, association between baseline and future change, and within-individual correlation at baseline, 6 and 12 months. RESULTS Population analysis shows that metrics were not associated at baseline. All of the studied metrics at baseline were associated with change in 12 months, with the exception of anxiety/depression scores. Pairwise within-individual correlation was strong between MoCA and grip strength (0.13, p = 0.02) and activity of daily living (- 0.48, p < 0.001), and between activities of daily living and multimorbidity index (0.28, p < 0.001). No within-individual correlation was found between anxiety depression score and other metrics. CONCLUSION The results suggest an interdependence between comorbidities, physical capacity, cognition and activities of daily living in aged care residents. Comprehensive measurement of frailty-related metrics may provide improved understanding of frailty progression at later life stages.
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Affiliation(s)
- A Q Andrade
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia.
| | - I Widagdo
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
| | - R Lim
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
| | - T-L Kelly
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
| | - G Parfitt
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - N Pratt
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
| | - R L Bilton
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - E E Roughead
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
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Katsiroumpas E, Dunsmure L, Lim R. A service evaluation of patient care relating to Clostridioides difficile infection (CDI) in Oxford University Hospital NHS Foundation. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Introduction
The bacterium Clostridioides difficile (C. difficile) frequently colonises the human intestine. In an adult who is healthy, this organism is relatively harmless. However, disruption of the normal gut flora, which is frequently brought on by the use of antibiotics, can result in Clostridioides difficile (C. difficile) infection (CDI). As a result, C. difficile can grow and produce a toxin that causes diarrhoea. Due to the ease with which C. difficile can be spread in healthcare environments, it is essential to recognise and treat CDI patients as soon as possible and in accordance with best practises.
Aim
This service evaluation aimed to explore and understand how adult inpatients presenting with diarrhoea where (CDI is suspected are managed according to Trust Clostridioides difficile guidelines.
Methods
Purposive sampling of up to 100 adult inpatients presenting with diarrhoea where C. difficile is suspected and the patient has been an in-patient for least 48 hours post sample request. A data collection tool was developed, pilot tested and used to collect patient data from the Oxford University Hospital's Electronic Prescribing Record. Data was analysed using descriptive statistics and the Functional Resonance Analysis Method (FRAM) that involved 1) Identifying and describing key functions relating to the management of patients 2) Identifying variability in performing key functions and 3) Determine the possibility of function resonance. Ethical approval was obtained from University of Reading.
Results
Fifty patient records were accessed. The results showed that many patients had a stool sample sent for review as soon as possible, a clinical review of their condition and where there was the absence of a strong suspicion or strong evidence of C. Difficile a delay in the initiation of empirical therapy. Documentation was an area with poor compliance to guidelines. 50 % had a Bristol stool chart completed before sample sent and after CDI suspected, 60 % had isolation of the patient documented, 47 % had placement of contact precautions documented, and 20 % had documentation of discontinuation of empirical therapy. A FRAM model was developed and a total of 14 functions were identified with three functions “Record Bristol stool charts”, “clinical review of the patient”, and “placement of contact precautions” being most connected to the other functions, demonstrating the significance of these functions in the management of patients who are suspected of having CDI.
Discussion/Conclusion
The three key tasks outlined by FRAM are important to ensure that provide patients with the best care. Understanding variability in how the functions identified in FRAM are performed is important to understand how work is performed in order to then design ways of working that benefits both patients and HCPs. Further work is required to explore this area.
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Affiliation(s)
| | - L Dunsmure
- Oxford University Hospitals NHS Foundation Trust
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3
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Ahmed F, Lim R, Moseley I, Hoang M, Wisco O, Robinson-Bostom L, Qureshi A, Cho E. 227 Socioeconomic predictors of melanoma Breslow thickness at a Rhode Island academic center. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.234] [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: 10/17/2022]
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Liu B, Lisberg A, Salehi-Rad R, Lee J, Tran LM, Krysan K, Lim R, Dumitras C, Jing Z, Oh M, Abtin F, Suh R, Genshaft S, Oh S, Fishbein G, O'Higgins CM, Kaul A, Kahlon K, Ashouri S, Goldman J, Elashoff D, Garon E, Dubinett S. Abstract CT219: Phase I trial of in situ vaccination with autologous CCL21 gene-modified dendritic cells (CCL21-DC) combined with pembrolizumab for advanced non-small cell lung cancer (NSCLC). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although immune checkpoint blockade (ICB) targeting Programmed Death-1/Programmed Death-Ligand 1 (PD-1/PD-L1) alone or in combination with chemotherapy is now a first-line option for patients with advanced NSCLC, the majority of patients do not benefit from anti-PD-1/PD-L1 monotherapy, and the combination with chemotherapy is often associated with toxicity. For patients who initially respond to PD-1/PD-L1 inhibition, many relapse after an initial response and are in need for innovative strategies to overcome the resistance to ICB. One possible approach is to utilize in situ vaccination with functional chemokine gene-modified antigen presenting cells (APCs) that take advantage of the full repertoire of tumor antigens in the tumor microenvironment (TME) in order to restore tumor antigen presentation, promote tumor infiltration of immune cells driven by chemokine gradient, and facilitate tumor-specific T cell activation, both locally and systemically. The chemokine CCL21 is a therapeutic candidate due to its ability to promote infiltration and co-localization of naïve T cells and antigen-experienced dendritic cells (DCs) and facilitate T cell activation. In preclinical studies as well as a phase I clinical trial, we observed that intratumoral (IT) injection of CCL21-DC induces the infiltration of autologous DC and T cells into the TME, and generates systemic tumor-specific immune responses against multiple tumor antigens. We also observed tumoral PD-L1 upregulation following CCL21-DC injection, which may hinder T cell function. Similarly, the lack of efficacy of PD-1/PD-L1 inhibitors could potentially be combated by enhanced T cell infiltration and augmented APC function in the TME following in situ vaccination with CCL21-DC. Therefore, we are currently evaluating the safety and efficacy of combining IT CCL21-DC and intravenous (IV) pembrolizumab in advanced NSCLC patients following progression on ICB or tyrosine kinase inhibitor (TKI) therapy in a phase I trial (NCT03546361).
Methods: Phase I, dose-escalating, multi-cohort trial followed by dose expansion. Maximum of 24 patients (9-12 escalation + 12 expansion) with stage IV NSCLC will be evaluated who have tumors accessible for IT injection and are either EGFR/ALK wild-type after progression on a PD-(L)1 inhibitor or EGFR/ALK mutant after progression on TKI. Three IT injections of autologous CCL21-DC (days 0, 21, 42) will be concurrently administered with pembrolizumab, followed by q3wk pembrolizumab up to 1 year. Primary objective of dose escalation is safety and determination of maximum tolerated dose (MTD) of IT CCL21-DC when combined with pembrolizumab. Primary objective of dose expansion is objective response rate at MTD. Secondary objectives include adverse event profiling and immune monitoring studies.
[B.L. and A.L. contributed equally to this work as first authors.]
Citation Format: Bin Liu, Aaron Lisberg, Ramin Salehi-Rad, Jay Lee, Linh M. Tran, Kostyantyn Krysan, Raymond Lim, Camelia Dumitras, Zhe Jing, Michael Oh, Fereidoun Abtin, Robert Suh, Scott Genshaft, Scott Oh, Gregory Fishbein, Ciara M. O'Higgins, Anita Kaul, Kanwarpal Kahlon, Shahryar Ashouri, Jonathan Goldman, David Elashoff, Edward Garon, Steven Dubinett. Phase I trial of in situ vaccination with autologous CCL21 gene-modified dendritic cells (CCL21-DC) combined with pembrolizumab for advanced non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT219.
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Lisberg AE, Liu B, Salehi-Rad R, Lee JM, Tran L, Krysan K, Lim R, Dumitras C, Jiang Z, Abtin F, Suh R, Genshaft S, Oh S, Fishbein GA, O'Higgins CM, Ashouri S, Goldman JW, Elashoff D, Garon EB, Dubinett SM. Phase I trial of in situ vaccination with autologous CCL21-modified dendritic cells (CCL21-DC) combined with pembrolizumab for advanced NSCLC. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9154 Background: Effective immunotherapy options are lacking for patients with advanced non-small cell lung cancer (NSCLC) who progress on a programmed cell death-(ligand)1 [PD-(L)1] inhibitor and for those that are epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement positive after progression on tyrosine kinase inhibitor (TKI) therapy. One potential approach to improve immune checkpoint efficacy in these patient populations is to promote cytolytic T cell infiltration into tumors. This can be accomplished via in situ vaccination with functional antigen presenting cells (APCs) which can take advantage of the full repertoire of tumor antigens and convert the tumor into a lymph node-like environment promoting both local and systemic T cell activation. The chemokine CCL21 promotes co-localization of naive T cells and antigen-experienced dendritic cells (DCs) to facilitate T cell activation. Our preclinical studies and phase I trial of intratumoral (IT) administration of DC genetically modified to overexpress CCL21 (CCL21-DC) revealed augmentation of tumor antigen presentation in situ, resulting in systemic antitumor immunity. However, increased PD-L1 expression was observed in some patient tumors, suggesting that tumor-mediated impairment of T cell function may be forestalling a more robust CCL21-DC mediated antitumor response. Similarly, improved PD-(L)1 inhibitor efficacy may be possible with enhanced T cell infiltration and augmented APC function following IT CCL21-DC. Therefore, we are conducting a phase I trial, combining IT CCL21-DC with pembrolizumab in patients with advanced NSCLC that are either (1) EGFR/ALK wild-type after progression on a PD-(L)1 inhibitor or (2) EGFR/ALK mutant after progression on TKI therapy. Methods: Phase I, dose-escalating, multi-cohort trial followed by dose expansion. Maximum of 24 patients (9-12 escalation + 12 expansion) with stage IV NSCLC will be evaluated who have tumors accessible for IT injection and are either (1) EGFR/ALK wild-type after progression on a PD-(L)1 inhibitor or (2) EGFR/ALK mutant after progression on TKI therapy. Three IT injections of autologous CCL21-DC (days 0, 21, 42) will be concurrently administered with pembrolizumab, followed by q3wk pembrolizumab up to 1 year. Primary objective of dose escalation is safety and determination of maximum tolerated dose (MTD) of IT CCL21-DC (5x106, 1x107, or 3x107) when combined with pembrolizumab. Primary objective of dose expansion is objective response rate at MTD. Secondary objectives include adverse event profiling and determination of drug target activity by immune monitoring studies. This trial is currently open for enrollment. Clinical trial information: NCT03546361.
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Affiliation(s)
| | - Bin Liu
- University of California-Los Angeles, Los Angeles, CA
| | | | - Jay M. Lee
- University of California-Los Angeles, Los Angeles, CA
| | - Linh Tran
- University of California-Los Angeles, Los Angeles, CA
| | | | - Raymond Lim
- University of California-Los Angeles, Los Angeles, CA
| | | | - Zhe Jiang
- University of California-Los Angeles, Los Angeles, CA
| | - Fereidoun Abtin
- Univercity of California at Los Angeles (UCLA), Los Angeles, CA
| | - Robert Suh
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Scott Oh
- University of California-Los Angeles, Los Angeles, CA
| | | | | | - Shay Ashouri
- David Geffen School of Medicine at UCLA, Westlake Village, CA
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Lee K, Le T, Lim R, Hanna G, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Hau E. PO-1276 A review into the radiological features predicting local recurrence post-SABR in patients with NSCLC. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Khan X, Lim R, Rymer C, Ray P. Fijian farmers’ attitude and knowledge towards antimicrobial use and antimicrobial resistance in livestock production systems: a qualitative study. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac021.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Antimicrobial resistance (AMR) is a global health issue to humans and livestock (1). To mitigate AMR risks, responsible use of antimicrobials in livestock production systems have been advocated (1). Studies have demonstrated the patterns of antimicrobial use (AMU) in livestock production systems; however, there is limited information on the drivers of AMU. For successful antimicrobial stewardship (AMS), identifying the psychological (knowledge and attitude) and contextual drivers (environmental factors, economic status, and resource accessibility) for intervention is a crucial first step in the agri-food value chain. The theory of planned behaviour (TPB) has been used to understand behaviour influenced by a person’s intention, attitude, and knowledge; therefore, evaluating behaviour allows understanding of drivers that affect and shape the farmers’ intention and decisions (2).
Aim
To explore and understand the attitude and knowledge of Fijian livestock farmers on AMU and AMR.
Methods
Face to face one-to-one semi-structured qualitative interviews were conducted between September and November 2019 with Fijian livestock farmers and managers located in the Central and Western divisions of Viti Levu, Fiji. A sample of at least 20 participants from the cattle and poultry production systems was targeted and recruited using purposive and snowball sampling methods. TPB informed the development of the semi-structured interview guide. The interviews were audio-recorded and analysed inductively using Braun and Clarke’s reflexive thematic analysis and deductively using the TPB framework (results reported elsewhere). An interpretative approach underpinned the design and conduct of this study.
Results
Nineteen livestock farmers and managers took part in interviews. Our analysis generated four themes: 1) Uninformed use of antimicrobials and unaware of AMR, 2) Safeguarding livestock and generating income source as primary motivators for using medicine, 3) Medicine shortage resulting in hoarding and self-prescribing, and 4) Foreign farmers and veterinarians trusted over Fijian veterinarian and para-veterinarian knowledge. Livestock farmers did not differentiate amongst different types of medicine, including antimicrobials. Therefore, antimicrobials were unwittingly used and without an awareness of the risks of AMR. Medicines, including antimicrobials, were used to protect livestock and promote production for food and financial security. Farmers hoarded medicines and self-prescribed them on the farms. Farmers lacked confidence in the advice on livestock management, and medicine use, provided by Fijian veterinarians and para-veterinarians. They sought help online and from foreign farmers and veterinarians. No participant sought advice from pharmacists who are experts in medicine.
Conclusion
This study uncovered the first documented accounts of Fijian livestock farmers’ attitude and knowledge on AMU and AMR. AMS programmes promoting awareness and rational use of antimicrobials and resistance in Fijian livestock production is recommended. These programmes need to consider the social, economic, and environmental factors driving irrational medicine use by farmers. We acknowledge the views shared by participants may not be representative of all farmers in Fiji; however, we believe all participants provided in-depth insight into the current drivers of AMU. Future studies exploring the attitude and knowledge of Fijian veterinarians, para-veterinarians and pharmacists on AMU and AMR in livestock production can inform the design of AMS programmes that currently do not exist.
References
(1) WHO. Antimicrobial Resistance Geneva Switzerland: World Health Organization; 2021 [cited 2021 1 September]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance.
(2) Ajzen I. The theory of planned behaviour. Organizational Behaviour and Human Decision Processes. 1991;50(2):179-211.
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Affiliation(s)
- X Khan
- Department of Animal Sciences, University of Reading, Reading, United Kingdom
| | - R Lim
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
| | - C Rymer
- Department of Animal Sciences, University of Reading, Reading, United Kingdom
| | - P Ray
- Department of Animal Sciences, University of Reading, Reading, United Kingdom
- The Nature Conservancy, Arlington, Virginia, USA
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Dagnone JD, Brooks J, Mann M, Cameron B, Gray S, Poonja Z, Lim R. Reconceptualizing ER physician wellness in the midst of the pandemic: survival through the lens of personal agency. CAN J EMERG MED 2022; 24:16-19. [PMID: 34928492 PMCID: PMC8686091 DOI: 10.1007/s43678-021-00253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- J D Dagnone
- Emergency Medicine, Queen's University, Kingston, ON, Canada.
| | - J Brooks
- College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - M Mann
- Emergency Medicine, Stratford General Hospital, Stratford, ON, Canada
| | - B Cameron
- Michael Garron Hospital, Toronto, ON, Canada
| | - S Gray
- St. Michael's Hospital, Toronto, ON, Canada
| | - Z Poonja
- Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - R Lim
- Paediatric Emergency Medicine, Western University, London, ON, Canada
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Lisberg A, Liu B, Salehi-Rad R, Lee J, Tran L, Kostyantyn K, Lim R, Dumitras C, Jing Z, Abtin F, Suh R, Genshaft S, Fishbein G, Kaul A, Kahlon K, Ashouri S, Goldman J, Elashoff D, Garon E, Dubinett S. P11.01 Phase I Trial of in Situ Vaccination With Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined With Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.320] [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: 10/20/2022]
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Saggese P, Martinez CA, Tran LM, Lim R, Dumitras C, Grogan T, Elashoff D, Ramin SR, Dubinett SM, Liu B, Scafoglio C. Genotoxic Treatment Enhances Immune Response in a Genetic Model of Lung Cancer. Cancers (Basel) 2021; 13:cancers13143595. [PMID: 34298808 PMCID: PMC8307650 DOI: 10.3390/cancers13143595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023] Open
Abstract
Recent advances in immunotherapy have reshaped the clinical management of lung cancer, and immune checkpoint inhibitors (ICIs) are now first-line treatment for advanced lung cancer. However, the majority of patients do not respond to ICIs as single agents, and many develop resistance after initial responses. Therefore, there is urgent need to improve the current ICI strategies. Murine models currently available for pre-clinical studies have serious limitations for evaluating novel immunotherapies. GEMMs are reliable and predictable models driven by oncogenic mutations mirroring those found in cancer patients. However, they lack the mutational burden of human cancers and thus do not elicit proper immune surveillance. Carcinogen-induced models are characterized by mutational burden that more closely resembles human cancer, but they often require extremely long experimental times with inconsistent results. Here, we present a hybrid model in which genetically engineered mice are exposed to the carcinogen N-Methyl-N-Nitrosourea (MNU) to increase tumor mutational burden (TMB), induce early-stage immune responses, and enhance susceptibility to ICIs. We anticipate that this model will be useful for pre-clinical evaluation of novel immunotherapies.
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Affiliation(s)
- Pasquale Saggese
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Cesar A. Martinez
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Linh M. Tran
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Raymond Lim
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Camelia Dumitras
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (T.G.); (D.E.)
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (T.G.); (D.E.)
| | - Salehi-Rad Ramin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Steven M. Dubinett
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Bin Liu
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
| | - Claudio Scafoglio
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (P.S.); (C.A.M.); (L.M.T.); (R.L.); (C.D.); (S.-R.R.); (S.M.D.); (B.L.)
- Correspondence: ; Tel.: +1-310-825-9577
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11
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Lisberg AE, Liu B, Salehi-Rad R, Lee JM, Tran L, Krysan K, Lim R, Dumitras C, Jiang Z, Abtin F, Suh R, Genshaft S, Fishbein G, Kaul A, Kahlon K, Ashouri S, Goldman JW, Elashoff D, Garon EB, Dubinett SM. Phase I trial of in situ vaccination with autologous CCL21-modified dendritic cells (CCL21-DC) combined with pembrolizumab for advanced NSCLC. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9135 Background: Effective immunotherapy options are lacking for patients with advanced non-small cell lung cancer (NSCLC) who progress on a programmed cell death-(ligand)1 [PD-(L)1] inhibitor and for those that are epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement positive after progression on tyrosine kinase inhibitor (TKI) therapy. One potential approach to improve immune checkpoint efficacy in these patient populations is to promote cytolytic T cell infiltration into tumors. This can be accomplished via in situ vaccination with functional antigen presenting cells (APCs) which can take advantage of the full repertoire of tumor antigens and convert the tumor into a lymph node-like environment promoting both local and systemic T cell activation. The chemokine CCL21 promotes co-localization of naive T cells and antigen-experienced dendritic cells (DCs) to facilitate T cell activation. Our preclinical studies and phase I trial of intratumoral (IT) administration of DC genetically modified to overexpress CCL21 (CCL21-DC) revealed augmentation of tumor antigen presentation in situ, resulting in systemic antitumor immunity. However, increased PD-L1 expression was observed in some patient tumors, suggesting that tumor-mediated impairment of T cell function may be forestalling a more robust CCL21-DC mediated antitumor response. Similarly, improved PD-(L)1 inhibitor efficacy may be possible with enhanced T cell infiltration and augmented APC function following IT CCL21-DC. Therefore, we are conducting a phase I trial, combining IT CCL21-DC with pembrolizumab in patients with advanced NSCLC that are either (1) EGFR/ALK wild-type after progression on a PD-(L)1 inhibitor or (2) EGFR/ALK mutant after progression on TKI therapy. Methods: Phase I, dose-escalating, multi-cohort trial followed by dose expansion. Maximum of 24 patients (9-12 escalation + 12 expansion) with stage IV NSCLC will be evaluated who have tumors accessible for IT injection and are either (1) EGFR/ALK wild-type after progression on a PD-(L)1 inhibitor or (2) EGFR/ALK mutant after progression on TKI therapy. Three IT injections of autologous CCL21-DC (days 0, 21, 42) will be concurrently administered with pembrolizumab, followed by q3wk pembrolizumab up to 1 year. Primary objective of dose escalation is safety and determination of maximum tolerated dose (MTD) of IT CCL21-DC (5x106, 1x107, or 3x107) when combined with pembrolizumab. Primary objective of dose expansion is objective response rate at MTD. Secondary objectives include adverse event profiling and determination of drug target activity by immune monitoring studies. This trial, NCT03546361, is currently open for enrollment. Clinical trial information: NCT03546361.
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Affiliation(s)
| | - Bin Liu
- University of California, Los Angeles, Los Angeles, CA
| | | | - Jay M. Lee
- University of California, Los Angeles, Los Angeles, CA
| | - Linh Tran
- University of California, Los Angeles, Los Angeles, CA
| | | | - Raymond Lim
- University of California, Los Angeles, Los Angeles, CA
| | | | - Zhe Jiang
- University of California, Los Angeles, Los Angeles, CA
| | - Fereidoun Abtin
- Univercity of California at Los Angeles (UCLA), Los Angeles, CA
| | - Robert Suh
- University of California, Los Angeles, Los Angeles, CA
| | | | | | - Anita Kaul
- University of California, Los Angeles, Los Angeles, CA
| | | | - Shay Ashouri
- University of California, Los Angeles, Los Angeles, CA
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12
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Li A, Barabadi M, Kusuma G, James D, Lim R. Improving cell viability using counterflow centrifugation elutriation. Cytotherapy 2021. [DOI: 10.1016/s1465324921005879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Sampaio Rodrigues T, Koshy A, Gow P, Nerlekar N, Testro A, Lim R, Smith G, Farouque O. Long-Term Prognostic Value of Coronary Artery Disease - Reporting and Data System (CAD-RADS) Score for Cardiovascular Events in Asymptomatic Liver Transplant Recipients. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.229] [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: 10/20/2022]
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14
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Sampaio Rodrigues T, Nerlekar N, Gow P, Testro A, Lim R, Smith G, Farouque O. Risk Factors for Advanced Atherosclerosis Detected on Computed Tomography Coronary Angiography in Patients with Liver Cirrhosis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Liu Y, Lim R, Chanchareonsook N, Walboomers XF, Jansen JA, Saffari SE, Goh BT. Third-generation modular mandible endoprosthesis in Macaca fascicularis. Int J Oral Maxillofac Surg 2020; 50:887-894. [PMID: 33272771 DOI: 10.1016/j.ijom.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 09/24/2020] [Indexed: 10/22/2022]
Abstract
The aim of this study was to develop a third-generation modular mandible endoprosthesis that would experience less stress concentration at its stems compared to earlier generations, thereby minimizing micromotion and achieving long-term stability. In this three-piece modular design, different degrees of movement were incorporated between the endoprosthesis module interfaces. It was hypothesized that this unique feature would minimize stress concentration at the stems and hence promote osseointegration during the early phase of implantation. The endoprosthesis system was made of commercially pure grade 4 titanium, machined and surface-treated, then sterilized and implanted in segmental mandible defects of nine Macaca fascicularis. Clinical, radiological, histological, and histomorphometric evaluations were performed 4 months post-implantation. The endoprosthesis systems with a degree of movement incorporated, exhibited superior performance compared to the rigid system: 30.9-34.8 times higher percentage bone-implant contact (P< 0.0001) and 3.4-4.1 times higher percentage bone area (P<0.0001), with osseointegration noted at the posterior stems. However, fibrous tissue encapsulation was noted around the majority of the anterior stems in all groups. Although the degree of movement was favourable for improving bone healing and stability of the endoprosthesis system, more work needs to be done to investigate other strategies to further reduce loading on the endoprosthesis to achieve predictable osseointegration at the stems.
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Affiliation(s)
- Y Liu
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore.
| | - R Lim
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.
| | - N Chanchareonsook
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore; Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore.
| | - X F Walboomers
- Department of Dentistry - Biomaterials, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - J A Jansen
- Department of Dentistry - Biomaterials, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - S E Saffari
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - B T Goh
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore; Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore.
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16
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Li R, Salehi-Rad R, Momcilovic M, Ong S, Lim R, Huang ZL, Tran L, Jing Z, Paul M, Teitell M, Minna J, Shackelford D, Kostyantyn K, Liu B, Dubinett S. Abstract 1016: Inhibition of chemokine-induced myeloid cells potentiates the anti-PD-1 response in KRAS/LKB1 mutant non-small cell lung cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Dysregulated inflammation dictated by oncogene/tumor suppressor mutations can often lead to an immune suppressive tumor microenvironment (TME). Lung tumors with LKB1 mutations account for 30% of KRAS-mutant non-small cell lung cancer (NSCLC). These tumors are particularly aggressive and resistant to immunotherapy despite a high mutational burden (TMB). The mechanisms of this impaired immunogenicity remain obscure. Here, we report that LKB1 loss leads to a heightened secretion of the ELR(+) CXC chemokines, including CXCL1, CXCL2, CXCL3, CXCL5, and CXCL8, in premalignant and cancerous cells in vitro. Among multiple NSCLC cell lines, cancer cells with both KRAS and LKB1 mutations tend to express higher levels of these ELR(+) CXC chemokines. Consistently, ectopic expression of LKB1 in LKB1-null cancer cells decreases the chemokine production. In a genetically-engineered mouse model, an elevation of these chemokines is also observed in KrasG12D;Lkb1-/- (KL) tumors compared to their KrasG12D (K) or KrasG12D;Tp53-/- (KP) counterparts. Mechanistic studies reveal that the LKB1-MARK axis regulates these chemokines in the premalignant cells. Immune phenotyping of KL or KrasG12D;Tp53+/-;Lkb1-/- (KPL) tumors in vivo demonstrates significantly increased granulocytic myeloid-derived suppressor cells (G-MDSCs), which harbor high levels of reactive oxygen species (ROS). Utilizing a syngeneic murine lung cancer model with a high TMB, we demonstrate that KPL tumors have a minimal response to anti-PD-1 therapy compared to KP tumors. Therefore, we hypothesize that G-MDSCs may cause resistance to anti-PD-1 monotherapy in KPL tumors. We find that inhibition of the G-MDSCs either by depletion or by reduction of ROS can potentiate the anti-PD-1 response and subsequently eliminate the KPL tumors. Investigation of the TME reveals that G-MDSC depletion primes tumor-infiltrating lymphocytes (TILs) for activation: there is an increased percentage of TILs with high Ki67 and PD-1 expression and an increased percentage of antigen presenting cells (macrophages and dendritic cells) with high PD-L1 expression. Combination with anti-PD-1 therapy enhances the function of these TILs, evidenced by IFN-γ and TNF-α secretion. Re-challenge of these mice three months after the initial combination therapy leads to a rapid tumor rejection, suggesting a durable systemic anti-tumor immune response. In conclusion, we find that LKB1 deficiency leads to an increased ELR(+) CXC chemokine production and tumor infiltration of G-MDSCs. Inhibition of G-MDSC enhances the efficacy of anti-PD-1 blockade in LKB1-deficient tumors bearing a high TMB.
Citation Format: Rui Li, Ramin Salehi-Rad, Milica Momcilovic, Stephanie Ong, Raymond Lim, Zi Ling Huang, Linh Tran, Zhe Jing, Manash Paul, Michael Teitell, John Minna, David Shackelford, Krysan Kostyantyn, Bin Liu, Steven Dubinett. Inhibition of chemokine-induced myeloid cells potentiates the anti-PD-1 response in KRAS/LKB1 mutant non-small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1016.
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Affiliation(s)
- Rui Li
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | | | | | - Stephanie Ong
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Raymond Lim
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Zi Ling Huang
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Linh Tran
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Zhe Jing
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Manash Paul
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
| | | | - John Minna
- 2University of Texas Southwestern Medical Center, TX
| | | | | | - Bin Liu
- 1UCLA David Geffen School of Medicine, Los Angeles, CA
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17
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Kusuma G, Lim R. Characterisation of extracellular vesicles surface markers and co-expression studies with single particle interferometric imaging platform. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Kusuma G, Li A, Zhu D, McDonald H, Chambers D, Frith J, Lim R. Engineering mesenchymal stem cell paracrine activity with 3D culture. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.064] [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: 10/24/2022]
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19
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Lim R, Stefanato CM, Rickaby W, Morley AMS. Periocular discoid lupus erythematosus: diagnostic challenges of a clinical and histopathological masquerader. Clin Exp Dermatol 2020; 45:613-615. [PMID: 32048320 DOI: 10.1111/ced.14192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- R Lim
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C M Stefanato
- Department of Dermatopathology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - W Rickaby
- Department of Dermatopathology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A M S Morley
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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20
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Russell D, Cole W, Yheulon C, Wren S, Kellicut D, Lim R. USA Department of Defense audit of surgical antibiotic prophylaxis prescribing patterns in inguinal hernia repair. Hernia 2020; 25:159-164. [PMID: 32107656 DOI: 10.1007/s10029-020-02145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Antibiotic prophylaxis in inguinal hernia repair (IHR) is contentious in literature and practice. In low-risk patients, for whom evidence suggests antibiotic prophylaxis is unnecessary, many surgeons still advocate for its routine use. This study surveys prescription patterns of Department of Defense (DoD) general surgeons. METHODS An anonymous survey was sent electronically to approximately 350 DoD general surgeons. The survey asked multiple-choice and free text answers about prescribing patterns and knowledge of current evidence for low-risk patients undergoing elective open inguinal hernia repair without mesh (OIHRWOM), open inguinal hernia repair with mesh (OIHRWM), or laparoscopic inguinal hernia repair (LIHR). RESULTS 110 DoD general surgeons consented to participate. 58.6, 95 and 84.2% of surgeons always administer antibiotic prophylaxis in OIHRWOM, OIHRWM, and LIHR, respectively. 37.9, 70.9, and 63.2% of surgeons believe that it reduces rates of surgical site infection in OIHRWOM, OIHRWM, and LIHR, respectively. The most common reasons for empirically prescribing antibiotic prophylaxis include "I think the evidence supports it" (27 of 72 responses), "I would rather be conservative and safe" (15 of 72 responses), and "I am following my hospital/department guidelines" (9 of 72 responses). 11.8, 40.8, and 32.9% of surgeons believe current evidence supports antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. 50, 18.4, and 22.4% of surgeons believe current evidence refutes antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. CONCLUSION The survey results indicate that the majority of practicing DoD general surgeons still empirically prescribe surgical antibiotic prophylaxis in IHR despite more conflicting opinions that it has no meaningful effect or that current evidence does not supports its use.
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Affiliation(s)
- D Russell
- Tripler Army Medical Center, Honolulu, HI, 96815, USA.
| | - W Cole
- Tripler Army Medical Center, Honolulu, HI, 96815, USA
| | - C Yheulon
- Tripler Army Medical Center, Honolulu, HI, 96815, USA
| | - S Wren
- Stanford University, Stanford, CA, 94305, USA
| | - D Kellicut
- Tripler Army Medical Center, Honolulu, HI, 96815, USA
| | - R Lim
- University of Oklahoma, Tulsa, OK, 74104, USA
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21
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Rhee J, Vance TM, Lim R, Christiani DC, Qureshi AA, Cho E. Association of blood mercury levels with nonmelanoma skin cancer in the U.S.A. using National Health and Nutrition Examination Survey data (2003-2016). Br J Dermatol 2020; 183:480-487. [PMID: 32020585 DOI: 10.1111/bjd.18797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some studies have reported increased incidence or mortality of lung and brain cancers associated with occupations involving potential mercury exposure. Epidemiological evidence related to skin cancer is also limited. OBJECTIVES To investigate the association between blood mercury (Hg) levels and nonmelanoma skin cancer (NMSC). METHODS We used National Health and Nutrition Examination Survey data from 2003 to 2016. The exposures were blood total (tHg), inorganic (iHg) and methylmercury (MeHg). The outcome was a self-reported diagnosis of NMSC. We included participants aged ≥ 20 years who had information on blood mercury and sociodemographic factors. We conducted a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of NMSC associated with quartiles of blood Hg, after adjusting for the sociodemographic factors and survey year. RESULTS The number of participants was 29 413; mean age was 49 years and 52% were female. Compared with those with a tHg ≤ 0·47 μg L-1 (Q1), those with a tHg > 1·74 μg L-1 (Q4) had nearly double the odds of NMSC (OR 1·79, 95% CI 1·19-2·71; Ptrend = 0·004). Similarly, those in the highest quartile of MeHg (> 1·44 μg L-1 ) had 1·7 times greater odds of NMSC (OR 1·74, 95% CI 1·13-2·70; Ptrend = 0·01) than those in the lowest quartile (≤ 0·21 μg L-1 ). iHg levels were nonsignificantly positively associated with NMSC (Ptrend = 0·08). CONCLUSIONS We found that higher blood tHg and MeHg levels were associated with a higher prevalence of NMSC. Linked Comment: Taylor. Br J Dermatol 2020; 183:413-414.
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Affiliation(s)
- J Rhee
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - T M Vance
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - R Lim
- Brown University, Providence, RI, U.S.A
| | - D C Christiani
- Department of Environmental Health, Harvard University, Boston, MA, U.S.A.,Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A
| | - A A Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, U.S.A.,Department of Epidemiology, Brown School of Public Health, Providence, RI, U.S.A
| | - E Cho
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, U.S.A.,Department of Epidemiology, Brown School of Public Health, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
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22
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Salehi-Rad R, Li R, Lim R, Tran L, Abascal J, Ong S, Liu B, Dubinett S. A35 Dendritic Cell in Situ Vaccination Potentiates Anti-PD-1 Efficacy and Induces Immunoediting in a Murine Model of NSCLC. J Thorac Oncol 2020. [DOI: 10.1016/j.jtho.2019.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Thakur U, Michail M, Comella A, Tan S, Lim R, Gupta V, Rashid H, Brown A. 831 Functionally Significant Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation is Associated With Increased Mortality. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Yeong C, Conners G, Cox S, Garrahy P, Kyranis S, Lim R, McCann A, Moore P, Singbal Y, Camuglia A. 902 Time to First Device Time in ST Elevation Myocardial Infarction (STEMI) at a High-Volume STEMI Centre Stratified by Access Site Approach. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Poppi LA, Holt JC, Lim R, Brichta AM. A review of efferent cholinergic synaptic transmission in the vestibular periphery and its functional implications. J Neurophysiol 2019; 123:608-629. [PMID: 31800345 DOI: 10.1152/jn.00053.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
It has been over 60 years since peripheral efferent vestibular terminals were first identified in mammals, and yet the function of the efferent vestibular system remains obscure. One reason for the lack of progress may be due to our deficient understanding of the peripheral efferent synapse. Although vestibular efferent terminals were identified as cholinergic less than a decade after their anatomical characterization, the cellular mechanisms that underlie the properties of these synapses have had to be inferred. In this review we examine how recent mammalian studies have begun to reveal both nicotinic and muscarinic effects at these terminals and therefore provide a context for fast and slow responses observed in classic electrophysiological studies of the mammalian efferent vestibular system, nearly 40 years ago. Although incomplete, these new results together with those of recent behavioral studies are helping to unravel the mysterious and perplexing action of the efferent vestibular system. Armed with this information, we may finally appreciate the behavioral framework in which the efferent vestibular system operates.
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Affiliation(s)
- L A Poppi
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Preclinical Neurobiology Research Group, The University of Newcastle, Newcastle, NSW, Australia
| | - J C Holt
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - R Lim
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Preclinical Neurobiology Research Group, The University of Newcastle, Newcastle, NSW, Australia
| | - A M Brichta
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Preclinical Neurobiology Research Group, The University of Newcastle, Newcastle, NSW, Australia
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26
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Anderson JE, Ross AJ, Lim R, Kodate N, Thompson K, Jensen H, Cooney K. Nursing teamwork in the care of older people: A mixed methods study. Appl Ergon 2019; 80:119-129. [PMID: 31280795 DOI: 10.1016/j.apergo.2019.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people's wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = 65) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = 22; 34%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking.
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Affiliation(s)
- J E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
| | - A J Ross
- Dental School, University of Glasgow, UK
| | - R Lim
- Reading School of Pharmacy, University of Reading, UK
| | - N Kodate
- School of Applied Social Science, University College Dublin, UK
| | - K Thompson
- School of Social Science, Liverpool Hope University, UK
| | - H Jensen
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Cooney
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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27
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Li R, Salehi-Rad R, Ong S, Momcilovic M, Liu B, Lim R, Tran L, Huang Z, Jing Z, Paul M, Krysan K, Park S, Minna J, Teitell M, Shackelford D, Dubinett S. Abstract 2710: Depletion of CXCR2-dependent myeloid-derived suppressor cells (MDSCs) overcomes anti-PD-1 resistance in a murine model of LKB1-deficient non-small cell lung cancer (NSCLC) with high mutational load. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Checkpoint inhibitors such as PD-L1/PD-1 blockade have rapidly integrated into the paradigm of NSCLC treatment. However, a majority of patients do not benefit from monotherapy with checkpoint inhibitors. High tumor mutational burden (TMB), along with pre-existing intratumoral T cell infiltration and baseline high PD-L1 expression, predicts response to checkpoint blockade. Furthermore, a recent retrospective study identified LKB1 alterations as the most prevalent genomic driver of resistance to PD-1 axis inhibitors in KRAS-mutant lung adenocarcinoma. In this study, we investigate the mechanisms underlying LKB1-mediated immunosuppression in NSCLC. We show that loss of LKB1 in human bronchial epithelial cells (HBECs) and NSCLC cells leads to increased secretion of CXCR2 ligands, including CXCL1, CXCL2, CXCL3, CXCL5 and CXCL8. These CXCR2 ligands are also elevated in LKB1-deficient tumors from patient-derived xenografts and genetically-engineered murine models. We find abundant tumor infiltrating MDSCs in murine Lkb1-deficient NSCLC, consistent with the capacity for CXCR2 ligands to recruit MDSCs. MDSCs mediate potent immune suppressive activities at multiple levels including release of immunosuppressive cytokines, recruitment of regulatory T cells (Tregs), inhibition of CD8 T cell tumor infiltration and upregulation of PD-L1 expression. Although MDSC depletion activates interferon gamma signaling and decreases systemic Tregs in murine KrasK12D;Tp53-/-;Lkb1-/- (KPL) tumors, it does not sensitize KPL tumors to anti-PD-1 therapy. One of the major challenges in the preclinical assessment of lung cancer immunotherapy is that the commonly utilized murine models lack the mutational burden of human NSCLC. To assess this combination therapy in the context of a mutational burden that more accurately reflects the clinical disease, we generated tumors with high TMB by exposing KPL cells in vitroto the tobacco carcinogen N-methyl-N-nitrosourea. In the context of high TMB, MDSC depletion demonstrates remarkable anti-tumor effects in combination with anti-PD-1 therapy. Finally, we delineate the regulation of CXCR2 ligands by LKB1 which is dependent on the MARK-mediated NF-κB pathway. In conclusion, we find that LKB1 deficiency leads to increased CXCR2 ligand production and tumor infiltrating MDSCs. MDSC depletion enhances the efficacy of anti-PD-1 blockade in LKB1-deficient tumors bearing high TMB.
Citation Format: Rui Li, Ramin Salehi-Rad, Stephanie Ong, Milica Momcilovic, Bin Liu, Raymond Lim, Linh Tran, Ziling Huang, Zhe Jing, Manash Paul, Kostyantyn Krysan, Stacy Park, John Minna, Michael Teitell, David Shackelford, Steven Dubinett. Depletion of CXCR2-dependent myeloid-derived suppressor cells (MDSCs) overcomes anti-PD-1 resistance in a murine model of LKB1-deficient non-small cell lung cancer (NSCLC) with high mutational load [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2710.
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Di Saverio S, Gori A, Chisari E, Wheeler J, Lim R. Laparoscopic management of adhesive small bowel obstruction with strangulation: when to resect and how to distinguish reversible from nonreversible bowel ischaemia - a video vignette. Colorectal Dis 2019; 21:727-729. [PMID: 30933396 DOI: 10.1111/codi.14627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S Di Saverio
- Cambridge Colorectal and Emergency Surgery Unit, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Gori
- University of Bologna, Bologna, Italy
| | - E Chisari
- University of Catania, Catania, Italy
| | - J Wheeler
- Cambridge Colorectal and Emergency Surgery Unit, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Lim
- Tripler Army Medical Center, Tripler, Hawaii, USA
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Zhao C, Pan T, Dou T, Liu J, Liu C, Ge Y, Zhang Y, Yu X, Mitrovic S, Lim R. Making global river ecosystem health assessments objective, quantitative and comparable. Sci Total Environ 2019; 667:500-510. [PMID: 30833248 DOI: 10.1016/j.scitotenv.2019.02.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
Assessing and comparing global river ecosystem health in an objective and quantitative way remains a major challenge. In this study the widely-used semi-quantitative methods Rapid Biological assessment Protocols (RBPs) was used to determine the health of rivers. The findings were then compared to the results derived from our new UAV (Unmanned aerial vehicles) orthophotographic imagery method. This method quantitatively and objectively assesses river ecosystem health. As a comparison, our method was used to quantitatively measure distance and areas of a range of hydrological and biological attributes thus improving the accuracy of distance- and area-related indices, consequently avoiding subjective errors in these estimations that is fraught in methods like the RBPs. To strengthen the objectivity of the assessment the weights of these indices were objectively determined using the entropy weighting method. This new method was then tested using 9551 UAV orthophotographs taken over six field campaigns. It performed satisfactorily, showing that in our study area the health status of mountain rivers was the best with the highest score of 0.94 out of 1.0. Temporally, the health of the river was better in summer (0.65) compared with that in autumn (0.40). Changes in river ecosystem health were driven by variations in biology and water quality. In contrast the outputs of RBPs, especially in relation to distance and area indices, had ~ 20% uncertainty due to visual errors and subjectivity in estimations by observers. The UAV orthophotographic imaging method proposed in this study can improve the ability to compare the health of rivers across different periods and regions throughout the globe.
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Affiliation(s)
- C Zhao
- College of Water Sciences, Beijing Normal University, Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, Beijing 100875, PR China; ICube, UdS, CNRS (UMR 7357), 300 Bld Sebastien Brant, CS 10413, 67412 Illkirch, France
| | - T Pan
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - T Dou
- Jinan Survey Bureau of Hydrology and Water Resources, Jinan 250013, PR China
| | - J Liu
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055, PR China
| | - C Liu
- College of Water Sciences, Beijing Normal University, Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, Beijing 100875, PR China.
| | - Y Ge
- Jinan Survey Bureau of Hydrology and Water Resources, Jinan 250013, PR China
| | - Y Zhang
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - X Yu
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - S Mitrovic
- School of Life Sciences, Faculty of Science, University of Technology, Sydney, NSW 2007, Australia
| | - R Lim
- School of the Environment, Faculty of Science, University of Technology, Sydney, NSW 2007, Australia
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Gopalan A, Shaw PA, Lim R, Paramanund J, Patel D, Zhu J, Volpp KG, Buttenheim AM. Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health 2019; 19:674. [PMID: 31151390 PMCID: PMC6544953 DOI: 10.1186/s12889-019-6936-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Methods Members receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Results Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons. Conclusions None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. Trial registration NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-019-6936-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA94612, USA.
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond Lim
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Lim R, Sugino T, Nolte H, Andrade J, Zimmermann B, Shi C, Doddaballapur A, Ong YT, Wilhelm K, Fasse JWD, Ernst A, Kaulich M, Husnjak K, Boettger T, Guenther S, Braun T, Krüger M, Benedito R, Dikic I, Potente M. Deubiquitinase USP10 regulates Notch signaling in the endothelium. Science 2019; 364:188-193. [PMID: 30975888 DOI: 10.1126/science.aat0778] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022]
Abstract
Notch signaling is a core patterning module for vascular morphogenesis that codetermines the sprouting behavior of endothelial cells (ECs). Tight quantitative and temporal control of Notch activity is essential for vascular development, yet the details of Notch regulation in ECs are incompletely understood. We found that ubiquitin-specific peptidase 10 (USP10) interacted with the NOTCH1 intracellular domain (NICD1) to slow the ubiquitin-dependent turnover of this short-lived form of the activated NOTCH1 receptor. Accordingly, inactivation of USP10 reduced NICD1 abundance and stability and diminished Notch-induced target gene expression in ECs. In mice, the loss of endothelial Usp10 increased vessel sprouting and partially restored the patterning defects caused by ectopic expression of NICD1. Thus, USP10 functions as an NICD1 deubiquitinase that fine-tunes endothelial Notch responses during angiogenic sprouting.
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Affiliation(s)
- R Lim
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - T Sugino
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - H Nolte
- Institute for Genetics and Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D-50931 Cologne, Germany
| | - J Andrade
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - B Zimmermann
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - C Shi
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - A Doddaballapur
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - Y T Ong
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - K Wilhelm
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - J W D Fasse
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - A Ernst
- Institute of Biochemistry II, Faculty of Medicine, Goethe University, D-60590 Frankfurt am Main, Germany.,Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, D-60590 Frankfurt am Main, Germany
| | - M Kaulich
- Institute of Biochemistry II, Faculty of Medicine, Goethe University, D-60590 Frankfurt am Main, Germany
| | - K Husnjak
- Institute of Biochemistry II, Faculty of Medicine, Goethe University, D-60590 Frankfurt am Main, Germany
| | - T Boettger
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - S Guenther
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - T Braun
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany
| | - M Krüger
- Institute for Genetics and Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D-50931 Cologne, Germany
| | - R Benedito
- Molecular Genetics of Angiogenesis Laboratory, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - I Dikic
- Institute of Biochemistry II, Faculty of Medicine, Goethe University, D-60590 Frankfurt am Main, Germany.,Buchmann Institute for Molecular Life Sciences, Goethe University, D-60438 Frankfurt am Main, Germany
| | - M Potente
- Angiogenesis and Metabolism Laboratory, Max Planck Institute for Heart and Lung Research, D-61231 Bad Nauheim, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Frankfurt Rhine-Main, D-13347 Berlin, Germany.,International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
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Lim R, Li A, Kusuma G, Chan S, McPhee G, Fitzpatrick I, Wilson S, James D. Enabling clinical trials in an academic GMP setting through use of closed, semi-automated manufacturing of allogeneic amniotic epithelial cells. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baker E, Lim R, Malhotra A, Jacobs S, Davis P, Wallace E. Human amnion epithelial cells for the prevention of bronchopulmonary dysplasia: a phase 1 dose escalation study. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lim R, Lappas M. Expression and function of macrophage-inducible C-type lectin (Mincle) in inflammation driven parturition in fetal membranes and myometrium. Clin Exp Immunol 2019; 197:95-110. [PMID: 30793298 DOI: 10.1111/cei.13281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 12/31/2022] Open
Abstract
The pivotal role of inflammatory processes in human parturition is well known, but not completely understood. We have performed a study to examine the role of macrophage-inducible C-type lectin (Mincle) in inflammation-associated parturition. Using human samples, we show that spontaneous labour is associated with up-regulated Mincle expression in the myometrium and fetal membranes. Mincle expression was also increased in fetal membranes and myometrium in the presence of pro-labour mediators, the proinflammatory cytokines interleukin (IL)-1B and tumour necrosis factor (TNF), and Toll-like receptor (TLR) ligands fsl-1, poly(I:C), lipopolysaccharide (LPS) and flagellin. These clinical studies are supported by mouse studies, where an inflammatory challenge in a mouse model of preterm birth increased Mincle expression in the uterus. Importantly, elimination of Mincle decreased the effectiveness of proinflammatory cytokines and TLR ligands to induce the expression of pro-labour mediators; namely, proinflammatory cytokines and chemokines, contraction-associated proteins and prostaglandins, and extracellular matrix remodelling enzymes, matrix metalloproteinases. The data presented in this study suggest that Mincle is required when inflammatory activation precipitates parturition.
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Affiliation(s)
- R Lim
- Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - M Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
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Rodrigues TS, Azraai M, Crosthwaite A, Patel S, Farouque O, Ramchand J, Lim R, Roberts M, Ierino F, Burrell L. The Peguero-Lo Presti Criteria Improve the Sensitivity of the Electrocardiogram to Diagnose Left Ventricular Hypertrophy in Patients with End-Stage Kidney Disease. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Courtenay M, Lim R, Castro-Sanchez E, Deslandes R, Hodson K, Morris G, Reeves S, Weiss M, Ashiru-Oredope D, Bain H, Black A, Bosanquet J, Cockburn A, Duggan C, Fitzpatrick M, Gallagher R, Grant D, McEwen J, Reid N, Sneddon J, Stewart D, Tonna A, White P. Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education. J Hosp Infect 2018; 100:245-256. [PMID: 29966757 DOI: 10.1016/j.jhin.2018.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healthcare professionals are involved in an array of patient- and medicine-related stewardship activities, for which an understanding and engagement with antimicrobial stewardship (AMS) is important. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. AIM To provide UK national consensus on a common set of antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. METHODS A modified Delphi approach comprising two online surveys delivered to a UK national panel of 21 individuals reflecting expertise in prescribing and medicines management with regards to the education and practice of nurses and midwives, pharmacists, physiotherapists, and podiatrists; and antimicrobial prescribing and stewardship. Data collection took place between October and December 2017. FINDINGS A total of 21 participants agreed to become members of the expert panel, of whom 19 (90%) completed round 1 questionnaire, and 17 (89%) completed round 2. Panelists reached a consensus, with consistently high levels of agreement reached, on six overarching competency statements (subdivided into six domains), and 55 individual descriptors essential for antimicrobial stewardship by healthcare professionals. CONCLUSION Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.
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Affiliation(s)
- M Courtenay
- School of Health Sciences, Cardiff University, Cardiff, UK.
| | - R Lim
- Reading School of Pharmacy, Reading University, Reading, UK
| | - E Castro-Sanchez
- NIHR Health Protection Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - R Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - K Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - G Morris
- School of Health Sciences, Cardiff University, Cardiff, UK; Hywel Dda University Health Board, Carmarthen, UK
| | - S Reeves
- Faculty of Health, Social Care and Education, Kingston & St George's, University of London, London, UK
| | - M Weiss
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - D Ashiru-Oredope
- Antimicrobial Resistance Programme Public Health England, London, UK
| | - H Bain
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - A Black
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - J Bosanquet
- Antimicrobial Resistance Programme Public Health England, London, UK
| | - A Cockburn
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - C Duggan
- Royal Pharmaceutical Society, London, UK
| | | | | | - D Grant
- Reading School of Pharmacy, Reading University, Reading, UK
| | | | - N Reid
- Public Health Wales, Cardiff, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - D Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - A Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - P White
- Chartered Society of Physiotherapy, London, UK
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Lim R, Malhotra A, Mockler J, Wallace E. Allogeneic amniotic epithelial cells for established bronchopulmonary dysplasia in premature, low birthweight infants: A first-in-human safety trial. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.046] [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: 11/30/2022]
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Burian R, Appenzeller T, Oertle P, Raez C, Lim R, Forte S, Dellas S, Münst S, Obermann E, Plodinec M. Abstract OT1-06-05: Atomic force microscopy (AFM) - a novel nanotool for cancer diagnostics: A prospective, blinded study of nanomechanical profiling of human breast tissue as a potential biomarker for stratifying low- and high-risk breast cancer subtypes. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The crucial point in making treatment decisions for breast cancer patients is the assessment of tumour aggressiveness. The established prognostic markers may be insufficient to stratify cancer patients into treatment relevant risk groups. Emerging evidence indicates that mechanical properties of cancer cells and their microenvironment that occur on a nanometre scale play a critical role in cancer invasion and metastases. Therefore, detecting these nanomechanical changes could serve as biomarker of cancer aggressiveness.
Trial design
We conduct a prospective, blinded study in a routine clinical setting. Using minimal invasive breast biopsies we measure the nanomechanical (stiffness) properties of human breast tissue with our atomic force microscope (AFM) based method known as ARTIDIS (Automated and Reliable Tissue Diagnostics). These properties can only be measured using fresh (non-fixed) tissue under physiological conditions (Custodiol transplant buffer). This novel method is based on the use of a micro-fabricated 20nm-sharp tip that indents several thousand individual locations across tissue specimens within 60-180 minutes. Each indentation effectively measures the stiffness of local structures (e.g. cancer cells, extracellular matrix) located under the tip. Thus we obtain a quantitative, biopsy-wide, nanomechanical profile. Post-AFM the same biopsy is used for routine histopathological diagnosis, the current diagnostic gold standard to which the nanomechanical profile is then correlated.
Eligibility criteria
All women undergoing a minimal invasive breast biopsy (core needle or vacuum assisted biopsy) at the breast centre of the University of Basel.
Exclusion criteria: age younger than 18years, necrotic/disintegrated biopsy, and technical limitations
Specific aims
Our primary endpoint is to differentiate benign from cancerous breast lesions based on their nanomechanical properties. Our secondary endpoint is to subclassify biopsies with cancerous lesions into the current four main breast cancer subgroups (Luminal A, Luminal B, HER2+ and basal-like).
Statistical analysis
The full dataset will include all patients with valid AFM measurements. Primary analysis: the proportion of true positive results divided by the total number of patients with malignant tumour (sensitivity) will be estimated and presented together with its 95% confidence interval. The histological diagnosis of the same biopsy as analysed by AFM will serve as gold standard.
Present accrual and target accrual
Present accrual as of June 12, 2017: 200 breast tissue biopsies.
Target accrual is 508 biopsies. This will allow for a power of 0.8 and a sensitivity of 90%.
Contact information: Rosemarie.Burian@usb.ch
Citation Format: Burian R, Appenzeller T, Oertle P, Raez C, Lim R, Forte S, Dellas S, Münst S, Obermann E, Plodinec M. Atomic force microscopy (AFM) - a novel nanotool for cancer diagnostics: A prospective, blinded study of nanomechanical profiling of human breast tissue as a potential biomarker for stratifying low- and high-risk breast cancer subtypes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-05.
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Affiliation(s)
- R Burian
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - T Appenzeller
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - P Oertle
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - C Raez
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - R Lim
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Forte
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Dellas
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Münst
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - E Obermann
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - M Plodinec
- Breast Centre, University Hospital Basel, Basel, Switzerland; Biozentrum and the Swiss Nanoscience Institute, University of Basel, Basel, Switzerland; Kantonsspital Baden, Baden, Switzerland; Institute of Pathology, University Hospital Basel, Basel, Switzerland
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Ekmejian A, Eather S, Purvis C, Lim R, Zaky F, Sepahpour A. Characteristics and 4-Year Outcomes of Patients Presenting with Ventricular Arrhythmias to a Large Regional Centre. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.251] [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: 10/28/2022]
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Salehi H, Calafiore P, Neef P, Lim R, Smith G, Keraney L, Jones R, Ord M, Hughes T, Jones E, Srivastava P. Dobutamine Stress Echocardiography Compared with Coronary Computed Tomography Angiography in Screening for Coronary Artery Disease in End-Stage Liver Disease Patients Being Assessed for Liver Transplantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eather S, Ekmejian A, Lim R, Zaky F, Owensby D, Yeung A, Shetty P, Sepahpour A, Hsieh C, Lee A. Atrial Fibrillation: A Descriptive Study of Management in a Large Cardiology Practice. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.241] [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: 10/28/2022]
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Fuchshuber P, Schwaitzberg S, Jones D, Jones SB, Feldman L, Munro M, Robinson T, Purcell-Jackson G, Mikami D, Madani A, Brunt M, Dunkin B, Gugliemi C, Groah L, Lim R, Mischna J, Voyles CR. The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose. Surg Endosc 2017; 32:2583-2602. [PMID: 29218661 DOI: 10.1007/s00464-017-5933-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team. METHODS The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status. RESULTS The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE. CONCLUSIONS The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.
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Affiliation(s)
- P Fuchshuber
- Department of Surgery, Kaiser Walnut Creek Medical Center, The Permanente Medical Group, Inc., 1425 South Main Street, Walnut Creek, CA, 94596, USA.
| | - S Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo General Hospital, 100 High Street, D-352, Buffalo, NY, 14203, USA
| | - D Jones
- Harvard Medical School, Boston, MA, USA.,Office of Technology and Innovation, Boston, MA, USA.,Division of Minimally Invasive Surgical Services, Boston, MA, USA.,Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - S B Jones
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA.,Department of Anesthesia/Crit Care/Pain, BIDMC, Boston, MA, USA
| | - L Feldman
- Department of Surgery, McGill University Health Centre, 1650 Cedar Ave L9-309, Montreal, QC, H3G 1A4, Canada
| | - M Munro
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA and Kaiser Permanenete Los Angeles Medical Center, Los Angeles, CA, USA
| | - T Robinson
- Rocky Mountain VA Medical Center, University of Colorado, Aurora, Colorado, USA
| | - G Purcell-Jackson
- Vanderbilt University Medical Center, 2200 Children's Way, Doctor's Office Tower Suite 7100, Nashville, TN, 37232, USA
| | - D Mikami
- John A. Burn School of Medicine, University of Hawaii, 1356 Lusitania Street, 6th Floor, Honolulu, HI, 96813, USA
| | - A Madani
- Department of Surgery, McGill University, 1650 Cedar Ave, Rm D6-257, Montreal, QC, H3G 1A4, Canada
| | - M Brunt
- Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - B Dunkin
- Houston Methodist Institute for Technology, Innovation & Education, Institute for Academic Medicine, Houston Methodist, Weill Cornell Medical College, 6550 Fannin St #1601, Houston, TX, 77030, USA
| | - C Gugliemi
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - L Groah
- AORN, 2170 South Parker Road. Suite 400, Denver, CO, 80231, USA
| | - R Lim
- Uniformed Services University of Health Sciences, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 95869, USA
| | - J Mischna
- Fundamentals Department SAGES, 11300 West Olympic Blvd Suite 600, Los Angeles, CA, 90064, USA
| | - C R Voyles
- , 3838 Eastover Drive, Jackson, MS, 39211, USA
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Choi N, Ackman J, Lim R, Gainor J, Sharp G, El Fakhri G, Niemierko A. Robust Correlation between Immediate Post Radio-Chemotherapy FDG PET Response and Clinical Outcome and Impact of Salvage Radiation for Partial Metabolic Responders in Locally Advanced Non–Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1673] [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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Lim R. A more stable transition matrix for acoustic target scattering by highly oblate elastic objects. J Acoust Soc Am 2017; 142:1362. [PMID: 28964086 DOI: 10.1121/1.4998730] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In previous work, a variant of Waterman's transition (T) matrix utilizing an ansatz for problematic outgoing basis functions in standard formulations was proposed and demonstrated to improve the stability of free-field acoustic scattering calculations for elongated axisymmetric elastic objects. The ansatz replaced the basis causing instability with one consisting of low-order spherical functions made complete by distributing the functions along the axis within the object. Unfortunately, these bases are not as useful for expanding outgoing source fields along oblate axisymmetric surfaces. However, related work by Doicu, Eremin, and Wriedt, [Acoustic & Electromagnetic Scattering Analysis Using Discrete Sources, Academic Press, London (2000)], suggests using an alternate basis of low-order spherical functions made complete by analytically continuing them into the complex plane of the object's axial coordinate, distributing them along the imaginary axis of this plane. This paper will show that this alternative does extend the range of stability of our T-matrix formulation for highly oblate axisymmetric objects to frequencies attainable with competing spheroidal-basis T-matrix formulations. Nevertheless, the range is not as great as achieved for prolate shapes and an analysis of the residual noise sources suggest more optimal basis sets are possible that further stabilize scattering computations for such shapes.
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Affiliation(s)
- Raymond Lim
- Naval Surface Warfare Center Panama City Division, 110 Vernon Avenue, Panama City, Florida 32407, USA
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Volpp KG, Troxel AB, Mehta SJ, Norton L, Zhu J, Lim R, Wang W, Marcus N, Terwiesch C, Caldarella K, Levin T, Relish M, Negin N, Smith-McLallen A, Snyder R, Spettell CM, Drachman B, Kolansky D, Asch DA. Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial. JAMA Intern Med 2017; 177:1093-1101. [PMID: 28654972 PMCID: PMC5710431 DOI: 10.1001/jamainternmed.2017.2449] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Adherence to medications prescribed after acute myocardial infarction (AMI) is low. Wireless technology and behavioral economic approaches have shown promise in improving health behaviors. OBJECTIVE To determine whether a system of medication reminders using financial incentives and social support delays subsequent vascular events in patients following AMI compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Two-arm, randomized clinical trial with a 12-month intervention conducted from 2013 through 2016. Investigators were blinded to study group, but participants were not. Design was a health plan-intermediated intervention for members of several health plans. We recruited 1509 participants from 7179 contacted AMI survivors (insured with 5 large US insurers nationally or with Medicare fee-for-service at the University of Pennsylvania Health System). Patients aged 18 to 80 years were eligible if currently prescribed at least 2 of 4 study medications (statin, aspirin, β-blocker, antiplatelet agent), and were hospital inpatients for 1 to 180 days and discharged home with a principal diagnosis of AMI. INTERVENTIONS Patients were randomized 2:1 to an intervention using electronic pill bottles combined with lottery incentives and social support for medication adherence (1003 patients), or to usual care (506 patients). MAIN OUTCOMES AND MEASURES Primary outcome was time to first vascular rehospitalization or death. Secondary outcomes were time to first all-cause rehospitalization, total number of repeated hospitalizations, medication adherence, and total medical costs. RESULTS A total of 35.5% of participants were female (n = 536); mean (SD) age was 61.0 (10.3) years. There were no statistically significant differences between study arms in time to first rehospitalization for a vascular event or death (hazard ratio, 1.04; 95% CI, 0.71 to 1.52; P = .84), time to first all-cause rehospitalization (hazard ratio, 0.89; 95% CI, 0.73 to 1.09; P = .27), or total number of repeated hospitalizations (hazard ratio, 0.94; 95% CI, 0.60 to 1.48; P = .79). Mean (SD) medication adherence did not differ between control (0.42 [0.39]) and intervention (0.46 [0.39]) (difference, 0.04; 95% CI, -0.01 to 0.09; P = .10). Mean (SD) medical costs in 12 months following enrollment did not differ between control ($29 811 [$74 850]) and intervention ($24 038 [$66 915]) (difference, -$5773; 95% CI, -$13 682 to $2137; P = .15). CONCLUSIONS AND RELEVANCE A compound intervention integrating wireless pill bottles, lottery-based incentives, and social support did not significantly improve medication adherence or vascular readmission outcomes for AMI survivors. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01800201.
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Affiliation(s)
- Kevin G Volpp
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Health Care Management, Wharton School of the University of Pennsylvania, Philadelphia.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Andrea B Troxel
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia.,Division of Biostatistics, New York University, New York
| | - Shivan J Mehta
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Laurie Norton
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Raymond Lim
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Wenli Wang
- University of Pennsylvania Health System, Philadelphia
| | - Noora Marcus
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Christian Terwiesch
- Operations and Information Management, Wharton School of the University of Pennsylvania, Philadelphia
| | - Kristen Caldarella
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | | | | | - Nathan Negin
- Horizon Blue Cross Blue Shield, Newark, New Jersey
| | | | | | | | - Brian Drachman
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Daniel Kolansky
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David A Asch
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Health Care Management, Wharton School of the University of Pennsylvania, Philadelphia.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.,LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Corrigendum: Adaptive biomedical innovation: Evolving our global system to sustainably and safely bring new medicines to patients in need. Clin Pharmacol Ther 2017; 101:542. [DOI: 10.1002/cpt.643] [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] [Accepted: 01/21/2017] [Indexed: 11/09/2022]
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Doshi JA, Lim R, Li P, Young PP, Lawnicki VF, Troxel AB, Volpp KG. Synchronized prescription refills and medication adherence: a retrospective claims analysis. Am J Manag Care 2017; 23:98-104. [PMID: 28245653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Medication adherence is often suboptimal, especially among patients on multiple chronic medications. We examined the association between synchronized medication refill schedules-which typically reduce organizational effort and logistical demands-and adherence. STUDY DESIGN Retrospective study among patients enrolled in Medicare Advantage prescription drug plans. METHODS We used 2012 pharmacy, medical, and enrollment data linked with consumer meta-data for Medicare patients filling 2 or more maintenance prescriptions for antihypertensives, lipid-lowering agents, antidiabetic agents, antidepressants, and/or antiosteoporotic agents. Medication adherence for the year was measured using the proportion of days covered (PDC) at the drug class level. Patients were deemed adherent if drug class PDC was ≥0.80. Outcomes were compared between 1:1 propensity score-matched patients on synchronized versus nonsynchronized refill schedules for maintenance medications. RESULTS The synchronized refill group showed better adherence than the control group, although the magnitude of effects varied by drug class and specific outcome measure. Mean PDC scores ranged from 0.02 higher for antihypertensives to 0.07 higher for antidepressants in the synchronized refill group relative to the control group (P <.01). Further, compared with the control group, a larger proportion of synchronized refill group members were deemed adherent, ranging from 6 percentage points higher for antihypertensives to 15 percentage points higher for lipid-lowering agents (P <.01). Differences between the synchronized and control groups were larger among exclusive users of retail versus mail order pharmacies for maintenance medications. CONCLUSIONS Synchronized medication refill schedules were associated with better medication adherence, particularly for patients filling maintenance medications exclusively at retail pharmacies.
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Affiliation(s)
- Jalpa A Doshi
- Economic Evaluations Unit, Center for Evidence-based Practice, Director, Value-based Insurance Design Initiatives, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 1223 Blockley Hall, Philadelphia, PA 19104. E-mail:
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Selvalogan N, Lim R. Pregnancy-Associated Myocardial Infarction (PAMI) Post Elective Caesarean Section. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Malancioiu A, Milne J, Garrahy P, Lim R. Reducing Delay to Reperfusion in a Contemporary Primary PCI Service. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.431] [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: 12/01/2022]
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Toh JWT, Lim R, Keshava A, Rickard MJFX. The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review. Colorectal Dis 2016; 18:1133-1141. [PMID: 27440227 DOI: 10.1111/codi.13464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 04/18/2016] [Accepted: 06/08/2016] [Indexed: 12/28/2022]
Abstract
AIM To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. METHOD Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. RESULTS The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). CONCLUSION Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered.
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Affiliation(s)
- J W T Toh
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - R Lim
- Bankstown Hospital, Bankstown, New South Wales, Australia
| | - A Keshava
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - M J F X Rickard
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
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