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Gladman DD, Chandran V, Rosen CF, Rohekar S, Boyd T, Eder L, Rahman P, Dutz J, Chan J, Haydey RP, Barac S, Laliberté MC, Girard T, Fournier PA, Sutton M, Pereira D, Chim T, Coupal L, Choquette D. Residual Disease Activity in Canadian Patients With Psoriatic Arthritis Treated With Advanced Therapies: Results From a Multiregistry Analysis (UNISON-PsA). J Rheumatol 2024; 51:479-487. [PMID: 38359937 DOI: 10.3899/jrheum.2023-0716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Although patient outcomes in psoriatic arthritis (PsA) have improved with the advent of advanced therapies, there remains a high unmet need to treat residual disease activity. The objective of the current study was to quantify residual disease activity and burden of disease in Canadian patients with PsA. METHODS This was a multiregion, observational, retrospective analysis of patient data extracted from the Rhumadata and the International Psoriasis and Arthritis Research Team (IPART) registries, analyzing deidentified data from patients who had initiated advanced therapy for the treatment of PsA between January 2010 and December 2019. The primary endpoint was the proportion of patients failing to achieve minimal disease activity (MDA) within 6 months; secondary endpoints included clinical and patient-reported burden of disease. Descriptive statistics included summaries by region, treatment class, and number of prior advanced therapies. RESULTS One thousand five hundred ninety-six patients were included. The proportions of patients who failed to achieve MDA within 6 months of an advanced therapy were 64.8% in Ontario, 68.3% in Western Canada, 74.8% in Quebec, and 75% in the Atlantic/East region. Failure to achieve MDA was higher among patients receiving an IL-17i compared with a TNFi in all regions except the Atlantic/East. Between 73.2% and 78.6% of patients reported pain at 6 months, and continuing functional impairment varied from 24% in the West to 83.3% in the Atlantic/East. CONCLUSION There is substantial burden and unmet need for improved therapies for Canadians with PsA. There is a wide regional variation in outcomes that requires further assessment.
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Affiliation(s)
- Dafna D Gladman
- D.D. Gladman, MD, University of Toronto, Department of Medicine, Division of Rheumatology, and Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario;
| | - Vinod Chandran
- V. Chandran, MBBS, MD, DM, PhD, University of Toronto, Department of Medicine, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | - Cheryl F Rosen
- C.F. Rosen, MD, Division of Dermatology, Department of Medicine, University of Toronto, and Division of Dermatology, Toronto Western Hospital, Toronto, Ontario
| | - Sherry Rohekar
- S. Rohekar, MD, Division of Rheumatology, Western University, London, Ontario
| | - Tristan Boyd
- T. Boyd, MD, Division of Rheumatology, Western University, and Division of Rheumatology, St. Joseph's Hospital, London, Ontario
| | - Lihi Eder
- L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario
| | - Proton Rahman
- P. Rahman, MD, Department of Medicine, Memorial University, St. John's, Newfoundland
| | - Jan Dutz
- J. Dutz, MD, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia
| | - Jonathan Chan
- J. Chan, MD, Department of Medicine, Division of Rheumatology, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | - Richard P Haydey
- R.P. Haydey, MD, S. Barac, MD, Winnipeg Clinic, Winnipeg, Manitoba
| | - Snezana Barac
- R.P. Haydey, MD, S. Barac, MD, Winnipeg Clinic, Winnipeg, Manitoba
| | - Marie-Claude Laliberté
- M.C. Laliberté, PhD, T. Girard, PhD, P.A. Fournier, MSc, MBA, AbbVie Corp., St. Laurent, Quebec
| | - Tanya Girard
- M.C. Laliberté, PhD, T. Girard, PhD, P.A. Fournier, MSc, MBA, AbbVie Corp., St. Laurent, Quebec
| | - Pierre-André Fournier
- M.C. Laliberté, PhD, T. Girard, PhD, P.A. Fournier, MSc, MBA, AbbVie Corp., St. Laurent, Quebec
| | - Mitchell Sutton
- M. Sutton, MSc, D. Pereira, BSc, T. Chim, MSc, Center for Prognosis Studies in the Rheumatic Diseases, Psoriatic Disease Program, Toronto Western Hospital, University Health Network, Toronto, Ontario
| | - Daniel Pereira
- M. Sutton, MSc, D. Pereira, BSc, T. Chim, MSc, Center for Prognosis Studies in the Rheumatic Diseases, Psoriatic Disease Program, Toronto Western Hospital, University Health Network, Toronto, Ontario
| | - Tina Chim
- M. Sutton, MSc, D. Pereira, BSc, T. Chim, MSc, Center for Prognosis Studies in the Rheumatic Diseases, Psoriatic Disease Program, Toronto Western Hospital, University Health Network, Toronto, Ontario
| | - Louis Coupal
- L. Coupal, MSc, D. Choquette, MD, Institut de Rhumatologie de Montréal, CHUM, University of Montreal, Montreal, Quebec, Canada
| | - Denis Choquette
- L. Coupal, MSc, D. Choquette, MD, Institut de Rhumatologie de Montréal, CHUM, University of Montreal, Montreal, Quebec, Canada
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Affiliation(s)
- Ma Bullimore
- Ophthalmic and Physiological Optics Research Group, Department of Vision Sciences, Aston University, Birmingham UK
| | - T Boyd
- Ophthalmic and Physiological Optics Research Group, Department of Vision Sciences, Aston University, Birmingham UK
| | - He Mather
- Ophthalmic and Physiological Optics Research Group, Department of Vision Sciences, Aston University, Birmingham UK
| | - B Gilmartin
- Ophthalmic and Physiological Optics Research Group, Department of Vision Sciences, Aston University, Birmingham UK
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Delwiche SR, Pierce RO, Chung OK, Seabourn BW, Baker L, Boyd T, Brenner C, Cain L, Chung E, Cohoef E, Delwiche S, Drapcho C, Flemm J, Gell A, Gerjets L, Gipson N, Guillemette R, Hughes R, Hurburgh C, Jackson C, Jessop D, Johnson D, Johnson D, Krouse R, LaCour CP, Lego M, Lewis V, Mbuvi S, McCaig T, Perbix K, Psotka J, Seabourn B. Protein Content of Wheat by Near-Infrared Spectroscopy of Whole Grain: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.3.587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
abstract
A collaborative study was performed to assess accuracy, repeatability, and reproducibility of a nearinfrared (near-IR) method for determining crude protein content (PC) of whole-grain wheat. Four types of commercially available near-IR instruments, representing various combinations of wavelength region, mode of energy capture, method of energy dispersion, and treatment of spectral data, were used. Eight, 9,10, and 11 collaborators were involved, the exact number depending on instrument type. All collaborators received 22 samples of whole-grain hard red winter (HRW) wheat. They were furnished reference PCs (i.e., protein concentrations, w/w) corrected to a 12% moisture basis for instrument standardization. AOAC Method 990.03— combustion analysis—was the reference procedure. Standardization consisted of performing one of the following treatments to the instrument manufacturer's (or federal agency's) PC equation: (1) bias correction, (2) slope and intercept correction, or (3) recalibration with inclusion of standardization sample spectra. Standardized equations were then applied to a test set of 12 unknown HRW wheat sample spectra, with 2 samples blindly duplicated. The PCs of test samples ranged from 9 to 16%. Near-IR predictions were compared with reference measurements. Averaged within instrument type, root mean square of differences were 0.22, 0.24, 0.25, and 0.26% PC, depending on instrument. Corrected for bias within the test set, standard errors became 0.22, 0.18, 0.21, and 0.24% PC, respectively. These values were approximately twice the estimated lower limit for error (representing sample inhomogeneity). Overall repeatability relative standard deviation (RSD,) values were 0.92, 0.36, 0.42, and 0.74%, respectively. Overall reproducibility relative standard deviation (RSDR) values were 1.15, 0.61,1.53, and 1.38%. Such values for within-laboratory and between-laboratory variations of the near- IR methods were equivalent to values reported for the combustion method (990.03) for wheat. An inhouse study that examined all 6 U.S. wheat classes with one of the 4 instrument types produced repeatability and reproducibility values similar to those of the collaborative study, suggesting that the near-IR technique may be applied to red, white, hard, soft, and durum wheats. The near-IR method for determination of PC of whole-grain wheat has been adopted First Action (997.06) by AOAC INTERNATIONAL.
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Affiliation(s)
- Stephen R Delwiche
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Instrumentation and Sensing Laboratory, Bldg 303, BARC-East, Beltsville, MD 20705-2350
| | - Richard O Pierce
- U.S. Department of Agriculture, Grain Inspection, Packers, and Stockyards Administration, Federal Grain Inspection Service, Technical Services Division, 10383 N. Executive Hills Blvd, Kansas City, MO 64153
| | - Okkyung K Chung
- U.S. Department of Agriculture, Agricultural Research Service, U.S. Grain Marketing and Production Research Laboratory, 1515 College Ave, Manhattan, KS 66502
| | - Bradford W Seabourn
- U.S. Department of Agriculture, Agricultural Research Service, U.S. Grain Marketing and Production Research Laboratory, 1515 College Ave, Manhattan, KS 66502
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Coras R, Kavanaugh A, Boyd T, Huynh D, Lagerborg KA, Xu YJ, Rosenthal SB, Jain M, Guma M. Choline metabolite, trimethylamine N-oxide (TMAO), is associated with inflammation in psoriatic arthritis. Clin Exp Rheumatol 2019; 37:481-484. [PMID: 30620278 PMCID: PMC6529247] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Dietary intake of choline has been linked to systemic inflammation through the microbial production of two metabolites, trimethylamine (TMA) and trimethylamine-N-oxide (TMAO). Herein we explore the association between choline metabolites and inflammation in psoriatic arthritis (PsA) patients. METHODS Thirty-eight patients with PsA, all of whom satisfied the CASPAR classification criteria for PsA, were studied. Outcomes reflecting the activity of peripheral arthritis as well as skin psoriasis, Disease Activity Score (DAS)28, Clinical Disease Index (CDAI) and Body Surface Area (BSA) were assessed. Serum concentration of choline metabolites (choline, TMA, TMAO, betaine and carnitine) were determined by LC-MS, and metabolite levels associated with disease scores. RESULTS Among the 38 PsA patients included, the mean DAS28PCR was 2.74±1.29. Twenty-seven patients had active skin disease, with an average BSA of 7.2±16.22. TMAO, but not TMA or choline, significantly correlated with measures of disease activity for both skin and peripheral joints. CONCLUSIONS In our cohort, only TMAO, but not TMA, choline, betaine or carnitine, was associated with inflammation in PsA patients, establishing a mechanistic link between TMAO and PsA phenotypes. Future studies will explore the modulation of TMAO and disease severity in PsA.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, University of California, San Diego, USA; and Department of Medicine, Autonomous University of Barcelona, Spain
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Tristan Boyd
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Doquyen Huynh
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Kim A Lagerborg
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Yong-Jiang Xu
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Sarah B Rosenthal
- Center for Computational Biology and Bioinformatics, University of California, San Diego, USA
| | - Mohit Jain
- Department of Medicine, School of Medicine, University of California, San Diego, USA
| | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego, USA; and Department of Medicine, Autonomous University of Barcelona, Spain.
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Coras R, Kavanaugh A, Boyd T, Huynh Q, Pedersen B, Armando AM, Dahlberg-Wright S, Marsal S, Jain M, Paravar T, Quehenberger O, Guma M. Pro- and anti-inflammatory eicosanoids in psoriatic arthritis. Metabolomics 2019; 15:65. [PMID: 31004236 PMCID: PMC6533065 DOI: 10.1007/s11306-019-1527-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/10/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Eicosanoids are biological lipids that serve as both activators and suppressors of inflammation. Eicosanoid pathways are implicated in synovitis and joint destruction in inflammatory arthritis, yet they might also have a protective function, underscoring the need for a comprehensive understanding of how eicosanoid pathways might be imbalanced. Until recently, sensitive and scalable methods for detecting and quantifying a high number of eicosanoids have not been available. OBJECTIVE Here, we intend to describe a detailed eicosanoid profiling in patients with psoriatic arthritis (PsA) and evaluate correlations with parameters of disease activity. METHODS Forty-one patients with PsA, all of whom satisfied the CASPAR classification criteria for PsA, were studied. Outcomes reflecting the activity of peripheral arthritis as well as skin psoriasis, Disease Activity Score (DAS)28, Clinical Disease Index (CDAI) and Body Surface Area (BSA) were assessed. Serum eicosanoids were determined by LC-MS, and the correlation between metabolite levels and disease scores was evaluated. RESULTS Sixty-six eicosanoids were identified by reverse-phase LC/MS. Certain eicosanoids species including several pro-inflammatory eicosanoids such as PGE2, HXB3 or 6,15-dk,dh,PGF1a correlated with joint disease score. Several eicosapentaenoic acid (EPA)-derived eicosanoids, which associate with anti-inflammatory properties, such as 11-HEPE, 12-HEPE and 15-HEPE, correlated with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) as well. Of interest, resolvin D1, a DHA-derived anti-inflammatory eicosanoid, was down-regulated in patients with high disease activity. CONCLUSION Both pro- and anti-inflammatory eicosanoids were associated with joint disease score, potentially representing pathways of harm as well as benefit. Further studies are needed to determine whether these eicosanoid species might also play a role in the pathogenesis of joint inflammation in PsA.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
- Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, Bellaterra, 08193, Barcelona, Spain
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Tristan Boyd
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Quyen Huynh
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Brian Pedersen
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Aaron M Armando
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
- Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Signe Dahlberg-Wright
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
- Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Sara Marsal
- Rheumatology Department, Vall Hebron Research Institute, Autonomous University of Barcelona, Passeig Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Mohit Jain
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
- Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Taraneh Paravar
- Department of Dermatology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Oswald Quehenberger
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
- Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA.
- Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, Bellaterra, 08193, Barcelona, Spain.
- Division of Rheumatology, Allergy and Immunology, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093-0656, USA.
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Boyd T, Kavanaugh A. Interleukin-17 inhibition in psoriatic arthritis. Clin Exp Rheumatol 2015; 33:S119-S123. [PMID: 26471234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
Greater understanding of the underlying disease process has led to the development of targeted therapeutic agents and innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses novel medications targeting the T helper 17 cell pathway, specifically those inhibiting interleukin-17A and its receptor, and discusses their role as effective therapies in the management of PsA.
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Affiliation(s)
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, Center for Innovative Therapy (CIT), University of California, La Jolla, CA, USA.
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Kavanaugh A, Boyd T. Trial design in psoriatic arthritis: what could be changed? Clin Exp Rheumatol 2015; 33:S15-S18. [PMID: 26458015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
A greater understanding of the underlying disease process, combined with the development of novel therapeutic agents, has led to innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses unmet needs in clinical trial design in PsA, and proposes some amendments that may yield data that can potentially improve patient outcomes in the management of PsA.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California, La Jolla, CA, USA.
| | - Tristan Boyd
- Division of Rheumatology, University of California, La Jolla, CA, USA
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Chowdhry S, Davis J, Boyd T, Choo J, Brooks RM, Kelishadi SS, Tutela JP, Yonick D, Wilhelmi BJ. Safe Tummy Tuck: Anatomy and Strategy to Avoid Injury to the Lateral Femoral Cutaneous Nerve During Abdominoplasty. Eplasty 2015; 15:e22. [PMID: 26171094 PMCID: PMC4473816] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Abdominoplasty is one of the most common aesthetic procedures performed in the United States. While poor contour and unsatisfactory cosmetic result have been recognized, neuropathic pain from lateral femoral cutaneous nerve injury has been poorly described. We aim to improve outcomes by using an anatomical study to develop a strategy to avoid injury to the lateral femoral cutaneous nerve in abdominoplasty. METHODS Twenty-three fresh cadaver abdomens were dissected to evaluate the course of the lateral femoral cutaneous nerve, using 2.5× loupe magnification. Measurements were taken from the nerve to the anterior superior iliac spine and from the pubic symphysis to the lateral femoral cutaneous nerve. Recordings of the relationship of the nerve to the inguinal ligament and depth at scarpa's fascia were also made. Statistical analysis was performed to find average distances with a standard deviation. RESULTS On average, the distance from the lateral femoral cutaneous nerve to the anterior superior iliac spine was 3.62 (SD = 1.32) cm and 13.58 (SD = 2.41) cm from the pubic symphysis in line with the inguinal ligament. The lateral femoral cutaneous nerve was found at the inguinal ligament 80% of the time and 20% of the time superior to the ligament and always deep to scarpa's fascia. CONCLUSION Abdominoplasty carries a high patient and surgeon satisfaction rate. The plastic surgeon is continuously challenged to identify ways to improve outcomes, efficiency, and morbidity. Minimal and careful dissection in the area around 4 cm of the anterior superior iliac spine in addition to preserving scarpa's fascia near the inguinal ligament may serve as key strategies to avoiding lateral femoral cutaneous nerve injury.
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Affiliation(s)
- S. Chowdhry
- Division of Plastic Surgery, University of Louisville, Louisville, Ky,Correspondence:
| | - J. Davis
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - T. Boyd
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - J. Choo
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - R. M. Brooks
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - S. S. Kelishadi
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - J. P. Tutela
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - D. Yonick
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
| | - B. J. Wilhelmi
- Division of Plastic Surgery, University of Louisville, Louisville, Ky
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Omar A, Boyd T, Sari I, Thavaneswaran A, Ayearst R, Inman R, Haroon N. SAT0233 Acute Anterior Uveitis in Ankylosing Spondylitis: Association with Inflammatory Bowel Disease and Psoriasis Independent of HLA-B27. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Komrokji R, Garcia-Manero G, Ades L, Laadem A, Vo B, Prebet T, Stamatoullas A, Boyd T, Delaunay J, Steensma D, Sekeres M, Beyne-Rauzy O, Zou J, Attie K, Sherman M, Fenaux P, List A. 14 A PHASE 2, DOSE-FINDING STUDY OF SOTATERCEPT (ACE-011) IN PATIENTS WITH LOWER-RISK MYELODYSPLASTIC SYNDROMES (MDS) OR NON-PROLIFERATIVE CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) AND ANEMIA REQUIRING TRANSFUSION. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30015-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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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Chow SL, Carter Thorne J, Bell MJ, Ferrari R, Bagheri Z, Boyd T, Colwill AM, Jung M, Frackowiak D, Hazlewood GS, Kuriya B, Tugwell P. Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question. J Rheumatol 2015; 42:682-9. [DOI: 10.3899/jrheum.141140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/22/2022]
Abstract
Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.
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Abstract
OBJECTIVES Paranoid thinking has been linked to greater availability in memory of past threats to the self. However, remembered experiences may not always closely resemble events that trigger paranoia, so novel explanations must be elaborated for the likelihood of threat to be determined. We investigated the ability of paranoid individuals to construct explanations for everyday situations and whether these modulate their emotional impact. METHODS Twenty-one participants experiencing paranoia and 21 healthy controls completed a mental simulation task that yields a measure of the coherence of reasoning in everyday situations. RESULTS When responses featured positive content, clinical participants produced less coherent narratives in response to paranoid themed scenarios than healthy controls. There was no significant difference between the groups when responses featured negative content. CONCLUSIONS The current study suggests that difficulty in scenario construction may exacerbate paranoia by reducing access to non-threatening explanations for everyday events, and this consequently increases distress.
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Affiliation(s)
- V Huddy
- Department of Psychosis Studies, Institute of Psychiatry, KCL, London, UKDepartment of Psychology, Royal Holloway, University of London, UKBarnet Enfield and Haringey Mental Health Trust, London, UKDepartment of Psychology, Institute of Psychiatry, KCL, London, UK
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Mussen L, Boyd T, Bykerk V, de Leon F, Li L, Boire G, Hitchon C, Haraoui B, Thorne JC, Pope J. Low prevalence of work disability in early inflammatory arthritis (EIA) and early rheumatoid arthritis at enrollment into a multi-site registry: results from the catch cohort. Rheumatol Int 2012; 33:457-65. [DOI: 10.1007/s00296-012-2407-3] [Citation(s) in RCA: 4] [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] [Received: 11/10/2011] [Accepted: 03/11/2012] [Indexed: 10/28/2022]
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Savel T, Hall K, Lee B, McMullin V, Miles M, Stinn J, White P, Washington D, Boyd T, Lenert L. A Public Health Grid (PHGrid): Architecture and value proposition for 21st century public health. Int J Med Inform 2010; 79:523-9. [PMID: 20472493 DOI: 10.1016/j.ijmedinf.2010.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 02/03/2010] [Accepted: 04/18/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE This manuscript describes the value of and proposal for a high-level architectural framework for a Public Health Grid (PHGrid), which the authors feel has the capability to afford the public health community a robust technology infrastructure for secure and timely data, information, and knowledge exchange, not only within the public health domain, but between public health and the overall health care system. METHODS The CDC facilitated multiple Proof-of-Concept (PoC) projects, leveraging an open-source-based software development methodology, to test four hypotheses with regard to this high-level framework. The outcomes of the four PoCs in combination with the use of the Federal Enterprise Architecture Framework (FEAF) and the newly emerging Federal Segment Architecture Methodology (FSAM) was used to develop and refine a high-level architectural framework for a Public Health Grid infrastructure. RESULTS The authors were successful in documenting a robust high-level architectural framework for a PHGrid. The documentation generated provided a level of granularity needed to validate the proposal, and included examples of both information standards and services to be implemented. Both the results of the PoCs as well as feedback from selected public health partners were used to develop the granular documentation. CONCLUSIONS A robust high-level cohesive architectural framework for a Public Health Grid (PHGrid) has been successfully articulated, with its feasibility demonstrated via multiple PoCs. In order to successfully implement this framework for a Public Health Grid, the authors recommend moving forward with a three-pronged approach focusing on interoperability and standards, streamlining the PHGrid infrastructure, and developing robust and high-impact public health services.
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Affiliation(s)
- T Savel
- National Center for Public Health Informatics, CDC, Atlanta, GA 30333, USA.
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Boyd T, Wright C, Colby K, Sens M, Elliott A, Folkerth R, Kinney H, Odendaal H. O139 PASS stillbirth classification: Incorporating mechanism, etiology and recurrence. Prenatal alcohol stillbirth and SIDS (PASS) network, NIAAA/NICHD. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60511-7] [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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Smith D, Conkling P, Richards D, Alemany C, Boyd T, Garbo L, Wu H, Wages D, Bexon A, Murphy J. 9148 Phase 1 study of the toll-like receptor 9 (TLR9) agonist, IMO-2055, combined with erlotinib (E) and bevacizumab (B) in patients (pts) with advanced or metastatic non-small cell lung cancer (NSCLC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71861-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Konduri K, Spira AI, Jotte RM, Boyd T, Boyd T, Gaffar YA, Reynolds C, Witta SE. Results from a phase I safety lead-in study investigating the combination of erlotinib and the histone deacetylase inhibitor entinostat in patients with advanced NSCLC. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14545 Background: Preclinical studies showed the synergistic effect of entinostat with epidermal growth factor tyrosine kinase inhibitors (EGFR-TKI) in NSCLC cell lines. Entinostat (SNDX-275, Syndax Pharmaceuticals) is an oral, class 1 isoform selective HDACi that restores the expression of e-cadherin and sensitivity to EGFR-TKI in NSCLC cell lines. The aim of this study was to determine the safety and feasibility of combining entinostat with erlotinib in advanced NSCLC patients in order to determine the recommended Phase 2 dose. Methods: Patients with recurrent or metastatic NSCLC whose tumors progressed on prior chemotherapy were treated with either 5 or 10mg orally of entinostat once every two weeks and erlotinib 150mg daily. Results: A total of 9 patients were enrolled (3 at entinostat 5mg; 6 at 10mg). Characteristics: Sex: M/F: 6/3; Age range: 46–84 yrs; ECOG PS: 0–1; Smoking status: 1/8 (never/current or prior smokers); Number of prior treatments: 1–2. There was one DLT of grade 3 asthenia. This occurred in one of the six patients in the 10mg dose cohort. The most common adverse events were anorexia, and asthenia. This was more often noted in elderly patients. Of the 9 evaluable patients, one patient had a confirmed partial response and remains on study (>5 cycles) and another patient had stable disease for 8 months. Pharmacokinetic analysis has been completed with both drugs exhibiting levels comparable to historical data. No drug:drug interaction was observed. EGFR FISH, EGFR mutation, and epithelial-to-mesenchymal marker analysis is in progress. Conclusions: This study has established the safety and a recommended phase 2 dose of 10 mg of entinostat once every other week in combination with 150 mg daily of erlotinib in a 28-day cycle in advanced NSCLC patients. A randomized, double blinded phase 2 study has been initiated with 43 patients enrolled to date. [Table: see text]
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Affiliation(s)
- K. Konduri
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - A. I. Spira
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - R. M. Jotte
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - T. Boyd
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - T. Boyd
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - Y. A. Gaffar
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - C. Reynolds
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
| | - S. E. Witta
- US Oncology Research, Houston, TX; US Oncology Research, Houston, TX
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Boyd T. Rodney Kevan Hassard Parker. West J Med 2008. [DOI: 10.1136/bmj.a1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Novick S, O'Brien S, Moore J, Boyd T, Ding L, Rai K. 6004 ORAL Oblimersen plus fludarabine/cyclophosphamide (FC) significantly increases complete remission and overall survival in non-refractory patients (Pts) with relapsed chronic lymphocytic leukemia (CLL): results from a prospective randomized phase 3 trial. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Perlin A, Moum JN, Klymak JM, Levine MD, Boyd T, Kosro PM. Organization of stratification, turbulence, and veering in bottom Ekman layers. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2004jc002641] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Koziner B, O’Brien S, Boyd T, Larratt L, Moore J, Chanan-Khan A. Pooled safety analysis of oblimersen alone or with fludarabine and cyclophosphamide in patients with advanced chronic lymphocytic leukemia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6611] [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
6611 Background: Bcl-2 is an antiapoptotic protein linked to chemotherapy resistance and poor prognosis in chronic lymphocytic leukemia (CLL) patients (pts). Oblimersen (Obl), an anti-Bcl-2 oligonucleotide, has been shown to enhance apoptosis induced by fludarabine (Flu) + cyclophosphamide (Cy) in pts with relapsed CLL. We combined safety results from 2 CLL clinical trials to determine the relative effect of Obl on treatment-emergent adverse events (TEAEs) in Obl+Flu+Cy therapy. Methods: This analysis included 30 pts who received Obl 3mg/kg/d alone by continuous IV on days 5–7 and 230 pts who received Flu 25mg/m2/d + Cy 250mg/m2/d on days 5–7, every 28th day, either with (n=115) or without (n=115) Obl 3mg/kg/d on days 1–7. Mean number of cycles initiated were 3.3, 3.6, and 4.0 for Obl, Obl+Flu+Cy, and Flu+Cy, respectively. Results: The most frequent (>2% patients) grade 4 TEAEs were mainly hematologic: neutropenia (Obl alone, 0.0%; Flu+Cy, 11.3%; Obl+Flu+Cy 7.0%), thrombocytopenia (3.3%, 1.7%, 4.3%), anemia (0.0%, 5.2%, 3.5%), febrile neutropenia (0.0%, 0.9%, 2.6%), hypotension (0.0%, 0.0%, 2.6%), and leukopenia (0.0%, 2.6%, 0.0%). Thrombocytopenic events with Obl-Flu-Cy were reversible and were not associated with clinically significant bleeding events. The most frequent non-hematologic grade 3–4 TEAEs (>5%) were nausea (0.0%, 1.7%, 7.8%), vomiting (0.0%, 0.9%, 6.1%), fatigue (3.3%, 4.3%, 6.1%), and dyspnea (3.3%, 1.7%, 5.2%). Serious TEAEs occurred at a rate of 23.3%, 32.2%, and 57.4%, respectively. TEAEs resulting in death occurred in 2 pts (Obl alone), 5 pts (Flu+Cy), and 9 pts (Obl+Flu+Cy). One Obl+Flu+Cy death was due to cytokine release reaction and one to tumor lysis syndrome. Discontinuation due to TEAEs occurred in 20.0% of pts who received Obl alone, in 34.8% of Flu+Cy pts, and in 34.8% of Obl+Flu+Cy pts. Conclusions: The addition of Obl to Flu+Cy was well tolerated, with similar low frequencies of grade 3+4 TEAEs, primarily the same type observed with Flu+Cy alone. Despite an increased incidence of serious TEAEs observed with Obl+Flu+Cy, the percentage of patients who discontinued protocol therapy due to a TEAE was the same in each group. First cycle reactions mandate close observation when initiating combination therapy. [Table: see text]
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Affiliation(s)
- B. Koziner
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - S. O’Brien
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - T. Boyd
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - L. Larratt
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - J. Moore
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A. Chanan-Khan
- Unidad de Investigacione Oncohem, Buenos Aires, Argentina; University of Texas, Houston, TX; Yakima Regional Cancer Care Center, Yakima, WA; Walter MacKenzie Centre, Edmonton, AB, Canada; Duke University Medical Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
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Kolibaba KS, Chanan-Khan AA, Bociek G, Boyd T, Moore J, O’brien S. Clinical characterization of first cycle reactions in patients with chronic lymphocytic leukemia treated with oblimersen. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16514] [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
16514 Background: Serious adverse reactions during the first treatment cycle characterize many drugs used for chronic lymphocytic leukemia (CLL), including rituximab, alemtuzumab, flavopiridol, lenalidomide, and oblimersen. Termed cytokine release reactions (CRRs), these events have occurred more commonly in pts with bulky disease and elevated leukocyte counts, and some have been fatal. Rapid increases in serum levels of tumor necrosis factor-α, interleukin-6, interleukin-2, interferon-γ, and other cytokines may result in symptoms including fever, chills, nausea, vomiting, hypotension, and dyspnea. Ex vivo treatment of CLL cells with oblimersen induce release of vasoactive interleukin-8. First cycle reactions, including tumor lysis syndrome (TLS), proved dose-limiting in a phase 1–2 trial of oblimersen in pts with relapsed or refractory CLL. To characterize these reactions, we evaluated data from this single-agent study and from a phase 3 randomized clinical trial of oblimersen with fludarabine and cyclophosphamide (Flu/Cy). Methods: Data on investigator assessment of CRR and TLS were obtained from both studies, which included 155 pts; 40 were treated with oblimersen alone (3–7mg/kg/d by CIV for 5–7 days) and 115 with oblimersen (3 mg/kg/d × 7 days) in combination with Flu/Cy. Results: Of 145 pts treated with oblimersen 3mg/kg/d, either alone or with Flu/Cy, 2 pts (1.3%) experienced CRR and TLS, respectively. Two CRRs occurred in 10 pts treated with 4–7mg/kg/d. Reactions typically began 24–48 hours after starting treatment. CCR was usually associated with spiking fever, nausea, dehydration, rigors, and back pain. Rarely pts developed hypotension, acidosis, or reversible renal insufficiency, usually with a reduction in WBC. Symptoms lasted 1 day to several weeks (1 pt). In most cases, reactions were reversible with intensive supportive care, including IV fluids, pressors, and antibiotics; 1 death from TLS and 1 from CCR occurred during cycle 1. There was no definitive correlation with baseline measures of disease burden. Conclusion: First cycle oblimersen reactions are uncommon but represent a risk. Early symptoms (fever, nausea, and dehydration) require aggressive treatment, which may prevent progression of the reaction. [Table: see text]
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Affiliation(s)
- K. S. Kolibaba
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
| | - A. A. Chanan-Khan
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
| | - G. Bociek
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
| | - T. Boyd
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
| | - J. Moore
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
| | - S. O’brien
- Northwest Cancer Specialists, Vancouver, WA; Roswell Park Cancer Institute, Buffalo, NY; University of Nebraska Medical Center, Omaha, NE; Yakima Regional Cancer Care Center, Yakima, WA; Duke University Medical Center, Durham, NC; University of Texas, Houston, TX
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Abstract
The WT1 tumor suppressor gene encodes a zinc finger transcription factor expressed in differentiating glomerular podocytes. Complete inactivation of WT1 in the mouse leads to failure of mesenchymal induction and renal agenesis, an early developmental phenotype that prevents analysis of subsequent stages in glomerular differentiation [1]. In humans with Denys-Drash Syndrome, a heterozygous germline mutation in WT1 is associated with specific defects in glomeruli and an increased risk for developing Wilms Tumor [2,3]. WT1 target genes implicated in cell cycle regulation and cellular proliferation have been proposed [4], but the link between WT1 function and glomerular differentiation is unexplained. Here, we show that inducible expression of WT1 in rat embryonic kidney cell precursors leads to the induction of endogenous Podocalyxin, the major structural membrane protein of glomerular podocytes, which is implicated in the maintenance of filtration slits. Binding of WT1 to conserved elements within the Podocalyxin gene promoter results in potent transcriptional activation, and the specific expression pattern of Podocalyxin in the developing kidney mirrors that of WT1 itself. These observations support a role for WT1 in the specific activation of a glomerular differentiation program in renal precursors and provide a molecular basis for the glomerulonephropathy that is characteristic of Denys-Drash Syndrome.
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Affiliation(s)
- R E Palmer
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, MA 02129, USA
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Bakotic BW, Boyd T, Poppiti R, Pflueger S. Recurrent umbilical cord torsion leading to fetal death in 3 subsequent pregnancies: a case report and review of the literature. Arch Pathol Lab Med 2000; 124:1352-5. [PMID: 10975937 DOI: 10.5858/2000-124-1352-ructlt] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
During a span of 3.5 years, a 30-year-old, gravida 9, para 3 woman experienced 3 pregnancies complicated by umbilical cord torsion and constriction. In each case, the complication resulted in acute vascular compromise and intrauterine fetal demise. Gross examination disclosed cord constriction and torsion at the fetal end of the cord in each instance. Histologic sections from the cord torsion sites demonstrated fibrosis and deficiencies in Wharton's jelly in each case. Cytogenetic studies prepared using fetal villous tissue demonstrated normal karyotypes in fetal cells from the first 2 pregnancies (46,XX and 46,XY, respectively). The karyotype from the third pregnancy showed a 46,XX,del(X)(q24) mutation in 3 of 15 cultured cells, while 12 of 15 cells possessed a normal 46,XX karyotype. This cytogenetic abnormality was not believed to represent the cause of fetal demise in this case. To our knowledge, this is the first report of umbilical cord torsion in 3 pregnancies within one family. The familial clustering observed in this report suggests that a genetic predisposition for umbilical cord torsion may exist in some cases.
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Affiliation(s)
- B W Bakotic
- The Arkadi M. Rywlyn, MD, Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL, USA
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Abstract
An understanding of a broader concept of health is increasingly important for all health professionals, including dentists, and has recently been incorporated as a key principle in the Government White Paper, The New NHS. This aims to deliver a dependable, high quality, egalitarian health service. In the past, performance measurements in the UK have often relied simply on those areas which are most easily quantified. For example, within the hospital service, performance was measured in terms of the cost and the number of finished consultant episodes, from which the 'purchaser efficiency index' was calculated. This tended to produce a driving force rewarding those doing more rather than those doing more better. It is analogous to the system which has been the backbone of NHS dental practice for many years, 'fee per item of service', where throughout is rewarded rather than outcome. However, the White Paper has signalled a move away from simply counting activity. From April 1999 within the hospital service the purchaser efficiency index has been replaced with more rounded measures, reflecting the changing concepts of health, in a new broader performance framework to determine what really counts for patients. It will focus on measuring health improvement, fairer access, better quality and outcome, including the views of patients.
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Affiliation(s)
- M A Corson
- Dental Hospital and School, Newcastle upon Tyne
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Abstract
CONTEXT Early identification of iron deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for iron deficiency and iron deficiency anemia in children. OBJECTIVE To develop an effective approach for the diagnosis of iron deficiency and iron deficiency anemia in young children. DESIGN AND SETTING Retrospective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis. PATIENTS A total of 210 children (mean [SD] age, 2.9 [2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician. MAIN OUTCOME MEASURES Levels of hemoglobin (Hb), iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor and reticulocyte Hb content (CHr) among patients with and without iron deficiency, defined as Tfsat of less than 20%, and iron deficiency anemia, defined as Tfsat of less than 20% and Hb level of less than 110 g/L. RESULTS Of the 210 subjects, 43 (20.5%) were iron deficient; 24 of these had iron deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of iron deficiency (likelihood ratio test [LRT] = 15.96; P<.001 for CHr, and LRT = 6.59; P = .01 for Hb), and CHr was the only significant multivariate predictor of iron deficiency anemia (LRT = 30.43; P<.001). Plasma ferritin level had no predictive value (P = .97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P<.001 for all). CONCLUSIONS Reticulocyte Hb content level was the strongest predictor of iron deficiency and iron deficiency anemia in children. It holds promise as an alternative to biochemical iron studies in diagnosis.
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Affiliation(s)
- C Brugnara
- Department of Pathology, The Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
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Boyd T, Mehta MP, Donahue B, Prados M, Allen J. 19 Feasibility & acute toxicities of craniospinal hyperfractionated radiotherapy (CHFRT) for high risk intracranial primitive neuroectodermal tumors (HRPNET); CCG-9931; A groupwide phase II study of intensive chemotherapy (CT) & CHFRT. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80577-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
This paper describes a new six-load component pedal dynamometer designed for study of knee overuse injury in cycling. A unique capability of the dynamometer is the ability to interface with multiple pedal platforms of varying height while maintaining a desired elevation of the foot above the pedal spindle axis. The dynamometer was designed using a concept described in an earlier article by Quinn and Mote (1991, Exp. Mech. 30, 40-48) which measures shear strain across multiple, thin cross-sections. An optimal design technique was used for choosing dimensions of the load measuring cross-sections. A dynamometer was designed and built using the optimal results. Calibration, accuracy results, and sample data are presented. A comparison of accuracy reveals that the new dynamometer is more accurate than previously reported instruments.
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Affiliation(s)
- T Boyd
- Department of Mechanical Engineering, University of California, Davis 95616, USA
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Boyd T, Rosen S, Redline RW, Genest DR. Nondysplastic fetal renal hypoplasia associated with severe oligohydramnios: clinical, pathologic, and morphometric findings. Pediatr Pathol Lab Med 1995; 15:485-501. [PMID: 8597836 DOI: 10.3109/15513819509026985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two fetuses with severe bilateral renal hypoplasia are described; both diagnoses were made following elective abortion for oligohydramnios and suspected renal dysplasia. A 20-week female fetus (46,XX) had pulmonary hypoplasia and very small kidneys (7% of expected weight) that were normally shaped and nondysplastic, with well-formed medullae and metanephric blastema and markedly diminished cortices with only rare glomeruli. A 23-week male fetus (46,XY) had small kidneys (13% of expected weight) that were nondysplastic, normally shaped, and histologically well organized with moderately decreased numbers of glomeruli. Isolated bilateral renal hypoplasia has not previously been well characterized in fetuses; the presence of oligohydramnios (both cases) and pulmonary hypoplasia (one case) suggests that this finding is associated with impaired fetal renal function and may adversely influence neonatal survival.
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Affiliation(s)
- T Boyd
- Department of Pathology, Children's Hospital Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
It has been suggested that inferences about fetal karyotype can be made from examination of placental and decidual histology in early, spontaneous abortions (SABs). We assessed the reproducibility and predictive value of histologic features in 75 karyotyped, first trimester SABs; 32% (24 of 75) had normal male karyotypes (46,XY) and 68% (51 of 75) were cytogenetically abnormal (29 trisomy, 12 triploidy, eight monosomy X, and two tetraploidy). Three pathologists independently assessed 17 fetal, placental, and decidual histological findings and made predictions about the karyotype (normal, abnormal, or uncertain). Good to excellent interobserver and intraobserver reproducibility (kappa > 0.58) was achieved for the identification of five histological features: villous cavitation, anucleate fetal erythrocytes, amnion, umbilical cord, and fetal tissue. When histology and karyotype were compared using Fisher's exact test, no histological feature was associated with "any abnormal karyotype," two features (anucleate, fetal erythrocytes and umbilical cord) were associated with a normal karyotype, two features (villous dysmorphism and cisterns) were associated with triploidy, and four features (villous hydrops, no umbilical cord, no fetal tissue, and no anucleate erythrocytes) were associated with trisomy. Despite these significant histological-cytogenetic associations, the positive predictive values of each of these histological features with their corresponding karyotypes were low, ranging from 0.41 to 0.73 (mean, 0.53). Our data suggest that certain histological features in first trimester SABs are associated with the SAB's karyotype and are reproducible; however, such histological features did not perform as well as diagnostic tests for predicting the likelihood of normal versus abnormal karyotype.
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Affiliation(s)
- D R Genest
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115
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Cole AA, Boyd T, Luchene L, Kuettner KE, Schmid TM. Type X collagen degradation in long-term serum-free culture of the embryonic chick tibia following production of active collagenase and gelatinase. Dev Biol 1993; 159:528-34. [PMID: 8405676 DOI: 10.1006/dbio.1993.1261] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Type X collagen has a very limited distribution during skeletal development in regions of hypertrophic cartilage destined for degradation. In solution assay, type X collagen is degraded to a 32-kDa cleavage product which is resistant to further degradation, suggesting this product may have a function in skeletal development. In this study, we have identified the 32-kDa cleavage product of type X collagen present in the conditioned media (CM) during incubation of isolated 12-day chick tibiae in the absence of serum. In this culture system, chondrocytes throughout the tibial cartilages hypertrophied and deposited type X collagen within their matrix. During culture, the cartilage matrix was degraded in two stages. First proteoglycan was lost followed by degradation of the collagenous components. Collagen degradation was accompanied by the release of active interstitial collagenase and gelatinase into the CM. Purified type X collagen incubated in this CM was cleaved to form a 32-kDa product which was resistant to further degradation. This cleavage product has the same electrophoretic mobility as the 32-kDa chain produced by purified human collagenase.
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Affiliation(s)
- A A Cole
- Department of Biochemistry, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
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Abstract
The teratogenic effects of drinking during pregnancy on cognitive development were investigated in a cohort of disadvantaged mother-infant pairs. Three indices associated with maternal alcohol use were related to comprehensive cognitive measures obtained during five in-home assessments through age four years, ten months. Birth weight and a tally of craniofacial anomalies were also evaluated as early indicators of fetal alcohol damage. Multiple analyses relating the alcohol and cognitive measures provided no evidence of an adverse alcohol effect on cognitive development in the absence of Fetal Alcohol Syndrome. Assessments based on confidence intervals indicated that an average decrement of more than two points (IQ equivalent) on the five cognitive measures is unlikely for relatively heavy levels of maternal alcohol use or alcohol-related problems. Marginal relationships were observed between cognitive measures and the neonatal indicators, but depended heavily on the influence of a child exhibiting signs consistent with Fetal Alcohol Syndrome. This case therefore received special attention. The implications of the relationships involving the neonatal indicators were investigated using arguments based on path analysis.
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Affiliation(s)
- T Greene
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH
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Boyd T. Families, family doctors and family therapy. Practitioner 1987; 231:1289-93. [PMID: 3505022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Sett SS, Busse E, Boyd T, Burgess J. Penetrating chest wounds: a 10-year review. Can J Surg 1987; 30:371-3. [PMID: 3664394] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
From January 1975 to December 1984, 93 patients with penetrating chest wounds were admitted to three hospitals in Regina. Sixty-three percent of the wounds were caused by knives and 34% by firearms. Sixty-three patients were treated conservatively, 18 patients had thoracotomy and 12 others underwent laparotomy. Of the 18 patients, 16 had wounds between the nipples; 8 of the 16 had injuries to the heart or great vessels. Whereas the majority of penetrating wounds to the chest may be treated by observation or thoracostomy alone, a surgical approach is recommended when penetrating injuries are thought to have traversed the mediastinum, because of the high incidence of associated cardiac injuries. In doubtful cases the decision should favour early thoracotomy.
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Affiliation(s)
- S S Sett
- Department of Surgery, University of Saskatchewan, Saskatoon
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40
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Abstract
A series of modifications designed to increase the suitability of the quadrupole mass spectrometer for multipatient gas monitoring in the operating suite are presented and evaluated. The adaptations include a pressure-stabilised long capillary inlet system and computer control of the quadrupole filter together with tuning, calibration and subsequent multitheatre analysis and display of clinical information. A pilot study of three months clinical monitoring provided documentation of contributions towards the safety and effectiveness of anaesthesia. These included indication of equipment malfunction, and fluctuations in gas exchange associated with inappropriate ventilation, haemodynamic instability and variations in body temperature. Limited accuracy for carbon dioxide and a low signal-to-noise ratio together with rapid ageing of electron multipliers were identified as problems still only partially solved.
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Boyd T. Cross-validation of a psychometric system for screening neuropsychological abnormality in older children. Arch Clin Neuropsychol 1986. [DOI: 10.1016/0887-6177(86)90142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Boyd T. Family circles. J R Soc Med 1985; 78 Suppl 8:40-2. [PMID: 4009586 PMCID: PMC1289518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Boyd T. Thinking the unthinkable: should we go on? Grantsmanship Cent News 1982; 10:24-30. [PMID: 10299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gordon G, Boyd T, Salamonsen RF. Remote monitoring by mass spectrometry during anaesthesia. Evaluation of a suitable inlet system. Br J Anaesth 1982; 54:15-21. [PMID: 7055524 DOI: 10.1093/bja/54.1.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We describe a three-stage mass spectrometer inlet system suitable for use in operating theatres and evidence of its performance in delay and response times to step changes in oxygen and halothane concentrations. At 55 m and a sampled gas flow of 100mlmin-1, the inlet imposed a delay of 21s and prolonged the 10-90% response to 310ms for oxygen and 510ms for halothane. A linear relationship between inlet length and 10-90% response time at constant sampled gas flow was demonstrated for halothane but not for oxygen. Our results compared with those of other workers support the chosen compromise between practical flexibility and convenience versus maximum speed of response that was adopted in this system design.
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Abstract
This circuit is designed to maximise the range of respiratory variables that can be monitored by a mass spectrometer either alone, or preferably in association with blood gas analysis. In particular, it permits monitoring of respiratory dead space, lung shunt, ventilation, and gas exchange, as well as inspired and end-expired gas concentrations. Laboratory and clinical data indicate satisfactory performance of the circuit both clinically and analytically. The circuit is most suitable for controlled ventilation where, by operating as a "minute volume divider", it confers stability of minute volume on the manual ventilation technique.
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Abstract
Abstract
The automated method of O’Neal and Gochman [Clin. Chem. 16, 985 (1970)] for determination of serum and urine amylase activity has been modified to increase its accuracy, precision, and efficiency. Sampling rate is 50 specimens per hour. The analysis depends on α-amylase hydrolyzing glycogen to maltose-like subunits, which are measured with the copper neocuproine reaction. Results obtained by this method are compared to those for a manual reference method [Clin. Chem. 6, 434 (1960)].
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Affiliation(s)
- W S Matthews
- Department of Pathology, Los Angeles County-University of Southern California Medical Center, 1200 N. State St., Los Angeles, Calif. 90033
| | - R E Sterling
- Department of Pathology, Los Angeles County-University of Southern California Medical Center, 1200 N. State St., Los Angeles, Calif. 90033
| | - T Boyd
- Department of Pathology, Los Angeles County-University of Southern California Medical Center, 1200 N. State St., Los Angeles, Calif. 90033
| | - O R Flores
- Department of Pathology, Los Angeles County-University of Southern California Medical Center, 1200 N. State St., Los Angeles, Calif. 90033
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Matthews WS, Sterling RE, Boyd T, Flores OR. Modified automated saccharogenic determination of serum and urinary amylase activity. Clin Chem 1973; 19:1384-6. [PMID: 4757368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Benedetti-Pichler AA, Crowell WR, Donahoe C, Bryant JT, Stschigol M, Erényi G, Schneider H, Schapiro MJ, King JT, Wolfe SE, Lichtenau AL, Fischer J, Wenger P, Duchert R, Blancpain CP, Stefanowski W, Wisniewska J, Wawilow NW, Kolthoff IM, Griffith FS, Barlot J, Thomson TA, Ploetz, Drotschmann, Augusti S, Mahr C, Schoental R, Szebelledy L, Ajtai M, Rossi L, Lenaro CA, Lusin I, Hoffmann J, Korenman IM, Sandell EB, Wishnick DM, Wishnick EL, Schwarz F, Tananajew NA, Lowi RA, Procke O, Uzel R, Wolotschnewa JP, Engel AL, Duval C, Mazars G, ananajew NA, Woschtschnskaja MS, Oakes MC, Itallie L, Meixner H, Duffendack OS, Wolfe RA, Anger V, Wang S, Babkin MP, Rud MI, Liebhafsky HA, Winslow EH, Miller CF, Boyd T, Degering EF, Shreve RN, Saifer A, Hughes J, Wagenaar GH, Singh M, Hynes WA, Yanowski LK, Yutzy HC, Seljach LW, Shead AC. Qualitative Analyse. Anal Bioanal Chem 1939. [DOI: 10.1007/bf01547097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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