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  • 1
    In: Undersea and Hyperbaric Medicine, Undersea and Hyperbaric Medical Society (UHMS), Vol. 49, No. 3 ( 2022-05-06), p. 275-287
    Abstract: Introduction: The International Multicenter Registry for Hyperbaric Oxygen Therapy (International Report Registered Identifier DERR1-10.2196/18857) was established in 2011 to capture outcomes and complications data for both Undersea and Hyperbaric Medical Society (UHMS) approved and selected unapproved hyperbaric oxygen (HBO2) therapy indications. Methods: A Research Electronic Data Capture (REDCap) template was designed and distributed to all participating centers for prospective data collection. Centers contributed de-identified demographic, treatment, complications, and outcome data. This report provides summary data on sites and enrollment, as well as pre- and post-treatment data on quality of life (EQ-5D-5L questionnaire), head and neck radiation outcomes, non-healing wounds (Strauss score), and idiopathic sudden sensorineural hearing loss. Data were analyzed mainly using the Wilcoxon signed-rank test. Results: Twenty-two centers contributed data for 2,880 patients. The most common UHMS-approved indication was delayed radiation injury, followed by enhancement of wound healing, and carbon monoxide poisoning. One hundred and twenty-five patients were treated for non-UHMS approved indications. Quality of life, head and neck radiation symptoms, Strauss wound scores, and hearing were significantly improved after HBO2. Complication rates were low and comparable to previous reports. The registry also offered the ability to analyze factors that affect outcomes, such as smoking and severity of hearing loss. Discussion: The registry accrues prospective data on defined outcomes from multiple centers and allows for analysis of factors affecting outcomes. This registry does not have a control group, which is a limitation. Nevertheless, the registry provides a unique, comprehensive dataset on HBO2 outcomes from multiple centers internationally.
    Type of Medium: Online Resource
    ISSN: 1066-2936
    Language: Unknown
    Publisher: Undersea and Hyperbaric Medical Society (UHMS)
    Publication Date: 2022
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  • 2
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 9, No. 8 ( 2020-8-17), p. e18857-
    Abstract: Hyperbaric oxygen (HBO2)—oxygen at pressures higher than atmospheric—is approved for 14 indications by the Undersea and Hyperbaric Medical Society. HBO2’s main effect is to increase oxygen content in plasma and body tissues, which can counteract hypoxia or ischemia. Laboratory studies show that HBO2 has effects beyond relieving hypoxia (eg, promoting angiogenesis in irradiated tissue, anti-inflammatory effects, radiosensitization of tumors, hypoxia preconditioning, and fungal growth inhibition) and has potential to treat conditions such as inflammatory bowel disease and pyoderma gangrenosum. Lack of consistently collected outcome data on a large cohort of individuals receiving HBO2 therapy limits its use for both established and new indications. A course of therapy often involves 30-40 visits to a hyperbaric chamber, so the number of patients seen at any given center is constrained by chamber capacity. As a result, published HBO2 outcome data tend to be from small case series because few patients with a particular condition are treated at a given center. To solve this problem, a registry that collects and pools data systematically from multiple institutions has been established. Objective The aim of this study is to collect consistent outcome data across multiple hyperbaric centers to assess treatment effectiveness and establish a research consortium. Methods A consortium of hyperbaric centers who have agreed to collect consistent outcome data on all patients seen has been assembled. Data are collected at each participating center using Research Electronic Data Capture (REDCap), a web-based, data collection system used frequently for research. Standard outcome measures have been defined for each condition, which are programmed into the REDCap data collection templates. Governance is through a consortium agreement that defines data security, data sharing, publications, liability, and other issues. Centers obtain Institutional Review Board (IRB) and ethics approval to participate, either from their own institutions or by relying on the IRB at the coordinating center at Dartmouth College. Dissemination will occur through a yearly report and by publications based on the data in the registry. Results Early results from some common indications show significant pretreatment to posttreatment changes. Additional indications and outcome measures are being added using the procedures outlined in the consortium agreement. Conclusions The registry collects consistent outcome information for a therapy that needs further study and a stronger evidence base. It also overcomes the challenge of collecting data from an adequate number of patients for both established and emerging indications by combining data collection from multiple centers. The data entry requirements should be within the capabilities of existing staff at any given hyperbaric center. By using REDCap, the registry can be expanded to include detailed information on particular indications and long-term follow-up on selected patients without significantly increasing the basic data entry requirements. Through the registry, a network of enrolled hyperbaric centers has been established that provides the basis for a clinical trial network. International Registered Report Identifier (IRRID) DERR1-10.2196/18857
    Type of Medium: Online Resource
    ISSN: 1929-0748
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2020
    detail.hit.zdb_id: 2719222-2
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  • 3
    In: Journal of Urology, Ovid Technologies (Wolters Kluwer Health), Vol. 209, No. Supplement 4 ( 2023-04)
    Type of Medium: Online Resource
    ISSN: 0022-5347 , 1527-3792
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 4
    In: Health Technology Assessment, National Institute for Health and Care Research, Vol. 23, No. 2 ( 2019-1), p. 1-44
    Abstract: Randomised controlled trials (RCTs) exploring the potential of vitamin D to prevent acute respiratory infections have yielded mixed results. Individual participant data (IPD) meta-analysis has the potential to identify factors that may explain this heterogeneity. Objectives To assess the overall effect of vitamin D supplementation on the risk of acute respiratory infections (ARIs) and to identify factors modifying this effect. Data sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov and the International Standard Randomised Controlled Trials Number (ISRCTN) registry. Study selection Randomised, double-blind, placebo-controlled trials of supplementation with vitamin D 3 or vitamin D 2 of any duration having incidence of acute respiratory infection as a prespecified efficacy outcome were selected. Study appraisal Study quality was assessed using the Cochrane Collaboration Risk of Bias tool to assess sequence generation, allocation concealment, blinding of participants, personnel and outcome assessors, completeness of outcome data, evidence of selective outcome reporting and other potential threats to validity. Results We identified 25 eligible RCTs (a total of 11,321 participants, aged from 0 to 95 years). IPD were obtained for 10,933 out of 11,321 (96.6%) participants. Vitamin D supplementation reduced the risk of ARI among all participants [adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.81 to 0.96; heterogeneity p   〈  0.001]. Subgroup analysis revealed that protective effects were seen in individuals receiving daily or weekly vitamin D without additional bolus doses (aOR 0.81, 95% CI 0.72 to 0.91), but not in those receiving one or more bolus doses (aOR 0.97, 95% CI 0.86 to 1.10; p  = 0.05). Among those receiving daily or weekly vitamin D, protective effects of vitamin D were stronger in individuals with a baseline 25-hydroxyvitamin D [25(OH)D] concentration of 〈  25 nmol/l (aOR 0.30, 95% CI 0.17 to 0.53) than in those with a baseline 25(OH)D concentration of ≥ 25 nmol/l (aOR 0.75, 95% CI 0.60 to 0.95; p  = 0.006). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (aOR 0.98, 95% CI 0.80 to 1.20; p  = 0.83). The body of evidence contributing to these analyses was assessed as being of high quality. Limitations Our study had limited power to detect the effects of vitamin D supplementation on the risk of upper versus lower respiratory infection, analysed separately. Conclusions Vitamin D supplementation was safe, and it protected against ARIs overall. Very deficient individuals and those not receiving bolus doses experienced the benefit. Incorporation of additional IPD from ongoing trials in the field has the potential to increase statistical power for analyses of secondary outcomes. Study registration This study is registered as PROSPERO CRD42014013953. Funding The National Institute for Health Research Health Technology Assessment programme.
    Type of Medium: Online Resource
    ISSN: 1366-5278 , 2046-4924
    Language: English
    Publisher: National Institute for Health and Care Research
    Publication Date: 2019
    detail.hit.zdb_id: 2059206-1
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  • 5
    In: Cancer, Wiley, Vol. 120, No. 3 ( 2014-02), p. 408-414
    Abstract: Body mass index and smoking are associated with bladder cancer recurrence. Consideration of these lifestyle factors in diagnosis and intervention therapies should be examined in future studies.
    Type of Medium: Online Resource
    ISSN: 0008-543X , 1097-0142
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 1479932-7
    detail.hit.zdb_id: 2599218-1
    detail.hit.zdb_id: 2594979-2
    detail.hit.zdb_id: 1429-1
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  • 6
    Online Resource
    Online Resource
    Proceedings of the National Academy of Sciences ; 2012
    In:  Proceedings of the National Academy of Sciences Vol. 109, No. 28 ( 2012-07-10)
    In: Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, Vol. 109, No. 28 ( 2012-07-10)
    Abstract: In summary, our work shows that cofactor molecules play an essential role in determining all of the unique characteristics of mammalian prions, i.e., infectivity, PrP Sc structure, and strain properties (including selective neurotropism). The precise mechanism by which these characteristics are defined remains undetermined. The only two logical possibilities are either that cofactor molecules are integral components of infectious prions (rejecting the “protein only” hypothesis) or that cofactor molecules are necessary to exert a continuous selective pressure during the propagation of infectious prions (and specific strains) composed of only PrP Sc molecules. Additional considerations, such as the colocalization of fluorescently labeled PE molecules with PrP Sc molecules in prion aggregates, the effects of organic solvents on prion disinfection ( 2 ), and Anfinsen’s principle of protein folding ( 3 ), argue that cofactor molecules are likely essential structural components of infectious prions, but further studies are required to confirm this assertion. To test whether cofactor molecules can modulate strain properties, we changed only the cofactor component of a substrate mixture during the serial propagation of a purified recombinant prion. This single change caused dramatic changes in strain properties, as determined by clinical incubation time, neuropathology, and biochemical assays of PrP Sc structure in infected animals. Moreover, we found that three different prion strains all produced the same unique output strain when propagated in a substrate mixture containing only one available cofactor. The most remarkable aspect of these experiments is that the cofactor component of the reaction, rather than the input strains used as seed, was the active determinant of the output strain. Collectively, these results provide direct evidence that prion strain diversity cannot be maintained with a restricted cofactor repertoire and imply that specific sets of cofactor molecules may be responsible for generating specific prion strains ( Fig. P1 ). Here, we used a purified cofactor preparation containing only one available cofactor, PE, as a unique tool to test these possibilities in an in vitro prion propagation system. To test whether cofactor molecules are required to maintain prion infectivity, we serially propagated purified prions in substrate mixtures that either contained or lacked the cofactor. Interestingly, both sets of reactions produced self-propagating PrP Sc molecules, but, based on an enzymatic protein digestion assay, the shape of the “protein only” PrP Sc molecules appeared be slightly different from that of the cofactor PrP Sc molecules. We measured the specific infectivity of both types of PrP Sc molecules by inoculating wild-type mice with serial dilutions of each. PrP Sc molecules formed with the cofactor were at least 10 5 times more infectious than the “protein only” PrP Sc molecules, which failed to cause prion disease even at the highest concentration. Thus, cofactor molecules appear to be necessary to maintain the infectious PrP Sc structure in mammalian prions. We focused our efforts on generating purified infectious prions from chemically defined substrates in vitro. Using this approach, we discovered that molecules other than PrP C are needed to form infectious prions and that infectious prions are formed de novo from a substrate mixture containing PrP C and cofactor molecules. We also found that different types of cofactor molecules, including lipid and polyanionic molecules, are able to serve as prion cofactors. Most recently, we purified and identified phosphatidylethanolamine (PE) as a cofactor that, by itself, can facilitate the propagation of prions from a wide variety of animal species. These findings raise the possibility that cofactor molecules actually may play an essential role in maintaining infectious PrP Ss structure and that different classes of cofactor molecules may be responsible for enciphering strain diversity. There are two important reasons to doubt the “protein only” hypothesis for mammalian prions. First, despite efforts by many investigators, prions with significant levels of specific infectivity have not yet been produced with PrP alone. In contrast, prions with moderate levels of specific infectivity can be formed spontaneously from a mixture of PrP C and cofactor molecules ( 1 ). Second, prions exist as a variety of distinguishable “strains” that exhibit specific patterns of clinical symptoms, neuropathology, and PrP Sc biochemical characteristics. It is difficult to envision how a single protein, by itself, can encode such a diversity of infectious properties, especially the property of selective neurotropism by which prion strains can be differentiated by their preferential patterns of accumulation in specific regions of the brain. Mammalian prions are unorthodox infectious agents that cause fatal neurological diseases such as Creutzfeldt–Jakob disease, bovine spongiform encephalopathy (also known as “mad cow disease”), and scrapie. Prions lack informational nucleic acids; therefore, it is puzzling that they replicate within and cause specific patterns of disease in infected hosts. Prions are formed by the conversion of a normal cellular prion protein (PrP C ) into a misfolded shape called the “scrapie prion protein” (PrP Sc ). According to the popular “protein only” hypothesis, PrP Sc may be the only essential component of the infectious agent, possessing the ability to replicate and cause disease by inducing the conversion of PrP C molecules into additional PrP Sc molecules. Here, we demonstrate that cofactor molecules appear to be necessary to maintain PrP Sc structure and that specific sets of cofactor molecules may generate specific prion strains ( Fig. P1 ).
    Type of Medium: Online Resource
    ISSN: 0027-8424 , 1091-6490
    RVK:
    RVK:
    Language: English
    Publisher: Proceedings of the National Academy of Sciences
    Publication Date: 2012
    detail.hit.zdb_id: 209104-5
    detail.hit.zdb_id: 1461794-8
    SSG: 11
    SSG: 12
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  • 7
  • 8
    In: The Lancet Diabetes & Endocrinology, Elsevier BV, Vol. 9, No. 5 ( 2021-05), p. 276-292
    Type of Medium: Online Resource
    ISSN: 2213-8587
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 9
    In: JAMA, American Medical Association (AMA), Vol. 297, No. 21 ( 2007-06-06), p. 2351-
    Type of Medium: Online Resource
    ISSN: 0098-7484
    RVK:
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2007
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 10
    Online Resource
    Online Resource
    Microbiology Society ; 2008
    In:  Journal of General Virology Vol. 89, No. 10 ( 2008-10-01), p. 2642-2650
    In: Journal of General Virology, Microbiology Society, Vol. 89, No. 10 ( 2008-10-01), p. 2642-2650
    Abstract: Native mammalian prions exist in self-propagating strains that exhibit distinctive clinical, pathological and biochemical characteristics. Prion strain diversity is associated with variations in PrP Sc conformation, but it remains unknown precisely which physical properties of the PrP Sc molecules are required to encipher mammalian prion strain phenotypes. In this study, we subjected prion-infected brain homogenates derived from three different hamster scrapie strains to either (i) proteinase K digestion or (ii) sonication, and inoculated the modified samples into normal hamsters. The results show that the strain-specific clinical features and neuropathological profiles of inoculated animals were not affected by either treatment. Similarly, the strain-dependent biochemical characteristics of the PrP Sc molecules (including electrophoretic mobility, glycoform composition, conformational stability and susceptibility to protease digestion) in infected animals were unaffected by either proteolysis or sonication of the original inocula. These results indicate that the infectious strain properties of native prions do not appear to be altered by PrP Sc disaggregation, and that maintenance of such properties does not require the N-domain (approximately residues 23–90) of the protease-resistant PrP Sc molecules or protease-sensitive PrP Sc molecules.
    Type of Medium: Online Resource
    ISSN: 0022-1317 , 1465-2099
    RVK:
    RVK:
    Language: English
    Publisher: Microbiology Society
    Publication Date: 2008
    detail.hit.zdb_id: 2007065-2
    SSG: 12
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