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54. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

Author

Moise, Nathalie, Moise, Nathalie, Huang, Chen, Rodgers, Anthony, Kohli-Lynch, Ciaran N, Tzong, Keane Y, Coxson, Pamela G, Bibbins-Domingo, Kirsten, Goldman, Lee, Moran, Andrew E, Moise, Nathalie, Moise, Nathalie, Huang, Chen, Rodgers, Anthony, Kohli-Lynch, Ciaran N, Tzong, Keane Y, Coxson, Pamela G, Bibbins-Domingo, Kirsten, Goldman, Lee, and Moran, Andrew E

Abstract

The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled.

Published
2016

56. Single nucleotide polymorphisms in the insulin-like growth factor 1 (IGF-1) gene are associated with performance in Holstein-Friesian dairy cattle

Author

Mullen, Michael P., Berry, Donagh P., Howard, Dawn, Diskin, Michael G., Lynch, Ciaran O., Gibliin, Linda, Kenny, David A., Meade, Kieran G., and Waers, Sinead

Subjects
Performance, Holstein-Friesian dairy cattle, Faculty of Science and Health AIT, Single nucleotide polymorphism
Abstract

Insulin-like growth factor 1 (IGF-1) has been shown to be associated with fertility, growth, and development in cattle. The aim of this study was to (1) identify novel single nucleotide polymorphisms (SNPs) in the bovine IGF-1 gene and alongside previously identified SNPs (2) determine their association with traits of economic importance in Holstein-Friesian dairy cattle. Nine novel SNPs were identified across a panel of 22 beef and dairy cattle by sequence analysis of the 5′ promoter, intronic, and 3′ regulatory regions, encompassing ∼5 kb of IGF-1. Genotyping and associations with daughter performance for milk production, fertility, survival, and measures of body size were undertaken on 848 Holstein-Friesian AI sires. Using multiple regression analysis nominal associations (P < 0.05) were identified between six SNPs (four novel and two previously identified) and milk composition, survival, body condition score, and body size. The C allele of AF017143 a previously published SNP (C-512T) in the promoter region of IGF-1 predicted to introduce binding sites for transcription factors HSF1 and ZNF217 was associated (P < 0.05) with increased cow carcass weight (i.e., an indicator of mature cow size). Novel SNPs were identified in the 3′ region of IGF-1 were associated (P < 0.05) with functional survival and chest width. The remaining four SNPs, all located within introns of IGF-1 were associated (P < 0.05) with milk protein yield, milk fat yield, milk fat concentration, somatic cell score, carcass conformation, and carcass fat. Results of this study further demonstrate the multifaceted influences of IGF-1 on milk production and growth related traits in cattle.

Published
2011

58. A workina dav : 'Professor Cheese' likes to share his knowledge with customers

Author

Lynch, Ciaran

Subjects
Food additives industry -- Officials and employees, Executives -- Interviews, Agricultural industry, Business, Food and beverage industries, Business, international
Abstract

Q. What in your background prepared you for your current role? I've always had an interest in the science behind food, and it's been a central element throughout my education. [...]

Published
2014

60. Book reviews

Author

Gold, John R., Meller, Helen, Buder, Stanley, Marcuse, Peter, Lynch, Ciaran, Hebbert, Michael, Stephenson, Gordon, Curl, James Stevens, Miller, John, Meller, Helen, Holzner, Lutz, Munro, George E., Gleave, Stephen, Bosma, Koos, and Muller, Peter O.

Abstract

Unreal city. Urban experience in modern European literature and art. Edward Timms and David Kelley (eds), University Press, Manchester, 1985 268 pp, £26.50, ISBN 0 7190 1748 3Cities perceived. Urban society in European and American thought, 1820-1940. Andrew Lees, University Press, Manchester, 1985. 360 pp, £25.00, ISBN 0 7190 1725 4Crabgrass frontier: the suburbanization of the United States. Kenneth T. Jackson, Oxford University Press, New York, 1985. 396 pp, $21.95, ISBN 0 19 503610 7The transformation of San Francisco. Chester Hartman, Rowman and Allanheld, Totowa, New Jersey, 1984. 372 pp, $28.50 cloth ($10.95 paper), ISBN 0 8476 7372 3 (cloth) and 0 8476 7373 1 (paper)A hundred years of Irish planning. Volume I. The emergence of Irish planning 1880-1920. Michael J. Bannon (ed.), Turoe Press, Dublin, 1985. 336 pp, £18.95 (cloth) and £9.95 (paper), ISBN 0 905223 73X (cloth) and 0 905223 780 (paper)Strategic planning in south east England 1968-78: a case study. B. E. M. Linders, Pergamon (Progress in Planning, 23(2), 67-154), Oxford, 1985 $20.00, ISBN 0 08 032720 6Holford. A study in architecture, planning and civic design. Gordon E. Cherry and Leith Penny, Mansell (Studies in history, planning and the environment series), London, 1986. 293 pp, £25.00, ISBN 0 7201 1786 0The Royal Institute of British Architects. A guide to its archive and history. Angela Mace (ed.), Mansell, London, 1986 378 pp, £32.50, ISBN 0 7201 1773 9London 1500-1700. The making of the metropolis. A. L. Beier and Roger Finlay (eds), Longman, London, 1986 283 pp, £7.50, ISBN 0 582 49436 2C. R. Ashbee: architect, designer and romantic socialist. Alan Crawford, Yale University Press, Newhaven, 1986. 499 pp, $45.00, ISBN 0 300 03467 9Hitler's Berlin: the Speer plans for reshaping the central city. Stephen D. Helmer, VMI Research Press, Ann Arbor, Michigan, 1985 336 pp, $54.95, ISBN 08 357 16821The making of urban Europe, 1000-1950. Paul H. Hohenberg and Lynn Holden Lees, Howard University, Cambridge, Massachusetts, 1985. 398 pp, $32.50, ISBN 0 674 54360 2The homes and homeless of post-war Britain. Frederick Shaw, Barnes and Noble, Totowa, New Jersey, 1986. 288 pp, $45.00, ISBN 0 389 20520 6Public planning in the Netherlands. Perspectives and change since the Second World War. Ashok K. Dutt and Frank J. Costa (eds), Clarendon Press, Oxford, 1985 261 pp, £20.00, ISBN 0 19 823248 9Suburbia: an international assessment. Donald N. Rothblatt and Daniel J. Garr, Croom Helm, London; St Martins Press, New York, 1986. 318 pp, £19.95 ($32.50), 0 7099 2258 2

Published
1987
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61. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

62. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

63. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

64. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

65. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

66. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

67. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

68. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

69. Beyond ten-year risk: novel approaches to the primary prevention of cardiovascular disease

Author

Kohli-Lynch, Ciaran Navin and Kohli-Lynch, Ciaran Navin

Abstract

In cost-effectiveness analysis, outcomes are typically averaged across large groups to represent a patient population. Implementation and reimbursement decisions based on such analyses often ignore considerable heterogeneity in cost-effectiveness between patients. While good practice guidance for economic evaluations suggest including subgroup analysis, in practice this is frequently overlooked or underutilised. This thesis shows that failing to adequately represent heterogeneity in decision-making leads to an inefficient distribution of healthcare resources. This theory is applied in a study of cholesterol-reducing medication for the primary prevention of cardiovascular disease (CVD). Despite improvements in recent years, CVD remains a significant cause of mortality, morbidity, and health inequality around the world. Rates of the disease have begun to plateau in recent years and novel approaches to its prevention are required. Cholesterol reduction for the primary prevention of cardiovascular disease is a clinical area where better reflection of heterogeneity in cost-effectiveness could significantly improve current practice. Statins are a widely prescribed cholesterol-reducing medication which have recently come off patent. This has led them to become cheaper and cost-effective in a large proportion of CVD-free populations in high-income countries. PCSK9 inhibitors are a more expensive and more effective cholesterol-reducing medication. For both treatments, decision-makers must establish which groups they will prioritise for treatment. Through epidemiologic and health economic analysis, this thesis aims to establish optimal approaches for prioritising patients for cholesterol-reducing therapy. Preventive statin therapy is typically targeted at individuals estimated to have a high ten-year risk of developing CVD. However, individuals with the same ten-year risk may experience different outcomes from preventive treatment. The epidemiologic bases for three alternativ

70. Urinary incontinence in men -- the forgotten gender.

Author

Lynch, Ciaran and Almallah, Zaki

Subjects
*URINARY incontinence, *DISEASES in men, *OLDER people, *PROSTATECTOMY, *UROLOGY
Abstract

Urinary incontinence in men is a common but underestimated problem. The majority of female and male patients with urinary incontinence usually suffer from embarrassment and late presentation. With an increasingly elderly population, the problem is an expanding one. The causes of urinary incontinence, urgency incontinence, stress incontinence and overflow incontinence affect both sexes. In addition, the growing problem of post-prostatectomy incontinence is peculiar to men. This article reviews the major causes of urinary incontinence in the male patient, describes the initial assessment and outlines some strategies for management. [ABSTRACT FROM AUTHOR]

Published
2009

71. Potential Value of Long-term Intensive BP Treatment in 40-year Patients: A Computer Simulation Study.

Author

Thanataveerat, Anusorn, Kohli-Lynch, Ciaran N., Vittinghoff, Eric, Pletcher, Mark J., and Moran, Andrew E.

Abstract

Introduction: Intensive blood pressure (BP) goals are considered for high cardiovascular disease (CVD) risk adults ≥50 years old; the long-term value of intensive BP goals in younger high CVD risk patients has not been studied. Objectives: We used individual patient computer simulations to assess the incremental value of intensive BP goals in high CVD risk patients as young as 40 years. Methods: Six age/sex cohorts of 100,000 individuals were assembled by sampling NHANES surveys 1999-2010. BP and other risk factor trajectories were projected from ages 60 to 69, 50 to 69, and 40 to 69 years based on Framingham Offspring Cohort analyses. One BP treatment scenario simulated treating BP <140/90 mmHg in all patients ≥140/90; a second scenario added to the first a goal

Published
2017
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72. Long-Term Benefits of Blood Pressure Lowering in Young Adulthood: A Computer Simulation Study.

Author

Kohli-Lynch, Ciaran N., Thanataveerat, Anusorn, Vittinghoff, Eric, Pletcher, Mark J., and Moran, Andrew E.

Abstract

Introduction: Extended periods of exposure to elevated blood pressure (BP) in early adult life contribute independently to later life coronary heart disease (CHD) risk. Currently, there are significant gaps in hypertension awareness, treatment, and control in young adults. The long-term health benefits of controlling high BP in young adults have not previously been quantified. Objective: This study aimed to project CHD prevention benefits from controlling raised blood pressure starting in early adulthood compared with control at age 40 or older. Method: A state-transition microsimulation model estimated individual-level CHD outcomes, dependent on risk factors exposures and accounting for competing risk of stroke or non-cardiovascular death. Risk for first CHD event after age 40 was conditioned both on time-weighted average of early adult (ages 20-39) diastolic blood pressure (DBP), and raised DBP or systolic blood pressure (SBP) at age ≥ 40. We simulated CHD outcomes in a cohort of US adults with DBP ≥ 85 mmHg any time in young adulthood in 3 scenarios: no treatment, later life SBP control alone, or early DBP control plus later life BP control. Results: By age 39, 2.2% of the CVD-free young adult U.S. population was estimated to have early elevated DBP and was eligible for treatment. With follow up until age 69 years, early BP control prevented twice the number of primary CHD events (Table). Conclusion: This study quantifies the opportunity cost of failing to control hypertension identified in young adulthood. It is unclear whether early blood pressure control should be achieved by lifestyle or pharmacological intervention. [ABSTRACT FROM AUTHOR]

Published
2017
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73. Allogeneic stem-cell transplantation for renal-cell cancer

Author

Gommersalll, Lyndon, Hayne, Dickon, Lynch, Ciaran, Joseph, Jean V, Arya, Manit, and Patel, Hitendra R H

Subjects
*TRANSPLANTATION of organs, tissues, etc., *STEM cell transplantation, *TUMORS, *RENAL cell carcinoma, *CANCER, *RENAL cancer
Abstract

Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this disease have a poor outlook. Immunotherapy by use of cytokines and vaccines against tumour antigens has shown encouraging results in a small group of patients. Advances in the understanding of the graft-versus-tumour effect in haematological malignant disorders have led to the use of stem-cell transplantation for treatment of solid-organ malignant diseases such as RCC. Techniques of bone-marrow ablation have been superseded by safer conditioning regimens, with occasional complete remission and partial remission in some patients. Graft-versus-host disease, engraftment failure, and disease progression remain important obstacles to the widespread use of new techniques for metastatic RCC. Here, we summarise important issues surrounding immunotherapy for RCC, the problems encountered with use of immunotherapy, and the present use of non-myeloablative techniques for treatment of this disease. [Copyright &y& Elsevier]

Published
2004
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75. Synthesis of disaccharides derived from heparin and evaluation of effects on endothelial cell growth and on binding of heparin to FGF-2.

Author

O'Brien A, Lynch C, O'Boyle KM, and Murphy PV

Subjects
Angiogenesis Inhibitors chemistry, Animals, Aorta cytology, Binding, Competitive, Cattle, Cell Line, Cell Proliferation drug effects, Disaccharides chemistry, Endothelium, Vascular cytology, Fibroblast Growth Factor 2 pharmacology, Heparin metabolism, Heparin pharmacology, Heparin Antagonists chemical synthesis, Molecular Mimicry, Neovascularization, Physiologic, Angiogenesis Inhibitors chemical synthesis, Angiogenesis Inhibitors physiology, Disaccharides chemical synthesis, Disaccharides pharmacology, Endothelium, Vascular drug effects, Fibroblast Growth Factor 2 metabolism, Heparin chemistry
Abstract

The disaccharide beta-D-GlcA-(1-->4)-alpha-D-GlcNAc-1-->OMe and other small nonsulfated oligosaccharides related to heparin/heparan sulfate have been shown to bind to FGF and activated the fibroblast growth factor (FGF) signalling pathway in (F32) cells expressing the FGF receptor. Synthetic routes to beta-D-GlcA-(1-->4)-alpha-D-GlcNAc-1-->OMe and a glucose analogue beta-D-Glc-(1-->4)-alpha-D-GlcNAc-1-->OMe are described. The effects of these disaccharides on endothelial cell growth, which is relevant to angiogenesis, were evaluated and it was found they did not mimic the inhibitory effects that were observed for heparin albumin (HA) and that have also been observed by monosaccharide conjugates. They did not alter bovine aortic endothelial cell (BAEC) proliferation, in the presence of FGF-2 in serum free medium or in absence of FGF-2 in serum free and complete medium. Disaccharides (10 microg/mL) reduced by 25-31% the inhibition caused by HA (10 microg/mL) on BAEC growth in serum-free medium but had no effect in complete medium. There was no evidence obtained for the binding of these oligosaccharides to FGF-2 in competition with HA by ELISA.

Published
2004
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