Institution
McMaster University
Education•Hamilton, Ontario, Canada•
About: McMaster University is a education organization based out in Hamilton, Ontario, Canada. It is known for research contribution in the topics: Population & Health care. The organization has 41361 authors who have published 101269 publications receiving 4251422 citations.
Papers published on a yearly basis
Papers
More filters
••
University of Helsinki1, Churchill Hospital2, University of Western Ontario3, Hoffmann-La Roche4, Princess Alexandra Hospital5, Queen Elizabeth II Hospital6, University of Münster7, RMIT University8, Royal Prince Alfred Hospital9, University of Alberta10, Université de Montréal11, McMaster University12, Joseph Fourier University13, University of Zurich14, Beaumont Hospital15, Mario Negri Institute for Pharmacological Research16
TL;DR: MMF is associated with a significantly lower rate of treatment failure compared with AZA during the first 6 months after renal transplantation and produces a clinically important reduction in the incidence, severity, and treatment of acute graft rejection.
Abstract: Mycopehenolate mofetil (MMF) is a powerful immunosuppressant that inhibits the proliferation of T and B lymphocytes by blocking the enzyme inosine monophosphate dehydrogenase. MMF has been shown to prevent acute graft rejection in animal experiments and may have an important role in clinical renal transplantation. We conducted a prospective, double-blind, multi-center trial to compare the efficacy and safety of MMF and azathioprine within standard immunosuppressive regimen for patients receiving a first or second cadaveric renal graft. A total of 503 patients were randomized to groups receiving MMF 3 g (n=164), MMF 2 g (n=173), or azathioprine (AZA) 100-150 mg (n=166) daily. All were treated simultaneously with equivalent doses of cyclosporine and oral corticosteroids and followed for 12 months. The primary endpoint was treatment failure, defined as the occurrence of biopsy-proven graft rejection, graft loss, patient death, or discontinuation of the study drug during the first 6 months after transplantation. Treatment failure occurred in 50.% of patients in the AZA group by 6 months after transplantation, compared with 34.8% in the MMF 3g group (P=0.0045) and 38.2 % in the MMF 2g group (P=0.0287). Biopsy-proven rejection occurred in 15.9% of patients in the MMF 3 g group and 19.7% in the MMF2 g group, compared with 35.5% in the AZA group. Rejection of histologic severity grade II or more developed in 6.1 %, 10.4% and 19.9% of patients in the MMF 3 g, MMF 2 g, and AZA groups, respectively. Patients receiving MMF required less frequent and less intensive treatment for acute rejection: 24.4% of patients on MMF 3 g and 31.0% on MMF 2 g were tested for acute rejection, compared with 47.5% on AZA. Only 4.9% on MMF 3 g and 8.8% on MMF 2 g required antilymphocyte antibodies for treatment of severe or steroid-resistant rejection, compared with 15.4% of the patients on AZA. At 1 year after transplantation, graft survival in the MMF groups was marginally superior to that in the AZA group, although this difference was not statistically significant. Gastrointestinal toxicity and tissue-invasive cytomegalovirus infection were more common in the MMF 3 g group. Noncutaneous malignancies occurred in six patients on MMF 3 g, three patients on MMF 2 g, and four patients on AZA. Lymphoproliferative disorders occurred in two patients per MMF group, compared with one patient receiving AZA. MMF appears to be an important advance in prophylaxis following renal transplantation. It is associated with a significantly lower rate of treatment failure compared with AZA during the first 6 months after renal transplantation and produces a clinically important reduction in the incidence, severity, and treatment of acute graft rejection. These differences persist throughout the first year of follow-up. Clinical benefit was greatest with a dose of MMF 3 g/day, but gastrointestinal effects, invasive cytomegalovirus infection, and malignancies were slightly more common at that dose. The appropriate dose may lie between 2 g and 3 g per day and may require individualization depending on clinical course or other factors.
1,010 citations
••
TL;DR: Most patients will be better served by first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole.
1,009 citations
••
Vanderbilt University1, McMaster University2, National Institute for Health and Care Excellence3, University of Florida4, Case Western Reserve University5, Peninsula College of Medicine and Dentistry6, University Medical Center Freiburg7, University Hospital of Basel8, Harvard University9, University at Buffalo10
TL;DR: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to classifying the direction and strength of recommendations is described, separated into strong and weak.
1,009 citations
••
TL;DR: Susceptibility-weighted imaging (SWI) is a new neuroimaging technique, which uses tissue magnetic susceptibility differences to generate a unique contrast, different from that of spin density, T1, T2, and T2*.
Abstract: SUMMARY: Susceptibility-weighted imaging (SWI) is a new neuroimaging technique, which uses tissue magnetic susceptibility differences to generate a unique contrast, different from that of spin density, T1, T2, and T2*. In this review (the first of 2 parts), we present the technical background for SWI. We discuss the concept of gradient-echo images and how we can measure local changes in susceptibility. Armed with this material, we introduce the steps required to transform the original magnitude and phase images into SWI data. The use of SWI filtered phase as a means to visualize and potentially quantify iron in the brain is presented. Advice for the correct interpretation of SWI data is discussed, and a set of recommended sequence parameters for different field strengths is given.
1,008 citations
••
TL;DR: In this article, the authors conducted a population-based study of three ethnic groups in Canada: South Asians, Chinese, and Europeans, and found that the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease.
1,006 citations
Authors
Showing all 41721 results
Name | H-index | Papers | Citations |
---|---|---|---|
Salim Yusuf | 231 | 1439 | 252912 |
Gordon H. Guyatt | 231 | 1620 | 228631 |
Simon D. M. White | 189 | 795 | 231645 |
George Efstathiou | 187 | 637 | 156228 |
Stuart H. Orkin | 186 | 715 | 112182 |
Terrie E. Moffitt | 182 | 594 | 150609 |
John J.V. McMurray | 178 | 1389 | 184502 |
Jasvinder A. Singh | 176 | 2382 | 223370 |
Deborah J. Cook | 173 | 907 | 148928 |
Andrew P. McMahon | 162 | 415 | 90650 |
Jack Hirsh | 146 | 734 | 86332 |
Holger J. Schünemann | 141 | 810 | 113169 |
John A. Peacock | 140 | 565 | 125416 |
David Price | 138 | 1687 | 93535 |
Graeme J. Hankey | 137 | 844 | 143373 |