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Haarnoja T, Moran B, Lever G, Huang SH, Tirumala D, Humplik J, Wulfmeier M, Tunyasuvunakool S, Siegel NY, Hafner R, Bloesch M, Hartikainen K, Byravan A, Hasenclever L, Tassa Y, Sadeghi F, Batchelor N, Casarini F, Saliceti S, Game C, Sreendra N, Patel K, Gwira M, Huber A, Hurley N, Nori F, Hadsell R, Heess N. Learning agile soccer skills for a bipedal robot with deep reinforcement learning. Sci Robot 2024; 9:eadi8022. [PMID: 38598610 DOI: 10.1126/scirobotics.adi8022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024]
Abstract
We investigated whether deep reinforcement learning (deep RL) is able to synthesize sophisticated and safe movement skills for a low-cost, miniature humanoid robot that can be composed into complex behavioral strategies. We used deep RL to train a humanoid robot to play a simplified one-versus-one soccer game. The resulting agent exhibits robust and dynamic movement skills, such as rapid fall recovery, walking, turning, and kicking, and it transitions between them in a smooth and efficient manner. It also learned to anticipate ball movements and block opponent shots. The agent's tactical behavior adapts to specific game contexts in a way that would be impractical to manually design. Our agent was trained in simulation and transferred to real robots zero-shot. A combination of sufficiently high-frequency control, targeted dynamics randomization, and perturbations during training enabled good-quality transfer. In experiments, the agent walked 181% faster, turned 302% faster, took 63% less time to get up, and kicked a ball 34% faster than a scripted baseline.
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Affiliation(s)
| | | | | | | | - Dhruva Tirumala
- Google DeepMind, London, UK
- University College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neil Sreendra
- Google DeepMind, London, UK
- Proactive Global, London, UK
| | - Kushal Patel
- Google DeepMind, London, UK
- Proactive Global, London, UK
| | - Marlon Gwira
- Google DeepMind, London, UK
- Proactive Global, London, UK
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Arbuthnot EJ, Parker J, Cecil T, Mohamed F, Williams R, Page M, Moran B. Peritoneal malignancy in the global COVID-19 pandemic: experience of recovery and restoration in a high-volume centre through NHS and independent sector collaboration. Ann R Coll Surg Engl 2024; 106:385-388. [PMID: 38038177 PMCID: PMC10981979 DOI: 10.1308/rcsann.2022.0074] [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: 05/16/2022] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Treatment of peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) requires substantial critical care, theatre and nursing resources. The COVID-19 pandemic caused challenges in providing a high volume, tertiary referral service. METHODS We reviewed data on referrals and operations performed in a tertiary referral centre in both NHS and independent sector settings. The impact of COVID-19 on activity was assessed using 2019 as a benchmark. RESULTS New patient referrals were similar, with 891 in 2019 compared with 833 in 2020. Delivery of CRS and HIPEC operations were initially impacted by COVID-19. NHS and independent sector collaboration facilitated recovery, with 284 patients treated in 2020 compared with 280 in 2019. CONCLUSIONS Close collaboration and structural organisation between the clinical and management teams in the NHS and independent sectors facilitated recovery and restoration of a complex tertiary referral service for peritoneal malignancy during the COVID pandemic.
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Affiliation(s)
- EJ Arbuthnot
- Peritoneal Malignancy Institute, Hampshire Hospitals NHS Foundation Trust, UK
| | - J Parker
- Peritoneal Malignancy Institute, Hampshire Hospitals NHS Foundation Trust, UK
| | | | | | - R Williams
- Peritoneal Malignancy Institute, Hampshire Hospitals NHS Foundation Trust, UK
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Palma-Molina P, Hennessy T, Dillon E, Onakuse S, Moran B, Shalloo L. Evaluating the effects of grass management technologies on the physical, environmental, and financial performance of Irish pasture-based dairy farms. J Dairy Sci 2023; 106:6249-6262. [PMID: 37500433 DOI: 10.3168/jds.2022-23111] [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] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 07/29/2023]
Abstract
Grass management technologies (grass measuring devices and grassland management decision support tools) have been identified as important tools to improve the performance of pasture-based dairy farms. They have the potential to significantly improve the efficiency and sustainability of dairy systems by increasing milk production through enhanced pasture growth and utilization, which would reduce the need for supplementary feeds, along with increased output, therefore increasing farm profitability and environmental sustainability. Despite the several potential benefits of grass management technologies, there is a lack of empirical research around the effects of these technologies on the performance of pasture-based dairy systems. The current study aimed to fill this knowledge gap by using a 2018 nationally representative survey of Irish dairy farms and a propensity score matching approach to determine the effects of adopting grass management technologies on the physical, environmental, and financial performance of Irish pasture-based dairy farms. The findings showed that dairy farms utilizing grass management technologies had, on average, higher farm physical, environmental, and financial performance (in terms of grazed pasture use, total pasture use, length of the grazing season, milk yield, milk solids, greenhouse gas emissions per kilogram of fat- and protein-corrected milk, gross output, and gross margin) compared with dairy farms not utilizing these technologies. However, when controlling for selection bias, we can only attribute a positive causal effect of grass management technology adoption on the use of grazed pasture per cow, grazing season length, milk yield per cow, and milk solids per cow. This might be due to dairy farmers not yet using the technologies to their full potential, 2018 being an unusual year in terms of weather (and therefore not being able to capture the full range of farm performance benefits), or because grass management technologies need to be adopted in association with other technologies and practices to achieve their expected performance outcomes. Future research should include updated farm-level data to capture the weather and learning effects and so be able to determine the impact of grass management technologies on a wider range of performance indicators.
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Affiliation(s)
- P Palma-Molina
- Department of Food Business and Development, Cork University Business School, University College Cork, Cork, Ireland T12 K8AF; Animal and Grassland Research and Innovation Centre, Teagasc Moorepark Fermoy, Co. Cork, Ireland P61 C996; VistaMilk SFI Research Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996.
| | - T Hennessy
- Department of Food Business and Development, Cork University Business School, University College Cork, Cork, Ireland T12 K8AF
| | - E Dillon
- Teagasc, Rural Economy & Development Centre, Mellows Campus, Athenry, Co. Galway, Ireland H65 R718
| | - S Onakuse
- Department of Food Business and Development, Cork University Business School, University College Cork, Cork, Ireland T12 K8AF
| | - B Moran
- Teagasc, Rural Economy & Development Centre, Mellows Campus, Athenry, Co. Galway, Ireland H65 R718
| | - L Shalloo
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark Fermoy, Co. Cork, Ireland P61 C996; VistaMilk SFI Research Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996
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Payne T, Moran B, Loadsman J, Marschner I, McCulloch T, Sanders RD. Importance of sequential methods in meta-analysis: implications for postoperative mortality, delirium, and stroke management. Br J Anaesth 2023; 130:395-401. [PMID: 36931783 DOI: 10.1016/j.bja.2023.01.011] [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] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/17/2023] Open
Abstract
Trial sequential analysis is an adaptation of frequentist sequential methods that can be used to improve inferences from meta-analysis. Trial sequential analysis can help preserve type I and type II error rates at desired levels for analyses conducted before the required information size. Through three case studies recently published in the British Journal of Anaesthesia, we show how trial sequential analysis can inform the interpretation of meta-analyses. Limitations of trial sequential analysis, which also include those of the meta-analysis to which it is applied, must be carefully considered alongside its benefits.
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Affiliation(s)
- Thomas Payne
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Ben Moran
- Critical Care Program, George Institute of Global Health, Sydney, Australia; Department of Intensive Care, Gosford Hospital, Gosford, Australia; Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - John Loadsman
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Ian Marschner
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Tim McCulloch
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Robert D Sanders
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
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Palma-Molina P, Hennessy T, O'Connor AH, Onakuse S, O'Leary N, Moran B, Shalloo L. Factors associated with intensity of technology adoption and with the adoption of 4 clusters of precision livestock farming technologies in Irish pasture-based dairy systems. J Dairy Sci 2023; 106:2498-2509. [PMID: 36797180 DOI: 10.3168/jds.2021-21503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/23/2022] [Indexed: 02/16/2023]
Abstract
Precision livestock farming (PLF) technologies have been widely promoted as important tools to improve the sustainability of dairy systems due to perceived economic, social, and environmental benefits. However, there is still limited information about the level of adoption of PLF technologies (percentage of farms with a PLF technology) and the factors (farm and farmer characteristics) associated with PLF technology adoption in pasture-based dairy systems. The current research aimed to address this knowledge gap by using a representative survey of Irish pasture-based dairy farms from 2018. First, we established the levels of adoption of 9 PLF technologies (individual cow activity sensors, rising plate meters, automatic washers, automatic cluster removers, automatic calf feeders, automatic parlor feeders, automatic drafting gates, milk meters, and a grassland management decision-support tool) and grouped them into 4 PLF technology clusters according to the level of association with each other and the area of dairy farm management in which they are used. The PLF technology clusters were reproductive management technologies, grass management technologies, milking management technologies, and calf management technologies. Additionally, we classified farms into 3 categories of intensity of technology adoption based on the number of PLF technologies they have adopted (nonadoption, low intensity of adoption, and high intensity of adoption). Second, we determined the factors associated with the intensity of technology adoption and with the adoption of the PLF technology clusters. A multinomial logistic regression model and 4 logistic regressions were used to determine the factors associated with intensity of adoption (low and high intensity of adoption compared with nonadoption) and with the adoption of the 4 PLF technology clusters, respectively. Adoption levels varied depending on PLF technology, with the most adopted PLF technologies being those related to the milking process (e.g., automatic parlor feeders and milk meters). The results of the multinomial logistic regression suggest that herd size, proportion of hired labor, agricultural education, and discussion group membership were positively associated with a high intensity of adoption, whereas age of farmer and number of household members were negatively associated with high intensity of adoption. However, when analyzing PLF technology clusters, the magnitude and direction of the influence of the factors in technology adoption varied depending on the PLF technology cluster being investigated. By identifying the PLF technologies in which pasture-based dairy farmers are investing more and by detecting potential drivers and barriers for the adoption of PLF technologies, the current study could allow PLF technology companies, practitioners, and researchers to develop and target strategies that improve future adoption of PLF technologies in pasture-based dairy settings.
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Affiliation(s)
- P Palma-Molina
- Department of Food Business and Development, Cork University Business School, West Wing, Main Quadrangle, University College Cork, Ireland, T12 K8AF; Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996; VistaMilk SFI Research Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996.
| | - T Hennessy
- Department of Food Business and Development, Cork University Business School, West Wing, Main Quadrangle, University College Cork, Ireland, T12 K8AF
| | - A H O'Connor
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996; VistaMilk SFI Research Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996
| | - S Onakuse
- Department of Food Business and Development, Cork University Business School, West Wing, Main Quadrangle, University College Cork, Ireland, T12 K8AF
| | - N O'Leary
- Hincks Centre for Entrepreneurship Excellence, School of Business, Munster Technological University, Co. Cork, Ireland T12 P928
| | - B Moran
- Teagasc, Rural Economy & Development Centre, Mellows Campus, Athenry, Co. Galway, Ireland H65 R718
| | - L Shalloo
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996; VistaMilk SFI Research Centre, Teagasc Moorepark, Fermoy, Co. Cork, Ireland P61 C996
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Hanlon M, Canavan M, Neto N, Song Q, Gallagher P, Mullan R, Hurson C, Moran B, Monaghan M, Nagpal S, Veale D, Fearon U. OP0013 LOSS OF SYNOVIAL TISSUE MACROPHAGE HOMEOSTASIS PRECEDES RHEUMATOID ARTHRITIS CLINICAL ONSET. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSynovial tissue macrophages significantly contribute to Rheumatoid Arthritis, yet the precise nature/function of macrophage subsets within the inflamed joint remains unexplored.ObjectivesTo fully explore the spectrum of distinct macrophage activation states residing within the synovium of RA, at risk and healthy individuals.MethodsSingle-cell synovial tissue suspensions from RA (n=44), IAR (n=5), HC (n=11), PsA (n=11) and OA (n=4) were obtained, and synovial macrophage subsets examined by advanced multiparameter flow cytometric analysis, bulk RNA-sequencing, metabolic and functional assays.ResultsMultidimensional analysis identifies enrichment of CD206+CD163+ synovial-tissue macrophages co-expressing CD40 in the RA joint compared to healthy synovial-tissue, with frequency of CD206+CD163+CD40+ macrophages associated with increased disease activity and treatment response. In contrast, CX3CR1-expressing macrophages which form a protective barrier in healthy synovium are significantly depleted in RA. Importantly this signature of enriched CD40 expression coupled with depleted CX3CR1 expression is an early phenomenon, occurring prior to clinical manifestation of disease in individuals ‘at-risk’ of RA (IAR). RNAseq and metabolic profiling of sorted RA synovial-macrophages identified that this population is transcriptionally distinct, displaying unique inflammatory, phagocytic and tissue-resident gene signatures, paralleled by a bioenergetically stable profile as indicated by NAD(P)H emission. Functionally CD206+CD163+ RA macrophages are potent producers of pro-inflammatory mediators (reversed by CD40-signalling inhibition) and induce an invasive phenotype in healthy synovial-fibroblasts. These findings identify a distinct pathogenic population of synovial-tissue macrophage involved in shaping the immune response in RA. Crucially, this signature is present pre-disease representing a unique opportunity for early diagnosis and therapeutic intervention.ConclusionWe have identified a novel population of tissue-resident macrophages in the RA synovium which are transcriptionally/metabolically distinct and capable of contributing to disease pathology. Uncovering the molecular patterns and cues that transform this immunoregulatory macrophage population into a dysfunctional inflammatory activation state may provide opportunities to reinstate joint homeostasis in RA patients.Disclosure of InterestsMegan Hanlon: None declared, Mary Canavan: None declared, Nuno Neto: None declared, Qingxuan Song Employee of: Employee of Janssen Pharmaceuticals, Phil Gallagher: None declared, Ronan Mullan: None declared, Conor Hurson: None declared, Barry Moran: None declared, Michael Monaghan: None declared, Sunil Nagpal Employee of: Employee of Janssen Pharmaceuticals, Douglas Veale Consultant of: Janssen, Eli Lilly, Pfizer, Ursula Fearon Consultant of: Janssen, Eli Lilly, Pfizer
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Franklyn J, Lomax J, Labib P, Baker A, Hosking J, Moran B, Smolarek S. Colorectal cancer outcomes determined by mode of presentation: analysis of population data in England between 2010 and 2014. Tech Coloproctol 2022; 26:363-372. [PMID: 35084620 DOI: 10.1007/s10151-022-02574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to investigate associations between mode of presentation; categorized as emergency, suspected cancer outpatient referral pathway (2-week wait or 2WW pathway), non-cancer suspected outpatient referral (non-2-week wait pathway) or following screening, and stage of diagnosis and survival in patients with colorectal cancer in England. METHODS This was a retrospective cohort observational study of patients diagnosed with colorectal cancer between January 2010 and December 2014 in England using data from Public Health England collated from regional cancer registries. RESULTS The most common route to diagnosis among 167,501 patients diagnosed with colorectal cancer was via the non-cancer suspect (non-2WW) outpatient referral pathway (35.1%) followed by the suspected cancer (2WW) referral pathway (31.6%), emergency presentation (22.8%) and most infrequently following screening (10.6%) (p < 0.01). Screening confers the greatest likelihood of early-stage diagnosis (61.6%) compared to other modes of presentation. The 5-year overall survival was 81.8%, 53.3%, 53.0% and 27.6% in those diagnosed via screening, 2WW, non-2WW pathway and emergency presentation, respectively. Patients from most deprived regions were more likely to be diagnosed following emergency presentation (27.7 vs 19.7%, p < 0.01) and less likely via screening (8.1 vs 12%, p < 0.01). CONCLUSIONS Asymptomatic individuals diagnosed following screening have earlier stage cancers and better survival, the opposite was observed in those diagnosed following emergency presentation. Patients referred via the 2WW pathway do not have better survival outcomes when compared to those referred via the non-2WW pathway. In addition, this study has identified socio-economic groups that need to be targeted with public health campaigns to improve screening uptake.
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Affiliation(s)
- J Franklyn
- Basingstoke and North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstok, RG249NA, UK. .,University Hospital Plymouth NHS Trust, Plymouth, UK.
| | - J Lomax
- University of Plymouth, Plymouth, UK
| | - P Labib
- University Hospital Plymouth NHS Trust, Plymouth, UK
| | - A Baker
- University of Plymouth, Plymouth, UK
| | - J Hosking
- Medical Statistics, University of Plymouth, Plymouth, UK
| | - B Moran
- Basingstoke and North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstok, RG249NA, UK.,Peritoneal Malignancy Institute Basingstoke, Basingstoke and North Hampshire Hospitals, Basingstok, UK
| | - S Smolarek
- University Hospital Plymouth NHS Trust, Plymouth, UK
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Langdon QK, Powell DL, Kim B, Banerjee SM, Payne C, Dodge TO, Moran B, Fascinetto-Zago P, Schumer M. Predictability and parallelism in the contemporary evolution of hybrid genomes. PLoS Genet 2022; 18:e1009914. [PMID: 35085234 PMCID: PMC8794199 DOI: 10.1371/journal.pgen.1009914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022] Open
Abstract
Hybridization between species is widespread across the tree of life. As a result, many species, including our own, harbor regions of their genome derived from hybridization. Despite the recognition that this process is widespread, we understand little about how the genome stabilizes following hybridization, and whether the mechanisms driving this stabilization tend to be shared across species. Here, we dissect the drivers of variation in local ancestry across the genome in replicated hybridization events between two species pairs of swordtail fish: Xiphophorus birchmanni × X. cortezi and X. birchmanni × X. malinche. We find unexpectedly high levels of repeatability in local ancestry across the two types of hybrid populations. This repeatability is attributable in part to the fact that the recombination landscape and locations of functionally important elements play a major role in driving variation in local ancestry in both types of hybrid populations. Beyond these broad scale patterns, we identify dozens of regions of the genome where minor parent ancestry is unusually low or high across species pairs. Analysis of these regions points to shared sites under selection across species pairs, and in some cases, shared mechanisms of selection. We show that one such region is a previously unknown hybrid incompatibility that is shared across X. birchmanni × X. cortezi and X. birchmanni × X. malinche hybrid populations.
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Affiliation(s)
- Quinn K. Langdon
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Daniel L. Powell
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Bernard Kim
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Shreya M. Banerjee
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Cheyenne Payne
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Tristram O. Dodge
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Ben Moran
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
| | - Paola Fascinetto-Zago
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
- Department of Biology, Texas A&M University, College Station, Texas, United States of America
| | - Molly Schumer
- Department of Biology, Stanford University, Stanford, California, United States of America
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C., Calnali, Mexico
- Hanna H. Gray Fellow, Howard Hughes Medical Institutes, Chevy Chase, Maryland, United States of America
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Synnott A, Ryan C, O'Connell P, Steed F, Reale S, Carey L, English S, Fitzgibbon K, O'Connell Á, Smalle E, Ryan D, Shchetkovsky D, McCarthy A, Moran B, Murphy H, O'Shaughnessy Í. 178 A RETROSPECTIVE EVALUATION OF PROCESS OUTCOMES OF OLDER ADULTS REFERRED TO A COMMUNITY RE-ENABLEMENT TEAM FROM THE EMERGENCY DEPARTMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.178] [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: 02/25/2023] Open
Abstract
Abstract
Background
Emergency Departments (ED) are complex and challenging environments to provide care to older adults. There is currently a paucity of high quality methodological research investigating the effectiveness of interventions focused on transitions of care from the ED to primary care services (Hughes et al, 2019). This study aims to evaluate the impact of a collaborative model of care between primary and secondary care services for older adults discharged home following ED index visit.
Methods
This was an observational retrospective study. Participants aged ≥65 years discharged home from the ED of a University Teaching Hospital and referred to a Multidisciplinary Community Intervention Team (MDCIT) were included. Referral pathways were via the OPTIMEND team (Cassarino et al, 2021) and MDCIT, which is a rapid access re-enablement team based in the community and compromises nursing staff, an occupational therapist, physiotherapist, therapy and healthcare assistants. Descriptive statistics were used to profile the baseline characteristics of study participants and to summarise data related to process outcomes. Ethical approval was granted for this study (020/2021).
Results
In the study period, January—December 2020, 54 patients were referred to the MDCIT. The mean age of participants was 80.1 years (SD 8.2), 57% were female, and the most common Manchester Triage System presenting complaint was ‘limb problems’. The median Patient Experience Time within the ED was 7.4 hours (IQR 13.1); 55% of participants were seen in their home within 24 hours of discharge. A mean of 10 interventions were delivered by the MDCIT. A 9.1% incidence rate of 30 day unscheduled hospital readmission was recorded.
Conclusion
Integrated care programmes have been advocated to improve the continuum of care from the ED into the community. This evaluation has demonstrated the feasibility of implementing such a model of care. However, further methodologically robust research is required to advance the evidence base and should also focus on patient outcomes.
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Affiliation(s)
- A Synnott
- Emergency Department, University Hospital Limerick , Limerick, Ireland
- Physiotherapy Department, University Hospital Limerick , Limerick, Ireland
| | - C Ryan
- Multidisciplinary Community Intervention Team Limerick , Limerick, Ireland
| | - P O'Connell
- Physiotherapy Department, University Hospital Limerick , Limerick, Ireland
| | - F Steed
- Medicine Directorate, University Hospital Limerick , Limerick, Ireland
| | - S Reale
- Diagnostics Directorate, University Hospital Limerick , Limerick, Ireland
| | - L Carey
- Department of Occupational Therapy, University Hospital Limerick , Limerick, Ireland
| | - S English
- Multidisciplinary Community Intervention Team Limerick , Limerick, Ireland
| | - K Fitzgibbon
- Multidisciplinary Community Intervention Team Limerick , Limerick, Ireland
| | - Á O'Connell
- Multidisciplinary Community Intervention Team Limerick , Limerick, Ireland
| | - E Smalle
- Department of Medical Social Work, University Hospital Limerick , Limerick, Ireland
| | - D Ryan
- Emergency Department, University Hospital Limerick , Limerick, Ireland
| | - D Shchetkovsky
- Emergency Department, University Hospital Limerick , Limerick, Ireland
| | - A McCarthy
- Department of Occupational Therapy, University Hospital Limerick , Limerick, Ireland
| | - B Moran
- Physiotherapy Department, University Hospital Limerick , Limerick, Ireland
| | - H Murphy
- Department of Occupational Therapy, University Hospital Limerick , Limerick, Ireland
| | - Í O'Shaughnessy
- Emergency Department, University Hospital Limerick , Limerick, Ireland
- Department of Occupational Therapy, University Hospital Limerick , Limerick, Ireland
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Powell DL, Moran B, Kim B, Banerjee SM, Aguillon SM, Fascinetto-Zago P, Langdon Q, Schumer M. Two new hybrid populations expand the swordtail hybridization model system. Evolution 2021; 75:2524-2539. [PMID: 34460102 PMCID: PMC8659863 DOI: 10.1111/evo.14337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022]
Abstract
Natural hybridization events provide unique windows into the barriers that keep species apart as well as the consequences of their breakdown. Here, we characterize hybrid populations formed between the northern swordtail fish Xiphophorus cortezi and Xiphophorus birchmanni from collection sites on two rivers. We use simulations and new genetic reference panels to develop sensitive and accurate local ancestry calling in this novel system. Strikingly, we find that hybrid populations on both rivers consist of two genetically distinct subpopulations: a cluster of pure X. birchmanni individuals and one of phenotypically intermediate hybrids that derive ∼85-90% of their genome from X. cortezi. Simulations suggest that initial hybridization occurred ∼150 generations ago at both sites, with little evidence for contemporary gene flow between subpopulations. This population structure is consistent with strong assortative mating between individuals of similar ancestry. The patterns of population structure uncovered here mirror those seen in hybridization between X. birchmanni and its sister species, Xiphophorus malinche, indicating an important role for assortative mating in the evolution of hybrid populations. Future comparisons will provide a window into the shared mechanisms driving the outcomes of hybridization not only among independent hybridization events between the same species but also across distinct species pairs.
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Affiliation(s)
- Daniel L. Powell
- Department of Biology, Stanford University,Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C.,Correspondence to: and
| | - Ben Moran
- Department of Biology, Stanford University,Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C
| | | | - Shreya M. Banerjee
- Department of Biology, Stanford University,Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C
| | - Stepfanie M. Aguillon
- Department of Biology, Stanford University,Department of Ecology and Evolutionary Biology, Cornell University
| | - Paola Fascinetto-Zago
- Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C.,Department of Biology, Texas A&M University
| | - Quinn Langdon
- Department of Biology, Stanford University,Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C
| | - Molly Schumer
- Department of Biology, Stanford University,Centro de Investigaciones Científicas de las Huastecas “Aguazarca”, A.C.,Hanna H. Gray Fellow, Howard Hughes Medical Institutes,Correspondence to: and
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11
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Eustace AJ, Madden SF, Fay J, Collins DM, Kay EW, Sheehan KM, Furney S, Moran B, Fagan A, Morris PG, Teiserskiene A, Hill AD, Grogan L, Walshe JM, Breathnach O, Power C, Duke D, Egan K, Gallagher WM, O'Donovan N, Crown J, Toomey S, Hennessy BT. The role of infiltrating lymphocytes in the neo-adjuvant treatment of women with HER2-positive breast cancer. Breast Cancer Res Treat 2021; 187:635-645. [PMID: 33983492 PMCID: PMC8197702 DOI: 10.1007/s10549-021-06244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Pre-treatment tumour-associated lymphocytes (TILs) and stromal lymphocytes (SLs) are independent predictive markers of future pathological complete response (pCR) in HER2-positive breast cancer. Whilst studies have correlated baseline lymphocyte levels with subsequent pCR, few have studied the impact of neoadjuvant therapy on the immune environment. Methods We performed TIL analysis and T-cell analysis by IHC on the pretreatment and ‘On-treatment’ samples from patients recruited on the Phase-II TCHL (NCT01485926) clinical trial. Data were analysed using the Wilcoxon signed-rank test and the Spearman rank correlation. Results In our sample cohort (n = 66), patients who achieved a pCR at surgery, post-chemotherapy, had significantly higher counts of TILs (p = 0.05) but not SLs (p = 0.08) in their pre-treatment tumour samples. Patients who achieved a subsequent pCR after completing neo-adjuvant chemotherapy had significantly higher SLs (p = 9.09 × 10–3) but not TILs (p = 0.1) in their ‘On-treatment’ tumour biopsies. In a small cohort of samples (n = 16), infiltrating lymphocyte counts increased after 1 cycle of neo-adjuvant chemotherapy only in those tumours of patients who did not achieve a subsequent pCR. Finally, reduced CD3 + (p = 0.04, rho = 0.60) and CD4 + (p = 0.01, rho = 0.72) T-cell counts in 'On-treatment' biopsies were associated with decreased residual tumour content post-1 cycle of treatment; the latter being significantly associated with increased likelihood of subsequent pCR (p < 0.01). Conclusions The immune system may be ‘primed’ prior to neoadjuvant treatment in those patients who subsequently achieve a pCR. In those patients who achieve a pCR, their immune response may return to baseline after only 1 cycle of treatment. However, in those who did not achieve a pCR, neo-adjuvant treatment may stimulate lymphocyte influx into the tumour. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06244-1.
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Affiliation(s)
- A J Eustace
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
| | - S F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - E W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S Furney
- Department of Physiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - A Fagan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - A D Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - J M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - O Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - C Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Duke
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - W M Gallagher
- Conway Institute, University College Dublin, Dublin, Ireland
| | - N O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - J Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Cancer Trials Ireland, Dublin, Ireland
| | - S Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B T Hennessy
- Cancer Trials Ireland, Dublin, Ireland.,Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Crosby DA, Glover LE, Brennan EP, Kelly P, Cormican P, Moran B, Giangrazi F, Downey P, Mooney EE, Loftus BJ, McAuliffe FM, Wingfield M, O'Farrelly C, Brennan DJ. Dysregulation of the interleukin-17A pathway in endometrial tissue from women with unexplained infertility affects pregnancy outcome following assisted reproductive treatment. Hum Reprod 2021; 35:1875-1888. [PMID: 32614049 DOI: 10.1093/humrep/deaa111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION Which transcriptomic alterations in mid-luteal endometrial scratch biopsies, taken prior to the assisted reproductive treatment (ART) treatment cycle are associated with unsuccessful pregnancy? SUMMARY ANSWER Dysregulated interleukin-17 (IL-17) pathway components are demonstrated in women who fail to become pregnant after ART. WHAT IS KNOWN ALREADY Implantation failure is now recognised as a critical factor in unexplained infertility and may be an important component of failed ART. STUDY DESIGN, SIZE, DURATION Using a prospective longitudinal study design, 29 nulliparous women with unexplained infertility undergoing ART were recruited between October 2016 and February 2018. Mid-luteal stage endometrium and matched serum samples were collected, and patients underwent a single embryo transfer in the subsequent cycle. RNA-seq analysis of endometrial biopsies was performed on the discovery cohort (n = 20). PARTICIPANTS/MATERIALS, SETTING, METHODS Gene set enrichment analysis of the differentially expressed genes (DEGs) was performed. Endometrium and serum were then prepared for IL-17A analysis by ELISA. MAIN RESULTS AND THE ROLE OF CHANCE There were 204 differentially expressed protein-coding genes identified in tissue from women who became pregnant (n = 9) compared with tissue from women who failed to become pregnant (n = 11) (false discovery rate; P < 0.05). Of the 204 DEGs, 166 were decreased while 38 were increased in the pregnant compared to the non-pregnant groups. Gene set enrichment analysis of the DEGs identified an over-representation of IL-17 and Pl3K-Akt signalling pathways. All the DEGs within the IL-17 signalling pathway (MMP3, MMP1, IL1β, LCN2, S100A9 and FOSL1) demonstrated decreased expression in the pregnant group. Serum IL-17 protein levels were increased in the non-pregnant discovery cohort (n = 11) and these findings were confirmed a validation cohort (n = 9). LIMITATIONS, REASONS FOR CAUTION Limitations of our study include the cohort size and the lack of aneuploidy data for the embryos; however, all embryos transferred were single good or top-quality blastocysts. WIDER IMPLICATIONS OF THE FINDINGS These findings demonstrate dysregulated IL-17 pathway components in women who fail to become pregnant after ART. Elevated serum levels of the pro-inflammatory cytokine IL-17 may predict failure of ART in women with unexplained infertility. Future trials of anti-IL-17 therapies in this cohort warrant further investigation. STUDY FUNDING/COMPETING INTEREST(S) Funding from the UCD Wellcome Institutional Strategic Support Fund, which was financed jointly by University College Dublin and the SFI-HRB-Wellcome Biomedical Research Partnership (ref 204844/Z/16/Z), is acknowledged. The authors have no competing interests. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- D A Crosby
- Department of Reproductive Medicine, Merrion Fertility Clinic, Dublin, D2, Ireland.,Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, D2, Ireland
| | - L E Glover
- Department of Reproductive Medicine, Merrion Fertility Clinic, Dublin, D2, Ireland
| | - E P Brennan
- UCD Diabetes Complications Research Centre, UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, D4, Ireland
| | - P Kelly
- Comparative Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D2, Ireland.,School of Medicine, Trinity College Dublin, D2, Ireland
| | - P Cormican
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Grange, County Meath, Ireland
| | - B Moran
- Cancer Biology and Therapeutics Laboratory, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, D4, Ireland
| | - F Giangrazi
- Comparative Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D2, Ireland
| | - P Downey
- Department of Pathology & Laboratory Medicine, National Maternity Hospital, Dublin, D2, Ireland
| | - E E Mooney
- Department of Pathology & Laboratory Medicine, National Maternity Hospital, Dublin, D2, Ireland
| | - B J Loftus
- School of Medicine, Conway Institute, University College Dublin, D4, Ireland
| | - F M McAuliffe
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, D2, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, D4, Ireland
| | - M Wingfield
- Department of Reproductive Medicine, Merrion Fertility Clinic, Dublin, D2, Ireland.,Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, D2, Ireland.,School of Medicine, Trinity College Dublin, D2, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, D4, Ireland
| | - C O'Farrelly
- Comparative Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D2, Ireland.,School of Medicine, Trinity College Dublin, D2, Ireland
| | - D J Brennan
- Cancer Biology and Therapeutics Laboratory, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, D4, Ireland.,Systems Biology Ireland, UCD School of Medicine, University College Dublin, D4, Ireland
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13
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Lee J, Grubac V, Baxter N, Auer R, Porter G, Holm T, Moran B, Heald RJ, Simunovic M. Digital rectal examination in palpable rectal cancer: expert panel consensus on key elements and analysis of a case series. Br J Surg 2021; 108:e264-e265. [PMID: 33829239 DOI: 10.1093/bjs/znab113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/28/2021] [Indexed: 11/13/2022]
Affiliation(s)
- J Lee
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - V Grubac
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - N Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - R Auer
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - G Porter
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - T Holm
- Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - B Moran
- Department of Surgery, Basingstoke Hospital, Basingstoke, UK
| | - R J Heald
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - M Simunovic
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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14
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Fowler H, Clifford R, Sutton P, Watson A, Fearnhead N, Bach S, Moran B, Rose A, Jackson R, Vimalachandran D, Bach S, Badrinath K, Branagan G, Bronder C, Butcher D, Lacey‐Coulson J, Dennis R, Duff S, Gossedge G, Hill J, Fearnhead N, Hernon J, Hunt L, Kamal A, Khan J, Masekar S, Mitchell P, Moran B, Nassa H, Rooney P, Sheikh A, Slawik S, Smart C, Smart N, Smith D, Speake D, Stephenson B, Thornton M, Tou S, Tutton M, Watson A, Wilkinson L, Williamson M. Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study. Colorectal Dis 2020; 22:2114-2122. [PMID: 32939956 DOI: 10.1111/codi.15366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 02/08/2023]
Abstract
AIM In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. METHOD This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. RESULTS One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. CONCLUSION This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.
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Affiliation(s)
- H Fowler
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - R Clifford
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - P Sutton
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - N Fearnhead
- Cambridge University Hospitals, Cambridge, UK
| | - S Bach
- Queen Elizabeth Hospital, Birmingham, UK
| | - B Moran
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - A Rose
- Royal Free Hospital, London, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, Liverpool, UK
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15
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Sulaimani J, Cluxton D, Clowry J, Petrasca A, Molloy O, Moran B, Sweeney C, Malara A, McNicholas N, McGuigan C, Kirby B, Fletcher J. Dimethyl fumarate modulates the Treg–Th17 cell axis in patients with psoriasis*. Br J Dermatol 2020; 184:495-503. [DOI: 10.1111/bjd.19229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Affiliation(s)
- J. Sulaimani
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences InstituteTrinity College Dublin Dublin Ireland
| | - D. Cluxton
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences InstituteTrinity College Dublin Dublin Ireland
| | - J. Clowry
- Dermatology Research Education and Research CentreSt. Vincent's University HospitalDublin 4 Ireland
| | - A. Petrasca
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences InstituteTrinity College Dublin Dublin Ireland
| | - O.E. Molloy
- Dermatology Research Education and Research CentreSt. Vincent's University HospitalDublin 4 Ireland
| | - B. Moran
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences InstituteTrinity College Dublin Dublin Ireland
| | - C.M. Sweeney
- Dermatology Research Education and Research CentreSt. Vincent's University HospitalDublin 4 Ireland
| | - A. Malara
- Dermatology Research Education and Research CentreSt. Vincent's University HospitalDublin 4 Ireland
| | - N. McNicholas
- Department of Neurology St. Vincent's University Hospital Dublin 4 Ireland
| | - C. McGuigan
- Department of Neurology St. Vincent's University Hospital Dublin 4 Ireland
| | - B. Kirby
- Department of Dermatology St. Vincent's University Hospital Dublin 4 Ireland
| | - J.M. Fletcher
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences InstituteTrinity College Dublin Dublin Ireland
- School of Medicine Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland
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16
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Thomas IA, Buckley C, Kelly E, Dillon E, Lynch J, Moran B, Hennessy T, Murphy PNC. Establishing nationally representative benchmarks of farm-gate nitrogen and phosphorus balances and use efficiencies on Irish farms to encourage improvements. Sci Total Environ 2020; 720:137245. [PMID: 32325548 DOI: 10.1016/j.scitotenv.2020.137245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/07/2020] [Accepted: 02/09/2020] [Indexed: 06/11/2023]
Abstract
Agriculture faces considerable challenges of achieving more sustainable production that minimises nitrogen (N) and phosphorus (P) losses and meets international obligations for water quality and greenhouse gas emissions. This must involve reducing nutrient balance (NB) surpluses and increasing nutrient use efficiencies (NUEs), which could also improve farm profitability (a win-win). To set targets and motivate improvements in Ireland, nationally representative benchmarks were established for different farm categories (sector, soil group and production intensity). Annual farm-gate NBs (kg ha-1) and NUEs (%) for N and P were calculated for 1446 nationally representative farms from 2008 to 2015 using import and export data collected by the Teagasc National Farm Survey (part of the EU Farm Accountancy Data Network). Benchmarks for each category were established using quantile regression analysis and percentile rankings to identify farms with the lowest NB surplus per production intensity and highest gross margins (€ ha-1). Within all categories, large ranges in NBs and NUEs between benchmark farms and poorer performers show considerable room for nutrient management improvements. Results show that as agriculture intensifies, nutrient surpluses, use efficiencies and gross margins increase, but benchmark farms minimise surpluses to relatively low levels (i.e. are more sustainable). This is due to, per ha, lower fertiliser and feed imports, greater exports of agricultural products, and for dairy, sheep and suckler cattle, relatively high stocking rates. For the ambitious scenario of all non-benchmark farms reaching the optimal benchmark zone, moderate reductions in farm nutrient surpluses were found with great improvements in profitability, leading to a 31% and 9% decrease in N and P surplus nationally, predominantly from dairy and non-suckler cattle. The study also identifies excessive surpluses for each level of production intensity, which could be used by policy in setting upper limits to improve sustainability.
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Affiliation(s)
- I A Thomas
- Environment and Sustainable Resource Management Section, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.
| | - C Buckley
- Agricultural Economics and Farm Surveys Department, Rural Economy & Development Centre, Teagasc, Mellows Campus, Athenry, Ireland.
| | - E Kelly
- Agricultural and Food Economics, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.
| | - E Dillon
- Agricultural Economics and Farm Surveys Department, Rural Economy & Development Centre, Teagasc, Mellows Campus, Athenry, Ireland.
| | - J Lynch
- Department of Physics, University of Oxford, Oxford, UK.
| | - B Moran
- Agricultural Economics and Farm Surveys Department, Rural Economy & Development Centre, Teagasc, Mellows Campus, Athenry, Ireland.
| | - T Hennessy
- Food Business and Development, Business School, University College Cork, College Road, Cork, Ireland.
| | - P N C Murphy
- Environment and Sustainable Resource Management Section, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland; UCD Earth Institute, University College Dublin, Belfield, Dublin, Ireland.
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17
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Fletcher JM, Moran B, Petrasca A, Smith CM. IL-17 in inflammatory skin diseases psoriasis and hidradenitis suppurativa. Clin Exp Immunol 2020; 201:121-134. [PMID: 32379344 DOI: 10.1111/cei.13449] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
The skin is one of the most important organs in the body, providing integrity and acting as a barrier to exclude microbes, allergens and chemicals. However, chronic skin inflammation can result when barrier function is defective and immune responses are dysregulated or misdirected against harmless or self-antigens. During the last 15 years interleukin (IL)-17 cytokines have emerged as key players in multiple inflammatory disorders, and they appear to be especially prominent in skin inflammation. IL-17 cytokines produced by T cells and other cell types potently activate keratinocytes to promote inflammation in a feed-forward loop. Given this key pathogenic role of the IL-17 pathway in autoimmune and inflammatory disease, it has been the focus of intense efforts to target therapeutically. The inflammatory effects of IL-17 can be targeted directly by blocking the cytokine or its receptor, or indirectly by blocking cytokines upstream of IL-17-producing cells. Psoriasis has been the major success story for anti-IL-17 drugs, where they have proven more effective than in other indications. Hidradenitis suppurativa (HS) is another inflammatory skin disease which, despite carrying a higher burden than psoriasis, is poorly recognized and under-diagnosed, and current treatment options are inadequate. Recently, a key role for the IL-17 pathway in the pathogenesis of HS has emerged, prompting clinical trials with a variety of IL-17 inhibitors. In this review, we discuss the roles of IL-17A, IL-17F and IL-17C in psoriasis and HS and the strategies taken to target the IL-17 pathway therapeutically.
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Affiliation(s)
- J M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - B Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - A Petrasca
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - C M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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18
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Musilova J, Moran B, Sweeney C, Malara A, Zaborowski A, Hughes R, Winter D, Fletcher J, Kirby B. Enrichment of Plasma Cells in the Peripheral Blood and Skin of Patients with Hidradenitis Suppurativa. J Invest Dermatol 2020; 140:1091-1094.e2. [DOI: 10.1016/j.jid.2019.08.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 01/01/2023]
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19
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Kerr C, Heskin J, Moran B, Sadlier C, Bergin C. Anal cancer screening and Pap testing acceptability among
HIV
‐positive men who have sex with men populations. J Eur Acad Dermatol Venereol 2020; 34:e226-e228. [DOI: 10.1111/jdv.16195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- C. Kerr
- Department of Genito Urinary Medicine and Infectious Diseases (GUIDe) St. James's Hospital Dublin Ireland
| | - J. Heskin
- Department of Genito Urinary Medicine and Infectious Diseases (GUIDe) St. James's Hospital Dublin Ireland
| | - B. Moran
- School of Medicine Trinity College Dublin Dublin Ireland
| | - C. Sadlier
- Departments of Acute Medicine and Infectious Diseases Cork University Hospital Cork Ireland
| | - C. Bergin
- Department of Genito Urinary Medicine and Infectious Diseases (GUIDe) St. James's Hospital Dublin Ireland
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20
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Birjandi Nejad H, Blasco L, Moran B, Cebrian J, Woodger J, Gonzalez E, Pritts C, Milligan J. Bio-based Algae Oil: an oxidation and structural analysis. Int J Cosmet Sci 2020; 42:237-247. [PMID: 32010979 DOI: 10.1111/ics.12606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In search of natural components, vegetal oils are increasingly becoming more popular in cosmetics. However, high oxidation instability, presence of potential allergens and synthetic anti-oxidants have limited their applications so far. Therefore, a need exists for a natural emollient with high oxidation stability. In this work, we report on a novel sustainably produced triglyceride containing primarily three monounsaturated oleic acid chains, dubbed 'Bio-Based Algae Oil' hereafter, as a natural emollient for cosmetic formulations. To produce Bio-Based Algae Oil, simple sugars are converted into triglyceride oils using microalgae fermentation with minimal environmental impact. METHODS Bio-Based Algae Oil was compared to other commonly used triglyceride-based emollients in the skincare industry in terms of thermal/oxidation stability, composition and moisturizing properties. Oxidation stability of emollients was compared using Rancimat and pressurized differential scanning calorimetry (PDSC) techniques. Fatty acid composition of each oil was analysed using proton nuclear magnetic resonance (1 H-NMR) and gas chromatography (GC) techniques to correlate unsaturation level of each oil to its oxidation stability. We also conducted an in vivo moisturizing study in which skin hydration level of human subjects was compared before and after application of emollient up to 24 h. RESULTS Results showed that Bio-Based Algae Oil was the most stable emollient in thermal and oxidation stability studies given its low unsaturation and high anti-oxidant content determined by 1 H-NMR and GC techniques. It also provided the highest skin hydration level when applied on skin demonstrating its efficacy as a moisturizing emollient in cosmetic formulations. CONCLUSIONS Compositional analysis of Bio-Based Algae revealed that it is a triglyceride containing primarily three monounsaturated oleic acid chains with very low polyunsaturated fatty acid content resulting in high oxidation stability and consequently prolonged shelf-life. Given its sustainability, high oxidation stability and skin health benefits such as moisturization demonstrated during an in vivo study, we envision to utilize Bio-Based Algae Oil in many cosmetic formulations across skincare, suncare and bath and shower markets.
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Affiliation(s)
- H Birjandi Nejad
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA.,Corbion BioTech Inc., One Tower Place, Suite 600, South San Francisco, CA, 94080, USA
| | - L Blasco
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
| | - B Moran
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
| | - J Cebrian
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
| | - J Woodger
- Corbion BioTech Inc., One Tower Place, Suite 600, South San Francisco, CA, 94080, USA
| | - E Gonzalez
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
| | - C Pritts
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
| | - J Milligan
- Lubrizol Corp., 9911 Brecksville Rd, Brecksville, OH, 44141, USA
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D'Souza N, Lord AC, Shaw A, Patel A, Balyasnikova S, Tudyka V, Abulafi M, Moran B, Rasheed S, Tekkis P, Coffey JC, Terlizzo M, West NP, Quirke P, Brown G. Ex vivo specimen MRI and pathology confirm a rectosigmoid mesenteric waist at the junction of the mesorectum and mesocolon. Colorectal Dis 2020; 22:212-218. [PMID: 31535423 DOI: 10.1111/codi.14856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023]
Abstract
AIM Continuity of the mesentery has recently been established and may provide an anatomical basis for optimal colorectal resectional surgery. Preliminary data from operative specimen measurements suggest there is a tapering in the mesentery of the distal sigmoid. A mesenteric waist in this area may be a risk factor for local recurrence of colorectal cancer. This study aimed to investigate the anatomical characteristics of the mesentery at the colorectal junction. METHOD In this cross-sectional study, 20 patients were recruited. After planned colorectal resection, the surgical specimens were scanned in a MRI system and subsequently dissected and photographed as per national pathology guidelines. Mesenteric surface area and linear measurements were compared between MRI and pathology to establish the presence and location of a mesenteric waist. RESULTS Specimen analysis confirmed that a narrowing in the mesenteric surface area was consistently apparent at the rectosigmoid junction. Above the anterior peritoneal reflection, the surface area and posterior distance of the mesentery of the upper rectum initially decreased before increasing as the mesentery of the sigmoid colon. These anatomical properties created the appearance of a mesenteric 'waist' at the rectosigmoid junction. Using the anterior reflection as a reference landmark, the rectosigmoid waist occurred at a mean height of 23.6 and 21.7 mm on MRI and pathology, respectively. CONCLUSION A rectosigmoid waist occurs at the junction of the mesorectum and mesocolon, and is a mesenteric landmark for the rectum that is present on both radiology and pathology.
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Affiliation(s)
- N D'Souza
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A C Lord
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A Shaw
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A Patel
- Royal Marsden Hospital, Sutton, UK
| | - S Balyasnikova
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | | | - M Abulafi
- Croydon University Hospital, Croydon, UK
| | - B Moran
- Basingstoke Hospital, Basingstoke, UK
| | - S Rasheed
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - P Tekkis
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - J C Coffey
- University Hospital Limerick and University of Limerick, Limerick, Ireland
| | | | - N P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - P Quirke
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - G Brown
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
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22
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Glezeva N, Moran B, Collier P, Moravec C, Phelan D, Donnellan E, Russell-Hallinan A, O'connor D, Gallagher W, Gallagher J, McDonald K, Ledwidge M, Baugh J, Das S, Watson C. 3069Epigenetic changes in heart failure cohorts: novel insights into methylation changes of protein and RNA coding genes in human cardiac tissue. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Limited knowledge exists of the extent of epigenetic alterations, such as DNA methylation, in Heart Failure (HF). We conducted targeted DNA methylation sequencing to identify DNA methylation alterations in coding and non-coding RNA across different etiological sub-types of HF.
Methods and results
A targeted bisulfite sequence capture sequencing platform was applied to DNA extracted from cardiac interventricular septal tissue of 30 male HF patients encompassing etiologies including Hypertrophic Obstructive Cardiomyopathy (HOCM, n=12), Ischemic Cardiomyopathy (ISCM, n=9), Dilated Cardiomyopathy (DCM, n=9), and 9 control patients with non-failing hearts (NF). We detected 62,678 differentially methylated regions (DMR) in the studied HF cohort. By comparing each HF sub-group to the NF control group we identified 195 unique DMRs: 5 in HOCM, 151 in DCM, and 55 in ISCM. These translated to 4 genes/1 non-coding RNA (ncRNA) in HOCM, 131 genes/17 ncRNA in DCM, and 51 genes/5 ncRNA in ISCM. Subsequent gene/ncRNA expression analysis was assessed using qRT-PCR and revealed 6 genes: 4 hypermethylated (HEY2, MSR1, MYOM3, COX17), 2 hypomethylated (CTGF, MMP2); and 2 microRNA: 1 hypermethylated (miR-24–1), 1 hypomethylated (miR-155) with significantly up- or down-regulated expression levels consistent with the direction of methylation in the particular HF sub-group.
Conclusions
For the first time DNA methylation alterations and associated gene expression changes were identified in etiologically-variant pathological heart failure tissue. The methylation-sensitive and disease-associated genes/non-coding RNA identified from this study represent a unique cohort of loci that demonstrate a plausible potential as a novel diagnostic and/or therapeutic target in HF and warrant further investigation.
Acknowledgement/Funding
Enterprise Ireland; European Regional Development Fund under Ireland's European Structural and Investment Funds Programmes 2014-2020
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Affiliation(s)
- N Glezeva
- University College Dublin, Conway Institute, Dublin, Ireland
| | - B Moran
- University College Dublin, Conway Institute, Dublin, Ireland
| | - P Collier
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - C Moravec
- Cleveland Clinic Foundation, Department of Molecular Cardiology, Lerner Research Institute, Cleveland, United States of America
| | - D Phelan
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - E Donnellan
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, United States of America
| | | | - D O'connor
- Royal College of Surgeons in Ireland, Department of Molecular and Cellular Therapeutics, Dublin, Ireland
| | - W Gallagher
- University College Dublin, Conway Institute, Dublin, Ireland
| | - J Gallagher
- St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland
| | - K McDonald
- St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland
| | - M Ledwidge
- St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland
| | - J Baugh
- University College Dublin, Conway Institute, Dublin, Ireland
| | - S Das
- Royal College of Surgeons in Ireland, Department of Molecular and Cellular Therapeutics, Dublin, Ireland
| | - C Watson
- Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast, United Kingdom
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Panagiotopoulou IG, Shah N, Rowaiye B, Chandrakumaran K, Carr NJ, Moran B. Not all abdominal masses after colorectal cancer surgery are malignant: intra-abdominal fibromatosis masquerading as recurrence. Colorectal Dis 2019; 21:886-893. [PMID: 30927550 DOI: 10.1111/codi.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
AIM Intra-abdominal fibromatosis is an unusual mesenchymal tumour that can be locally aggressive without any metastatic potential. Fibromatosis may simulate cancer recurrence on imaging surveillance for colorectal cancer follow-up. The optimal treatment of recurrent peritoneal malignancy is cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Confirmatory biopsy of lesions suspicious for colorectal cancer recurrence may not be feasible, thereby rendering surgery the safest option. Our aim was to determine the incidence of fibromatosis in a cohort of patients undergoing CRS and HIPEC for suspected colorectal cancer recurrence. METHODS One hundred and seventy-one CRS and HIPEC cases were performed at our Peritoneal Malignancy Institute between February 2007 and October 2018 for colorectal peritoneal metastases and were included in a prospectively maintained database. RESULTS A total of 49 (29%) of 171 cases were performed for primary colorectal cancer with peritoneal metastases, whereas 122 (71%) of 171 cases were performed for suspected colorectal cancer recurrence detected on surveillance imaging after primary colorectal cancer resection. On histological analysis of the resected specimen, five (4.1%) of 122 cases undergoing CRS and HIPEC for colorectal recurrence had fibromatosis. CONCLUSION Fibromatosis can masquerade as colorectal cancer recurrence. In this series it occurred with an incidence of 4.1% among a cohort of patients undergoing CRS and HIPEC for probable recurrence. Surgical resection may be the only option to confirm the diagnosis and rule out malignancy.
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Affiliation(s)
- I G Panagiotopoulou
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N Shah
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Rowaiye
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - K Chandrakumaran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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24
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Haley K, Walsh L, Moran B, Das S, Tarrant F, Caldas C, Bernards R, Gallagher W, O'Connor D, Ni Chonghaile T. Abstract PD7-01: Bromodomain protein 3 is a novel therapeutic target in invasive lobular carcinoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd7-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Invasive lobular carcinoma (ILC) is a subtype of breast cancer comprising 10% of breast tumours. ILC is characterised by a loss of E-cadherin, and is generally estrogen receptor (ER) positive. The majority of ILC breast cancers are treated with endocrine therapy, although approximately one in three women are de novo resistant to therapy. To identify novel therapeutic targets for the treatment of ILC, we carried out RNA sequencing on 61 primary ILC samples. We found that high expression of the epigenetic reader, bromodomain protein 3 (BRD3) was associated with poor recurrence free survival. We also validated this finding in a separate cohort of 99 ILC patient samples using the METABRIC cohort. Next, we assessed ILC cell lines for sensitivity to JQ1, an inhibitor of BET family proteins. We found that JQ1 inhibited cell growth in all the cell lines tested. Interesting, two of the ILC cell lines were sensitive to JQ1-induced apoptosis, whereas two of the cell lines were inherently resistant to JQ1-induced apoptosis. Using dynamic BH3 profiling we showed that the JQ1 resistant cell lines were dependent on anti-apoptotic protein BCL-XL following JQ1 treatment. Interestingly, we show both in 2D and 3D cultures that JQ1 is synergistic when combined with the BH3 mimetic, ABT-263. Highlighting that combination treatment with JQ1 and ABT-263 may be a novel potential therapeutic option for ILC.
To unveil the mechanism underlying resistance to JQ1-induced apoptosis, we performed paired-end RNA sequencing and compared differentially expressed genes in JQ1 sensitive and JQ1 resistant ILC cell lines. DAVID gene ontology analysis identified 6 pathways differentially upregulated in the JQ1 resistant ILC cell line including MAPK, Wnt, and insulin resistance signaling. Interestingly, we found that ILC cell lines, which were resistant to BET inhibition with JQ1, demonstrated high levels of FGFR1-4 both at the mRNA level and the protein level. Combination treatment with JQ1 and the FGFR1 inhibitor PD173074 or following knockdown of FGFR with siRNA, resulted in increased cell death in JQ1 resistant cells. Currently, we are assessing how FGFR signaling enables survival of ILC cells following JQ1 treatment and determining the exact function of BRD3 in ILC. In conclusion, we have identified a novel therapeutic target, BRD3, which may be inhibited using JQ1 in combination with BH3 mimetic ABT-263 or FGFR1 inhibitor for a more effective treatment strategy for ILC.
Citation Format: Haley K, Walsh L, Moran B, Das S, Tarrant F, Caldas C, Bernards R, Gallagher W, O'Connor D, Ni Chonghaile T. Bromodomain protein 3 is a novel therapeutic target in invasive lobular carcinoma [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD7-01.
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Affiliation(s)
- K Haley
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - L Walsh
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - B Moran
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - S Das
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - F Tarrant
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - C Caldas
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - R Bernards
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - W Gallagher
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - D O'Connor
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - T Ni Chonghaile
- Royal College of Surgeons in Ireland, Dublin, Ireland; The School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; University of Cambridge, La Ka Shing Centre, Cambridge, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands
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O'Connor DP, Mooney B, Das S, Klinger R, Moran B, Ni Chonghaile T, Cagney G, Bracken A, Gallagher WM. Abstract P5-05-07: Expression of the cocaine- and amphetamine-regulated transcript (CART) recruits SWI/SNF chromatin remodelling complexes to the estrogen receptor. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-05-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Cocaine- and amphetamine-regulated transcript (CART) peptides are neuropeptides involved in regulating physiological processes, such as feeding and drug reward. Recent studies have associated high CART expression with worse overall survival in patients with small-bowel carcinoid tumours and estrogen receptor-positive (ER+), lymph node-negative breast cancer. CART was also shown to be associated with poor patient response to tamoxifen, suggesting CART may play a role in conferring tamoxifen resistance.
Materials and methods
We have previously demonstrated that CART can impact the transcriptional activity of ERα through the use of western blotting and qPCR for specific ERα gene targets. RNA sequencing was carried out using a stable CART-inducible cell line model to identify genes which are upregulated/downregulated in cells expressing CART. Further, using our stable CART-inducible cell line model, we preformed ERα-Immunoprecipitation followed by in-solution mass spectrometry to identify differentially recruited protein complexes +/- CART expression.
Results and discussion
RNA sequencing revealed 156 significantly downregulated, and 100 significantly upregulated, genes in cells expressing CART (p<0.05). Through mining of publicly available ERα ChIP-seq data sets, both upregulated and downregulated gene sets were found to contain genes which have previously been shown to contain ERα binding events within their promotor regions. Mass spectrometry analysis revealed that the majority of proteins recruited to ERα in the presence of CART were members of the SWI/SNF (BAF) chromatin remodelling complex. The identification of SMARCD1 within this complex was of particular interest to this study, as this protein has previously been reported to be a critical mediator of nuclear receptor function. Further in silico analysis demonstrated high expression of SMARCD1 correlates with poor overall survival (OS) (p<0.00001) and distant metastasis free survival (DMFS) (p=0.00708) in a cohort of ER+ breast cancer patients. Intriguingly, SMARCD1 expression did not correlate with poor OS or DMFS in a cohort of ER- breast cancer patients, suggesting that this negative impact on survival is dependent on ER status.
Conclusion
In conclusion, we suggest that CART expression results in the recruitment of chromatin remodelling complexes to ERα in order to facilitate the regulation of receptor function and this impacts on patient outcome.
Citation Format: O'Connor DP, Mooney B, Das S, Klinger R, Moran B, Ni Chonghaile T, Cagney G, Bracken A, Gallagher WM. Expression of the cocaine- and amphetamine-regulated transcript (CART) recruits SWI/SNF chromatin remodelling complexes to the estrogen receptor [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-07.
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Affiliation(s)
- DP O'Connor
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - B Mooney
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - S Das
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - R Klinger
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - B Moran
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - T Ni Chonghaile
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - G Cagney
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - A Bracken
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
| | - WM Gallagher
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland
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Murray C, Sivajohanathan D, Hanna TP, Bradshaw S, Solish N, Moran B, Hekkenberg R, Wei AC, Petrella T. Patient indications for Mohs micrographic surgery: a clinical practice guideline. ACTA ACUST UNITED AC 2019; 26:e94-e99. [PMID: 30853814 DOI: 10.3747/co.26.4439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer. Methods The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Recommendation 1 Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer. Recommendation 2 Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face. Recommendation 3 Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
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Affiliation(s)
- C Murray
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - D Sivajohanathan
- Department of Oncology, McMaster University, and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON
| | - T P Hanna
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON
| | | | - N Solish
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - B Moran
- Division of Dermatology, Queen's University, Kingston, ON
| | - R Hekkenberg
- Department of Surgery, Royal Victoria Regional Health Centre, and Surgical Oncology Program, Cancer Care Ontario, Barrie, ON
| | - A C Wei
- Quality and Knowledge Transfer, Surgical Oncology Program, Cancer Care Ontario, Toronto and, ON
| | - T Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, ON
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Flanagan M, Solon J, Chang K, Deady S, Moran B, Cahill R, Shields C, Mulsow J. Peritoneal metastases from extra-abdominal cancer – A population-based study. Eur J Surg Oncol 2018; 44:1811-1817. [DOI: 10.1016/j.ejso.2018.07.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/10/2018] [Accepted: 07/02/2018] [Indexed: 01/30/2023] Open
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Hamann H, Lee S, Browning T, Chavez C, Sanders J, Abbara S, Balis D, Chiu H, Moran B, Santini N, Gerber D. MA02.10 The First Year of Implementing a Lung Cancer Screening Program in an Urban Safety-Net Health System. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.329] [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]
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O'Brien D, Moran B, Shalloo L. A national methodology to quantify the diet of grazing dairy cows. J Dairy Sci 2018; 101:8595-8604. [DOI: 10.3168/jds.2017-13604] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
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Glynne-Jones R, Hall M, Lopes A, Pearce S, Goh V, Bosompem S, Bridgewater J, Chau I, Wasan H, Moran B, Melcher L, West N, Quirke P, Wong WL, Beare S, Hava N, Duggan M, Harrison M. BACCHUS: A randomised non-comparative phase II study of neoadjuvant chemotherapy (NACT) in patients with locally advanced rectal cancer (LARC). Heliyon 2018; 4:e00804. [PMID: 30258994 PMCID: PMC6151852 DOI: 10.1016/j.heliyon.2018.e00804] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/06/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chemoradiation (CRT) or short-course radiotherapy (SCRT) are standard treatments for locally advanced rectal cancer (LARC). We evaluated the efficacy/safety of two neoadjuvant chemotherapy (NACT) regimens as an alternative prior to total mesorectal excision (TME). METHODS/DESIGN This multi-centre, phase II trial in patients with magnetic resonance imaging (MRI) defined high-risk LARC (>cT3b, cN2+ or extramural venous invasion) randomised patients (1:1) to FOLFOX + Bevacizumab (Arm 1) or FOLFOXIRI + bevacizumab (Arm 2) every 14 days for 6 cycles prior to surgery. Patients were withdrawn if positron emission tomography (PET) standardised uptake value (SUV) after 3 cycles failed to decrease by >30% or increased compared to baseline. Primary endpoint was pathological complete response rate (pCR). Secondary endpoints included adverse events (AE) and toxicity. Neoadjuvant rectal (NAR) scores based on "T" and "N" downstaging were calculated. FINDINGS Twenty patients aged 18-75 years were randomised. The trial stopped early because of poor accrual. Seventeen patients completed all 6 cycles of NACT. One stopped due to myocardial infarction, 1 poor response on PET (both received CRT) and 1 committed suicide. 11 patients had G3 AE, 1 G4 AE (neutropenia), and 1 G5 (suicide). pCR (the primary endpoint) was 0/10 for Arm 1 and 2/10 for Arm 2 i.e. 2/20 (10%) overall. Median NAR score was 14·9 with 5 (28%), 7 (39%), and 6 (33%) having low, intermediate, or high scores. Surgical morbidity was acceptable (1/18 wound infection, no anastomotic leak/pelvic sepsis/fistulae). The 24-month progression-free survival rate was 75% (95% CI: 60%-85%). INTERPRETATION The primary endpoint (pCR rate) was not met. However, FOLFOXIRI and bevacizumab achieved promising pCR rates, low NAR scores and was well-tolerated. This regimen is suitable for testing as the novel arm against current standards of SCRT and/or CRT in a future trial.
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Affiliation(s)
- R. Glynne-Jones
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M.R. Hall
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - A. Lopes
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - S. Pearce
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - V. Goh
- Division of Imaging Sciences & Biomedical Engineering, Kings College London, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - S. Bosompem
- Pharmacy Department, Milton Keynes University Hospital NHS Trust, Milton Keynes, United Kingdom
| | - J. Bridgewater
- University College, London Cancer Institute, 72 Huntley St., London, WC1E 6AA, UK
| | - I. Chau
- Department of Medical Oncology, Royal Marsden Hospital, London & Surrey, UK
| | - H. Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - B. Moran
- Department of Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - L. Melcher
- Radiotherapy Department, North Middlesex Hospital, Sterling Way, London, N18 1QX, UK
| | - N.P. West
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - P. Quirke
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - W.-L. Wong
- Department of Radiology, Paul Strickland Scanner Centre, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - S. Beare
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - N. Hava
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M. Duggan
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M. Harrison
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
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Dwane L, Das S, Moran B, O’Connor A, Mulrane L, Jirstrom K, Bernards R, Gallagher W, Ní Chonghaile T, O’Connor D. PO-345 The role of the deubiquitinase USP11 in endocrine-driven breast cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.375] [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] Open
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Hanrahan L, McHugh N, Hennessy T, Moran B, Kearney R, Wallace M, Shalloo L. Factors associated with profitability in pasture-based systems of milk production. J Dairy Sci 2018. [DOI: 10.3168/jds.2017-13223] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Silva R, Moran B, Fahey C, Vlajinic T, Brennan D, Gallagher W, Perry A. PO-045 Evaluating liquid biopsies for methylomic profiling of prostate cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.578] [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] Open
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Mooney B, Das S, Klinger R, Moran B, Wynne K, Gallagher W, Chonghaile TN, Cagney G, Bracken A, O’Connor D. PO-090 Expression of the cocaine- and amphetamine-regulated transcript (CART) recruits SWI/SNF chromatin remodelling complexes to the oestrogen receptor. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.132] [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] Open
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Battersby NJ, Perez RO, Baxter N, Moran B, Brown G. Session 4: Trying to augment response with chemotherapy: a triumph of hope over experience? Colorectal Dis 2018; 20 Suppl 1:100-102. [PMID: 29878682 DOI: 10.1111/codi.14089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
As part of an approach to improve tumour regression and increase the proportion of patients with complete clinical and radiological response, Dr Perez reviews the methods and evidence base for augmenting therapy and thus augmenting response rates preoperatively. Much of the data reviewed were in the context of patients undergoing a watch-and-wait approach for rectal cancer after initial treatment with chemoradiotherapy.
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Affiliation(s)
| | - R O Perez
- Angelita & Joaquim Gama Institute, São Paulo, Brazil.,Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil.,Ludwig Institute for Cancer Research, São Paulo, Brazil.,Gastrointestinal Surgical Oncology Division, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - N Baxter
- University of Toronto, Toronto, ON, Canada
| | - B Moran
- North Hampshire Hospital, Basingstoke, UK
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Gastrointestinal Cancer Imaging, Imperial College London, London, UK
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Dattani M, Marijnen C, Moran B, Tait D, Cunningham C, Rodriguez-Bigas M, Brown G. Session 4: Shaping radiotherapy for rectal cancer: should this be personalized? Colorectal Dis 2018; 20 Suppl 1:92-96. [PMID: 29878670 DOI: 10.1111/codi.14087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preoperative radiotherapy continues to be widely used in patients with operable rectal cancer. However, the indications and goals for such treatment are evolving. Professor Marijnen reviews the historic and current evidence base for the use of preoperative neoadjuvant radiotherapy and the future challenges in tailoring the therapy according to the patients' needs and tumour stage.
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Affiliation(s)
- M Dattani
- Pelican Cancer Foundation, Basingstoke, UK
| | - C Marijnen
- Leiden University Medical Center, Leiden, The Netherlands
| | - B Moran
- North Hampshire Hospital, Basingstoke, UK
| | - D Tait
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - M Rodriguez-Bigas
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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Dwane L, Das S, Moran B, O'Connor AE, Mulrane L, Dirac AM, Jirstrom K, Crown JP, Bernards R, Gallagher WM, Ní Chonghaile T, O'Connor DP. Abstract P2-05-02: Functional genomic screening identifies ubiquitin-specific protease 11 (USP11) as a novel regulator of ER-alpha transcription in breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-05-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Approximately 70% of breast cancers overexpress the estrogen receptor α (ERα) and depend on this key transcriptional regulator for growth and differentiation. The discovery of novel mechanisms controlling ERα function represent major advances in our understanding of breast cancer progression and potentially offer attractive new therapeutic opportunities. Here, we investigated the role of deubiquitinating enzymes (DUBs), which act to remove ubiquitin moieties from proteins, in regulating transcriptional activity of ERα in breast cancer.
To identify DUBs involved in the regulation of ERα transcriptional activity, we performed an RNAi loss-of-function screen using a library of shRNA vectors targeting all human DUB genes. The DUB library consisted of pools of four non-overlapping shRNAs targeting all 108 known or putative DUBs (432 shRNAs in total). We found that suppression of a number of DUBs markedly repressed or enhanced the activity of an estrogen-response-element (ERE) luciferase reporter following estradiol (E2) stimulation. Of particular interest, suppression of the BRCA2-associated DUB, USP11, was found to down-regulate ERα transcriptional activity.
Subsequent validation using two individual siRNAs targeted to USP11 revealed a notable reduction in expression of endogenous ERα target genes in the ZR-75-1 cell line, as quantified using qRT-PCR. Further validation was carried out in a HEK293T USP11 knockout cell line, where reduced activity of an ERE-luciferase reporter was detected when compared to wild-type cells. This phenotype was rescued with a USP11 overexpression vector, both in the presence and absence of E2. Furthermore, USP11 expression was found to be upregulated in the estrogen-independent cell line LCC1 when compared to their parental MCF7 cells. Knockdown of USP11 in LCC1 cells resulted in decreased mRNA expression of a panel of ERα target genes, while RNA-seq revealed a downregulation of several putative ERα target genes and a downregulation of many cell cycle-associated proteins.
To support the prognostic relevance of USP11, immunohistochemical staining of a breast cancer tissue microarray (103 ER+ patients available for final analysis) was performed. Kaplan-Meier analysis of this cohort revealed a highly significant association between high USP11 expression and poor overall (p=0.030) and breast cancer-specific survival (p=0.041). In silico analysis of publically available breast cancer gene expression datasets further supported an association between high USP11 mRNA levels and poor prognosis. We observed a significant correlation between high expression of USP11 mRNA in ER-positive patients and poor distant metastasis-free survival (HR 2, CI 1.37-2.91, p=0.00023). This correlation was also significant in ER-positive patients who had received tamoxifen only (HR 2.9, CI 1.63-5.15, p=0.00015).
These results suggest a role for USP11 in driving cellular growth and identify USP11 as novel therapeutic target in breast cancer.
Citation Format: Dwane L, Das S, Moran B, O'Connor AE, Mulrane L, Dirac AM, Jirstrom K, Crown JP, Bernards R, Gallagher WM, Ní Chonghaile T, O'Connor DP. Functional genomic screening identifies ubiquitin-specific protease 11 (USP11) as a novel regulator of ER-alpha transcription in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-02.
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Affiliation(s)
- L Dwane
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - S Das
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - B Moran
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - AE O'Connor
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - L Mulrane
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - AM Dirac
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - K Jirstrom
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - JP Crown
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - R Bernards
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - WM Gallagher
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - T Ní Chonghaile
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
| | - DP O'Connor
- Royal College of Surgeons in Ireland, Dublin, Ireland; University College Dublin, Dublin, Ireland; Netherlands Cancer Institute, Amsterdam, Netherlands; Malmö University Hospital, Malmö, Sweden; St. Vincent's University Hospital, Dublin, Ireland
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Barron S, Jirström K, Jernström H, Ingvar C, Moran B, Wang CJA, Loughman T, Fender B, Dynoodt P, Lopez-Ruiz C, Russell N, Gallagher WM. Abstract P3-08-06: Prognostic value of OncoMasTR: A novel multigene signature based on master transcriptional regulators. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Multigene prognostic signatures (MGPS) enable identification of candidate patients for treatment de-escalation in early stage breast cancer (BC). Here we present OncoMasTR, a MGPS for classifying the risk of distant metastasis (DM) in ER-positive, HER2-negative BC patients with up to 3 involved lymph nodes (LNs). OncoMasTR was discovered via a novel transcriptional network analysis methodology that identified genes that regulate previously identified prognostic biomarkers. These upstream genes, termed master transcriptional regulators (MTRs), were shown to provide improved prognostic performance compared with downstream genes. OncoMasTR has been mechanistically verified by RT-qPCR, immunohistochemistry and chromatin immunoprecipitation. OncoMasTR has been further trained to include clinicopathological information (CPI) to maximise its prognostic performance.
Methods
Two independent sample sets: 225 patients from Malmö University Hospital and 100 patients from Skåne University Hospital were used for training, cross-validation and refinement of OncoMasTR. RNA extracted from 225 archived tissues was analysed by RT-qPCR to measure the expression levels of the MTRs. Statistical models of all possible combinations of MTRs were trained and cross-validated (1,000 times x 2-fold) using the first set of 225 samples. Statistical models with the best cross-validated performance were further evaluated on RT-qPCR data from the second independent set of 100 samples. Robustness of the data was verified by assessing the reproducibility of OncoMasTR across 6 days, using 6 unique kit lots, conducted by 4 operators on 3 RT-qPCR instruments.
Results
In the first training set of 225 patients, OncoMasTR classified up to 72% of LN0 patients and 58% of LN0-3 patients as low risk, with ≤ 5.0% DM within each group. When incorporating CPI, its prognostic performance further improved to a c (concordance) index > 0.8. Results showed that the OncoMasTR molecular score and CPI add statistically significant prognostic value to each other. In the independent verification set, all patients with DM were correctly classified as high risk (p<0.01). In relation to reproducibility, the OncoMasTR test displayed robust performance; the molecular score coefficient of variation was 2.6% across days, kit lots, operators and instruments. Individual MTR assays demonstrated linearity over >2000-fold RNA input range and PCR efficiencies ranged from 92% to 101%.
Conclusions
OncoMasTR development and verification results show analytical robustness and clinically accurate risk stratification. Furthermore, OncoMasTR's binary classification of risk avoids an ambiguous intermediate risk classification and has potential to provide clinicians with useful, actionable information to support treatment decisions. The OncoMasTR test is now ready for large-scale clinical validation.
Citation Format: Barron S, Jirström K, Jernström H, Ingvar C, Moran B, Wang C-JA, Loughman T, Fender B, Dynoodt P, Lopez-Ruiz C, Russell N, Gallagher WM. Prognostic value of OncoMasTR: A novel multigene signature based on master transcriptional regulators [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-06.
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Affiliation(s)
- S Barron
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - K Jirström
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - H Jernström
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C Ingvar
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - B Moran
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C-JA Wang
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - T Loughman
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - B Fender
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - P Dynoodt
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C Lopez-Ruiz
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - N Russell
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - WM Gallagher
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
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Barron S, Jirström K, Nodin B, Jernström H, Ingvar C, Moran B, Wang CJ, Loughman T, Fender B, Dynoodt P, Lopez-Ruiz C, Gallagher W. Prognostic value of master transcriptional regulators (MTRs) in early stage breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.052] [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: 11/14/2022] Open
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Chandramohan A, Thrower A, Smith SA, Shah N, Moran B. "PAUSE": a method for communicating radiological extent of peritoneal malignancy. Clin Radiol 2017; 72:972-980. [PMID: 28778454 DOI: 10.1016/j.crad.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/16/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022]
Abstract
Radiology reports of diffuse peritoneal disease should address key findings pertinent to the management of these patients. The reporting of radiology findings in patients with peritoneal malignancy is currently variable and poorly standardised. Using the acronym "PAUSE" we emphasise the key imaging features that a radiology report should include in a patient with peritoneal malignancy, focussing on the key elements determining feasibility and likely prognosis of surgery and potential benefits from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The term "PAUSE" incorporates the following: P, primary tumour and peritoneal carcinomatosis index (PCI) as estimated by imaging; A, ascites and abdominal wall involvement; U, unfavourable sites of involvement; S, small bowel and mesenteric disease; E, extra peritoneal metastases. Thus, "PAUSE" has the potential to standardise radiology reporting in this field.
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Affiliation(s)
- A Chandramohan
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK; Department of Radiology, Christian Medical College, Vellore, India.
| | - A Thrower
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - S A Smith
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - N Shah
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - B Moran
- Department of Surgery, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
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Solon JG, O'Neill M, Chang KH, Deady S, Cahill R, Moran B, Shields C, Mulsow J. An 18 year population-based study on site of origin and outcome of patients with peritoneal malignancy in Ireland. Eur J Surg Oncol 2017; 43:1924-1931. [PMID: 28583791 DOI: 10.1016/j.ejso.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 01/04/2017] [Revised: 04/15/2017] [Accepted: 05/10/2017] [Indexed: 12/17/2022] Open
Abstract
Peritoneal malignancy (PM) is predominantly metastatic spread from advanced gastrointestinal or gynaecological cancer. PM is generally considered incurable and therefore has rarely been the focus of novel therapeutic strategies. This study assessed patterns and survival outcomes for patients with PM in Ireland. The National Cancer Registry Ireland database was interrogated to identify patients diagnosed with PM during the period 1994-2012. Patient and tumour characteristics were retrieved and survival outcomes calculated. 5791 patients were diagnosed during the study period. Median age at diagnosis was 68 years; females accounted for 62%. The incidence increased annually from 228 in 1994 to 401 in 2012. Primary PM accounted for 3% of cases. Colorectal (22%), ovarian (16%) and gastric (13%) cancers accounted for the majority of cases of secondary PM. Almost 75% of patients had PM at initial presentation. Almost 40% of patients (n = 2274) underwent surgical intervention, while 44% (n = 2560) had tumour directed chemotherapy. The median survival (MS) in patients with secondary PM was 6.6 months, and did not improve significantly during the study period. Outcomes were best in patients with ovarian cancer (MS 15.9 months) and colorectal cancer (MS 14.3 months) and worst in patients with lung (MS 2.4 months) and pancreas (MS 1.9 months) cancers. This is the first population-based study from Ireland to report the incidence and outcomes for PM. PM is more common than previously reported and survival remains poor. These findings highlight the need for greater clinician awareness and the need to focus on new therapeutic approaches to improve patient outcomes.
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Affiliation(s)
- J G Solon
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - M O'Neill
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - K H Chang
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - S Deady
- The National Cancer Registry Ireland, Cork, Ireland
| | - R Cahill
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - B Moran
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland; Peritoneal Malignancy Institute, Basingstoke, UK
| | - C Shields
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J Mulsow
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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Jones H, Moran B, Crane S, Hompes R, Cunningham C. The LOREC APE registry: operative technique, oncological outcome and perineal wound healing after abdominoperineal excision. Colorectal Dis 2017; 19:172-180. [PMID: 27321172 DOI: 10.1111/codi.13423] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
AIM The Low Rectal Cancer Development programme (LOREC) perineal wound healing registry was developed to record data on abdominoperineal excision (APE) for rectal cancer in colorectal units in England between 2012 and 2014, to understand current practice in operative technique and results. METHOD Surgeons wishing to participate received secure Web-based access to the registry. Data were collected on preoperative staging, neoadjuvant treatment, operative details, histopathology, early outcome and follow up at 12 months. RESULTS Forty-two units entered 266 patients. Of these, 172 (65%) patients underwent extralevator APE (ELAPE) and 94 had non-ELAPE procedures. On preoperative staging, 64% were mrT3/4, and 67% received neoadjuvant treatment. For the ELAPE group the perineal wound was closed primarily with mesh in 55% of patients, without mesh in 15% and with a flap in 21%. For non-ELAPE procedures, 54% of wounds were closed primarily without mesh, 29% primarily with mesh and 5% by a flap. Wound breakdown occurred in 30% and 31% of patients in the ELAPE and non-ELAPE groups, respectively, and was more common after neoadjuvant radiotherapy. Donor-site complications occurred in 17% of patients treated with a flap. Perineal morbidity was recorded in 11% of patients at 12 months. On histopathology, the resection margin was positive in 13% of patients in the ELAPE group and in 4% of patients in the non-ELAPE group. CONCLUSION The LOREC registry provides a picture of current APE practice in England. ELAPE was used in two-thirds of patients but does not appear to confer any additional morbidity. Primary closure with mesh appeared as effective as flap reconstruction. The prevalence of an involved resection margin was lower than reported in many historical series but still remains high in the ELAPE group.
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Affiliation(s)
- H Jones
- Colorectal surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - B Moran
- Colorectal surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - S Crane
- Pelican Cancer Foundation, Basingstoke, UK
| | - R Hompes
- Colorectal surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Cunningham
- Colorectal surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O'Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG. A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 2017; 19:O1-O12. [PMID: 27671222 DOI: 10.1111/codi.13534] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Abstract
The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.
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Affiliation(s)
- A Vallance
- Royal College of Surgeons of England, London, UK
| | - S Wexner
- Cleveland Clinic Florida, Weston, Florida, USA
| | - M Berho
- Cleveland Clinic Florida, Weston, Florida, USA
| | - R Cahill
- University College Dublin, Dublin, Ireland
| | | | - N Haboubi
- University Hospital of South Manchester, Manchester, UK
| | - R J Heald
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - B Moran
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - R W Motson
- The ICENI Centre, Colchester University Hospital, Colchester, UK
| | - R Novell
- The Royal Free Hospital, London, UK
| | | | - F Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T Rockall
- Royal Surrey County Hospital, Guildford, UK
| | | | - A Windsor
- University College Hospital, London, UK
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Balyasnikova S, Haboubi N, Moran B, Brown G. Histopathological and radiological reporting in rectal cancer: concepts and controversies, facts and fantasies. Tech Coloproctol 2016; 21:15-23. [PMID: 27928687 DOI: 10.1007/s10151-016-1555-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023]
Abstract
In rectal cancer patients, the stage of the disease, local spread and distant metastases status drive the treatment decisions to be made. Histopathology remains the gold standard, but preoperative staging, particularly magnetic resonance imaging (MRI), is pivotal for defining surgical planes and finding patients who could potentially benefit from preoperative regimes. Unfortunately, due to a lack of awareness, expertise and practise the quality of rectal cancer MRI and histopathology reporting varies among centres. This paper highlights the most important and frequently occurring radiological and histopathological discrepancies/mistakes to be aware of.
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Affiliation(s)
- S Balyasnikova
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, UK.,Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham, UK.,Imperial College London, London, UK
| | - N Haboubi
- Department of Histopathology, Spire Hospital Healthcare Trust, Russell Road, Whalley Range, Manchester, M16 8AJ, UK.
| | - B Moran
- Department of Colorectal Surgery, North Hampshire Hospital, Basingstoke, UK
| | - G Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, UK.,Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham, UK.,Imperial College London, London, UK
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Smith L, Moran B, Rea H, Raverdeau M, McDonald I, Mills K, Steinhoff M. 268 Expression of Interleukin-33 by resident and immune cells in the skin of patients with atopic dermatitis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.288] [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: 10/21/2022]
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46
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Purfield DC, MacLeod IM, Hayes BJ, Butler S, Moore SG, Moran B, Kearney F, Berry DP. P5029 The use of Bayesian methods, biological priors and sequence variants to identify genomic regions associated with dairy cow fertility. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4129a] [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: 11/13/2022] Open
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47
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Branagan P, Moran B, Fitzgibbon M, Reid V, McMenamin M, Kane M, Kelly F, Barnes L, McLaughlin A, Keane J. Inoculation site leprosy in a tattoo as a paradoxical reaction following tuberculosis treatment. Int J Tuberc Lung Dis 2016; 20:706-8. [DOI: 10.5588/ijtld.15.0236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yonemura Y, Canbay E, Li Y, Coccolini F, Glehen O, Sugarbaker PH, Morris D, Moran B, Gonzaletz-Moreno S, Deraco M, Piso P, Elias D, Batlett D, Ishibashi H, Mizumoto A, Verwaal V, Mahtem H. A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent. Eur J Surg Oncol 2016; 42:1123-31. [PMID: 27160355 DOI: 10.1016/j.ejso.2016.03.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 12/29/2022] Open
Abstract
Recently, Peritoneal Surface Oncology Group International (PSOGI) developed a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) for the treatment of peritoneal metastases (PM) from gastric cancer with curative intent. This article reviews the results of this treatment and verifies its indication. In this strategy, peritoneal cancer index (PCI) is determined by laparoscopy, and a peritoneal port is placed. Neoadjuvant bidirectional intraperitoneal/systemic chemotherapy (NIPS) is performed for 3 cycles, and then laparotomy is performed. Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemoperfusion (HIPEC) are performed. Multivariate analyses showed that completeness of cytoreduction, pathologic response to NIPS and PCI level and cytologic status after NIPS, as independent prognostic factors. PCI less than cut-off level after NIPS, negative cytology after NIPS, and positive response to NIPS were identified as the indications for comprehensive treatment. Patients who hold these criteria should be considered as the candidates for CRS and HIPEC.
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Affiliation(s)
- Y Yonemura
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan; NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan.
| | - E Canbay
- NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan
| | - Y Li
- Department of Peritoneal Surface Oncology, Beijin Shijitan Hospital of Capital Medical University, Beijin, 100038, China
| | - F Coccolini
- General Surgery Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - O Glehen
- Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon, Universitē Lyon, 69495, France
| | - P H Sugarbaker
- Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - D Morris
- Department of Surgery, St George Hospital, University of New South Wales, Australia
| | - B Moran
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals Foundation Trust, Adelmaston Road, Basingstoke RG24 9NA, UK
| | - S Gonzaletz-Moreno
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Madrid, Spain
| | - M Deraco
- National Cancer Institute of Milan, Italy
| | - P Piso
- Krankenhaus Barmherzige Brieder, Teaching Hospital of the University of Regensburg, Regensburg, Germany
| | - D Elias
- Département de Chirurgie Générale, Institut Gustave Roussy, Villejuif, Cedex, France
| | - D Batlett
- Division of Surgical Oncology, Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - H Ishibashi
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan
| | - A Mizumoto
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan
| | - V Verwaal
- Oncologisch GE Chirurg, Catharina, Ziekenhuis Eindhoven, The Netherlands
| | - H Mahtem
- Department of Surgical Sciences, Uppsala University, Övriga Samarbeten, Akademiska Sjukhuset, Ing 70 1 Tr, 751 85, Uppsala, Sweden
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Sargant N, Roy A, Simpson S, Chandrakumaran K, Alves S, Coakes J, Bell J, Knight J, Wilson P, Mohamed F, Cecil T, Moran B. A protocol for management of blood loss in surgical treatment of peritoneal malignancy by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Transfus Med 2016; 26:118-22. [PMID: 27030339 DOI: 10.1111/tme.12301] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 03/01/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS The treatment of peritoneal malignancies with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be associated with massive surgical blood loss. Maintaining high fibrinogen levels throughout surgery may reduce blood loss in these patients. The primary aim of the study was to see if Tranexamic Acid (TXA) and cryoprecipitate reduced surgical blood loss and hence red cell transfusions. A comparison was made with a cohort of patients treated with fresh frozen plasma (FFP) alone. The secondary aim was to measure the effect of both protocols on coagulation parameters and the incidence of arterial or venous thrombosis. METHOD We used prospectively collected data from 201 patients who had complete CRS with HIPEC for peritoneal malignancy using different protocols during two discrete 12-month time periods. RESULTS The new transfusion protocol led to a higher average fibrinogen level intra-operatively and post-operatively, with a significant reduction in average RBC, FFP and platelet transfusion intra-operatively per patient from 4·2 to 1·8 units, 6·2 to 0·2 units and 0·1 to 0 units, respectively. No significant difference in PT or APTT was seen between patients treated with the standard and new protocols. Venous thrombosis occurred in seven patients treated with the standard protocol and five with the new protocol. A single case of arterial thrombosis was seen in both groups. CONCLUSION Patients treated with upfront TXA and cryoprecipitate during CRS required less RBC transfusion than those treated with the standard protocol of early FFP.
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Affiliation(s)
- N Sargant
- Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - A Roy
- Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - S Simpson
- Department of Haematology, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - K Chandrakumaran
- Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - S Alves
- Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - J Coakes
- Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - J Bell
- Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - J Knight
- Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - P Wilson
- Department of Anaesthesia, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - F Mohamed
- Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - T Cecil
- Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK
| | - B Moran
- Department of Pseudomyxoma Peritonei Surgery, Hampshire Hospitals NHS Trust, Basingstoke, UK
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50
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Saeed K, Dale AP, Leung E, Cusack T, Mohamed F, Lockyer G, Arnaudov S, Wade A, Moran B, Lewis G, Dryden M, Cecil T, Cepeda JA. Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy. Eur J Surg Oncol 2015; 42:234-43. [PMID: 26560024 DOI: 10.1016/j.ejso.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/05/2015] [Accepted: 10/16/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections. METHODOLOGY Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy. RESULTS Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively. CONCLUSION PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
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Affiliation(s)
- K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK.
| | - A P Dale
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - E Leung
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - T Cusack
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - F Mohamed
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lockyer
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - S Arnaudov
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - A Wade
- Department of Intensive Care Unit, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - B Moran
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lewis
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - M Dryden
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK
| | - T Cecil
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - J A Cepeda
- Department of Microbiology, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, KT2 7QB, UK
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