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Rogers SK, Phair A, Carriera J, Ghosh J, Bowling FL, McCollum C. Feasibility and Accuracy of Measuring Carotid Plaque Volume (Burden) With Contrast-Enhanced Tomographic 3D Ultrasound and Ultrasound Image Fusion. Ann Vasc Surg 2023; 91:168-175. [PMID: 36563846 DOI: 10.1016/j.avsg.2022.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/24/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stenosis severity has been the indication for carotid endarterectomy (CEA) for 4 decades, but the annual stroke risk in asymptomatic carotid stenosis >70% is under 2%. Atherosclerotic volume has emerged as a risk factor for future stroke, but needs to be measured noninvasively. Tomographic ultrasound (tUS) is a novel technology that assembles 3D images in seconds. We evaluated accuracy of measuring Carotid Plaque Volume (CPV) with tUS in patients undergoing CEA. METHOD Consecutive patients were imaged immediately before CEA by tUS and contrast-enhanced tUS (CEtUS). CPV was measured using tUS, CEtUS, and a fused images incorporating both tUS and CEtUS by trained vascular scientists. Precise volume of the endarterectomy specimen was measured using Archimedes technique. RESULTS Mean ± sd (range) CPV in 129 endarterectomy specimens was 0.75 ± 0.43 cm3 (0.10-2.47 cm3). Mean ± sd CPV measured by tUS (n = 114) was 0.87 ± 0.51 cm3, CEtUS (n = 104) was 0.75 ± 0.45 cm3 and with fusion (n = 95) was 0.83 ± 0.49 cm3. Differences between specimen volume and CPV measured by tUS (0.13 ± 0.24 cm3), CEtUS (-0.01 ± 0.21 cm3) or fusion (-0.08 ± 0.20) were clinically insignificant. Intra-/interobserver differences were minimal. CONCLUSIONS tUS accurately measures CPV with excellent intra-/interobserver agreement. CEtUS improves accuracy if precise CPV measurement is needed for research but tUS alone would be sufficient for population screening.
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Affiliation(s)
- S K Rogers
- University of Manchester, Manchester University NHS Foundation Trust, School of Medical Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, Manchester, UK; Manchester University NHS Foundation Trust, Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester, UK.
| | - A Phair
- University of Manchester, Manchester University NHS Foundation Trust, School of Medical Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, Manchester, UK
| | - J Carriera
- Manchester University NHS Foundation Trust, Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester, UK
| | - J Ghosh
- University of Manchester, Manchester University NHS Foundation Trust, School of Medical Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, Manchester, UK
| | - F L Bowling
- University of Manchester, Manchester University NHS Foundation Trust, School of Medical Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, Manchester, UK
| | - C McCollum
- University of Manchester, Manchester University NHS Foundation Trust, School of Medical Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, Manchester, UK
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Haque A, Wisely N, McCollum C. The Abdominal Aortic Aneurysm Get Fit Trial: A Randomised Controlled Trial of Exercise to Improve Fitness in Patients with Abdominal Aortic Aneurysm. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.10.016] [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: 11/19/2022]
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3
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Khan K, Chuntamongkol R, McCollum C, Gall L, Forshaw M. 964 Stage Migration in Newly Diagnosed Oesophago-Gastric Cancer During the First Wave Of COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.674] [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: 11/14/2022]
Abstract
Abstract
Aim
Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.
Method
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.
Results
349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p < 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).
Conclusions
The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
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Affiliation(s)
- K Khan
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | | | - C McCollum
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - L Gall
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - M Forshaw
- Glasgow Royal infirmary, Glasgow, United Kingdom
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Hughes M, Rogers S, Carreira J, Moore T, Manning J, Dinsdale G, McCollum C, Herrick AL. Imaging digital arteries in systemic sclerosis by tomographic 3-dimensional ultrasound. Rheumatol Int 2020; 41:1089-1096. [PMID: 32797279 DOI: 10.1007/s00296-020-04675-5] [Citation(s) in RCA: 4] [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: 05/07/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Objective methods are needed to quantify digital artery disease in systemic sclerosis (SSc) for clinical trials of vascular therapies. Our primary aim was to examine feasibility of a novel tomographic three-dimensional-(3-D) ultrasound (tUS) with high-frequency ultrasound (HFUS) or ultra-high-frequency ultrasound (UHFUS) to assess the digital arteries in patients with SSc compared to healthy controls. A secondary objective was to compare the total wall volume (TWV) as a measure of intimal/medial thickness. Eighteen patients with a confirmed diagnosis of SSc were studied by tUS HFUS (17.5 MHz, n = 10) or tUS UHFUS (48 and 70 MHz, n = 8) with equal numbers of healthy controls of similar age and gender. The majority of patients had limited cutaneous SSc and were representative of a spectrum of digital vasculopathy, with over half (n = 6 HFUS and n = 5 UHFUS) having previous digital ulceration. Over half were receiving oral vasodilatory therapy. TWV was measured in both digital arteries of the middle finger bilaterally. At least, two digital arteries could be identified at 17.5 MHz in all patients and healthy controls. Whereas, at least two digital arteries could be identified in relatively fewer patients compared to healthy controls using 48 MHz (n = 6 and 10) and especially 70 MHz (n = 4 and 10) UHFUS. The median difference in TWV between patients and healthy controls was -6.49 mm3 using 17.5 MHz, 1.9 mm3 at 48 MHz, and -0.4 mm3 at 70 MHz. tUS using UHFUS is a feasible method to measure TWV of digital arteries in SSc. Transducer frequency plays an important factor in successful digital artery measurement, with 48 MHz being the optimal frequency.
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Affiliation(s)
- M Hughes
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.
| | - S Rogers
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
| | - J Carreira
- Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - T Moore
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - J Manning
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - G Dinsdale
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - C McCollum
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - A L Herrick
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
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Khan M, Rogers S, Ghosh J, McCollum C. Ultrasound Characteristics that Predict Abdominal Aortic Aneurysm Growth. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.717] [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: 11/24/2022]
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6
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Ball S, Rogers S, Kanesalingam K, Taylor R, Katsogridakis E, McCollum C. Carotid plaque volume in patients undergoing carotid endarterectomy. Br J Surg 2018; 105:262-269. [PMID: 29315509 PMCID: PMC5873399 DOI: 10.1002/bjs.10670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/10/2017] [Accepted: 07/11/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated. METHODS The volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA. Time from last symptom and severity of stenosis measured by duplex ultrasonography were recorded. Middle cerebral artery emboli were counted using transcranial Doppler imaging (TCD) in a subset of patients. RESULTS Some 339 patients were included, 270 with symptomatic and 69 with asymptomatic carotid stenosis. Mean(s.d.) CPV was higher in symptomatic than in asymptomatic patients (0·97(0·43) versus 0.74(0·41) cm3 ; P < 0·001). CPV did not correlate with severity of carotid stenosis (P = 0·770). Mean CPV was highest at 1·03(0·46) cm3 in the 4 weeks following cerebral symptoms, declining to 0·78(0·36) cm3 beyond 8 weeks. Among 33 patients who had TCD, mean CPV was 1·00(0·48) cm3 in the 27 patients with ipsilateral cerebral emboli compared with 0·67(0·16) cm3 in those without (P = 0·142). There was excellent correlation between CPV measured by tomographic ultrasound imaging and the endarterectomy specimen in 34 patients (r = 0·93, P < 0·001). CONCLUSION CPV correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA.
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Affiliation(s)
- S Ball
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - S Rogers
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Independent Vascular Services Ltd, University Hospital of South Manchester, Manchester, UK
| | - K Kanesalingam
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - R Taylor
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - E Katsogridakis
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - C McCollum
- Academic Surgery Unit, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Bath M, Saratzis A, Saedon M, Sidloff D, Sayers R, Bown M, Pathak R, Brooks M, Hayes P, Imray C, Quarmby J, Choksy S, Earnshaw J, Shearman C, Grocott E, Rix T, Chetter I, Tennant W, Libertiny G, Sykes T, Dayer M, Pike L, Pherwani A, Nice C, Browning N, McCollum C, Yusuf S, Gannon M, Barwell J, Baker S, Vallabhaneni S, Davies A. Patients with Small Abdominal Aortic Aneurysm are at Significant Risk of Cardiovascular Events and this Risk is not Addressed Sufficiently. Eur J Vasc Endovasc Surg 2017; 53:255-260. [DOI: 10.1016/j.ejvs.2016.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/20/2016] [Indexed: 01/06/2023]
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8
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Dhorat Z, Hansrani V, Norse K, Moore E, McCollum C. Using trans-vaginal duplex ultrasound to detect pelvic vein incompetence in women: A diagnostic readability and interobserver variability study. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.498] [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: 11/25/2022]
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9
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Lowe C, Serracino-Inglott F, Ashleigh R, McCollum C. The UK Pilot Study on Multi-layer Flow-Modulating Stents for Thoraco-Abdominal and Peri-renal Aneurysms: Results at Three Years. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.045] [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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10
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Lowe C, Worthington A, Serracino-Inglott F, Ashleigh R, McCollum C. Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.01.015] [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: 10/22/2022]
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11
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Hansrani V, Kotecha D, Norse K, McCollum C. Trans-vaginal duplex ultrasound for detecting pelvic vein incompetence in women: A pilot study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Lowe C, Worthington A, Serracino-Inglott F, Ashleigh R, McCollum C. Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study. Eur J Vasc Endovasc Surg 2015; 51:225-31. [PMID: 26497254 DOI: 10.1016/j.ejvs.2015.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 07/28/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There remains a population of patients with aortic aneurysms that cannot be treated by conventional endovascular means. Multi-layer flow modulating stents (MFMS) are a novel approach for the treatment of aortic aneurysm; this study reports outcomes of a UK pilot study of first-generation MFMS in thoraco-abdominal (TAAA) and perirenal aneurysms (PAA) in patients who were also unfit for open surgery. METHODS Patients with TAAA and PAA unfit for open surgery and with no conventional options for endovascular repair were recruited. Follow-up included CTA at 1, 3, 6, and 12 months, then annually. Outcome measures included 30 day mortality, growth-free survival, branch vessel patency, complications, re-intervention, and maximal aortic diameter. RESULTS MFMS were implanted in 14 patients (6 PAA, 8 TAAA) between October 2011 and March 2014 with one (7%) 30 day death and 11 (79%) surviving to 12 months. The median aneurysm growth was 9 mm in the first 12 months following implantation. On mean follow-up of 22.8 months, seven (50%) patients had died including one confirmed rupture. AAA diameter remained stable in only two of the surviving patients. Fifty of 51 covered aortic branches remained patent with no embolic episodes or symptoms of ischaemia in any patient. MFMS dislocation occurred in four patients, leading to re-intervention in two. A total of six re-interventions were performed in five patients (35%) with one post-re-intervention death. CONCLUSION These first-generation MFMS were unstable and dislocated frequently. It is uncertain whether MFMS implantation influenced the natural history of these aneurysms as none decreased in size, but two remain stable after a mean of 22.8 months. Although side branch patency was maintained, our results do not support the continued use of these first-generation devices. Further development is needed if this technology is to have a role in treatment of aortic aneurysm.
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MESH Headings
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/physiopathology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/mortality
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/surgery
- Aortic Rupture/etiology
- Aortic Rupture/therapy
- Aortography/methods
- Blood Flow Velocity
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Endovascular Procedures/adverse effects
- Endovascular Procedures/instrumentation
- Endovascular Procedures/mortality
- England
- Female
- Foreign-Body Migration/etiology
- Foreign-Body Migration/therapy
- Humans
- Male
- Middle Aged
- Pilot Projects
- Prosthesis Design
- Regional Blood Flow
- Retreatment
- Risk Factors
- Stents
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Patency
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Affiliation(s)
- C Lowe
- Department of Academic Surgery, Institute of Cardiovascular Sciences, University of Manchester, Education and Research Centre, University Hospital South Manchester, Manchester, UK; Department of Vascular and Endovascular Surgery, University Hospital South Manchester, Manchester, UK.
| | - A Worthington
- Department of Academic Surgery, Institute of Cardiovascular Sciences, University of Manchester, Education and Research Centre, University Hospital South Manchester, Manchester, UK
| | - F Serracino-Inglott
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Manchester, UK
| | - R Ashleigh
- Department of Vascular and Endovascular Surgery, University Hospital South Manchester, Manchester, UK
| | - C McCollum
- Department of Academic Surgery, Institute of Cardiovascular Sciences, University of Manchester, Education and Research Centre, University Hospital South Manchester, Manchester, UK; Department of Vascular and Endovascular Surgery, University Hospital South Manchester, Manchester, UK
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13
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Lowe C, Worthington A, Serracino-Inglott F, Ashleigh R, McCollum C. Repair of Thoraco-abdominal and Peri-renal Aneurysms with the Multi-layer Flow-modulating Stent: The UK Pilot Study. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Purandare N, Oude Voshaar RC, Burns A, Velupandian UM, McCollum C. Paradoxical embolization: a potential cause of cerebral damage in Alzheimer's disease? Neurol Res 2013; 28:679-84. [PMID: 16945222 DOI: 10.1179/016164106x130425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There are considerable overlaps between vascular dementia and Alzheimer's disease (AD), with a suggestion that cerebrovascular disease (CVD) contributes to the neurodegenerative pathology of AD. Paradoxical embolization of venous emboli into the systemic circulation through a venous to arterial circulation shunt (v-aCS), the most commonly a patent foramen ovale (PFO), is known to cause cryptogenic stroke in younger people. We reviewed the potential role of paradoxical embolization in AD. METHODS A review of the literature on paradoxical embolization in neurological disorders and techniques to detect v-aCS and PFO, supplemented by data from our own studies. RESULTS Before our research, the role of paradoxical embolism in dementia had not been studied. The potential role of embolization in cerebral damage was highlighted by studies in patients undergoing coronary artery bypass or carotid surgery. Paradoxical embolization was found to occur in patients with cryptogenic stroke, migraine, decompression sickles and during hip surgery. The methods for detecting v-aCS or PFO had not been standardized. We found 'significant' v-aCS (equivalent to PFO) in 32% of AD patients compared with 22% of controls, but the study was not sufficiently powered to test the statistic significance of this difference. In AD, there was evidence of an association between 'significant' v-aCS and the severity of white matter hyperintensities on magnetic resonance imaging (MRI). CONCLUSION Paradoxical embolization through a v-aCS may be a potentially preventable or treatable cause of CVD in AD.
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Affiliation(s)
- N Purandare
- Division of Psychiatry, Education and Research Center, Wythenshawe Hospital, Wythenshawe, Manchester, M23 9LT, UK.
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Wild J, Stather P, Biancari F, Choke E, Earnshaw J, Grant S, Hafez H, Holdsworth R, Juvonen T, Lindholt J, McCollum C, Parvin S, Sayers R, Bown M. A Multicentre Observational Study of the Outcomes of Screening Detected Sub-aneurysmal Aortic Dilatation. Eur J Vasc Endovasc Surg 2013; 45:128-34. [DOI: 10.1016/j.ejvs.2012.11.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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16
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17
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Thomas C, Gayani R, Nikolos F, Hao R, Katchy A, McCollum C, Williams C, Bondesson M, Krishnamurthy S, Esteva F, Gustafsson JA. P1-02-04: Estrogen Receptor beta Inhibits Breast Cancer EMT by Regulating the Expression of miR-200. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-02-04] [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
Estrogen receptor beta (ERβ) mediates the effects of estrogens in a variety of human tissues and regulates cellular processes involved in initiation and progression of breast cancer such as cell proliferation and migration. Clinical studies produced contradictory data regarding the role for ERβ in prognosis of metastatic breast cancer and the molecular mechanism through which ERβ influences cell migration and invasion has not been fully elucidated. Here we show that induction of ERβ expression inhibits epithelial to mesenchymal transition (EMT) in metastatic breast cancer cells. This correlates with an ERβ-mediated induction in the expression of the epithelial marker E-cadherin and downregulation of its transcriptional repressors ZEB1 and SIP1. ERβ alters the expression of ZEB1 and SIP1 by inducing the expression of the miR-200a, miR200b and miR-429. Downregulation of these miRNAs in ERβ-expressing cells resulted in decreased cell-cell contact and decline of E-cadherin levels. In addition, ERβ was found to inhibit the invasiveness of metastatic breast cancer cells in a zebrafish xenotransplantation model. We are now examining breast cancer specimens derived from ductal carcinomas and metaplastic breast cancers to see whether ERβ levels decline in the mesenchymal regions and ERβ expression is correlated with epithelial markers. These data propose a crucial role for ERβ in the regulation of EMT and in prognosis of invasive and metastatic breast cancer.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-04.
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Affiliation(s)
- C Thomas
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - R Gayani
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - F Nikolos
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - R Hao
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - A Katchy
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - C McCollum
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - C Williams
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - M Bondesson
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - S Krishnamurthy
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - F Esteva
- 1University of Houston; University of Texas MD Anderson Cancer Center
| | - J-A Gustafsson
- 1University of Houston; University of Texas MD Anderson Cancer Center
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18
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McCollum PT, Bush JA, James G, Mason T, O'Kane S, McCollum C, Krievins D, Shiralkar S, Ferguson MWJ. Randomized phase II clinical trial of avotermin versus placebo for scar improvement. Br J Surg 2011; 98:925-34. [DOI: 10.1002/bjs.7438] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2010] [Indexed: 01/28/2023]
Abstract
Abstract
Background
Scarring is a major problem following skin injury. In early clinical trials, transforming growth factor β3 (avotermin) improved scar appearance. The aim of this study was to determine whether an injection of avotermin at the time of wound closure is effective in improving scar appearance.
Methods
Study RN1001-0042, a double-blind, randomized, within-patient, placebo-controlled trial, investigated the efficacy and safety of four doses of avotermin given once. Patients undergoing bilateral surgery to remove varicose leg veins by saphenofemoral ligation and long saphenous vein stripping were enrolled at 20 European centres. A total of 156 patients were randomized to receive one of four doses of avotermin (5, 50, 200 or 500 ng per 100 µl, at 100 µl per linear cm of wound margin), administered by intradermal injection to the groin and distal wound margins of one leg; placebo was administered to the other leg. Scar appearance was evaluated by an independent panel of lay people (lay panel), investigators and patients. The primary efficacy variable was lay panel Total Scar Score (ToScar), derived from visual analogue scale scores for groin scars between 6 weeks and 7 months.
Results
Avotermin 500 ng significantly improved groin scar appearance compared with placebo (mean lay panel ToScar difference 16·49 mm; P = 0·036).
Conclusion
Avotermin 500 ng per 100 µl per linear cm of wound margin given once is well tolerated and significantly improves scar appearance. Registration number: NCT00430326 (http://www.clinicaltrials.gov).
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Affiliation(s)
- P T McCollum
- Department of Vascular Surgery, Hull Royal Infirmary, UK
| | - J A Bush
- Renovo, Core Technology Facility, South Manchester University Hospital, Manchester, UK
- Facultie of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - G James
- Renovo, Core Technology Facility, South Manchester University Hospital, Manchester, UK
| | - T Mason
- Renovo, Core Technology Facility, South Manchester University Hospital, Manchester, UK
| | - S O'Kane
- Renovo, Core Technology Facility, South Manchester University Hospital, Manchester, UK
| | - C McCollum
- Department of Academic Surgery, Education and Research Centre, South Manchester University Hospital, Manchester, UK
| | - D Krievins
- P. Stradinas Clinical University Hospital, Riga, Latvia
| | - S Shiralkar
- Surgery Department, Russells Hall Hospital, Dudley, UK
| | - M W J Ferguson
- Renovo, Core Technology Facility, South Manchester University Hospital, Manchester, UK
- Facultie of Life Sciences, University of Manchester, Manchester, UK
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19
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Grant SW, Grayson AD, Purkayastha D, Wilson SD, McCollum C. Logistic risk model for mortality following elective abdominal aortic aneurysm repair. Br J Surg 2011; 98:652-8. [DOI: 10.1002/bjs.7463] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The aim was to develop a multivariable risk prediction model for 30-day mortality following elective abdominal aortic aneurysm (AAA) repair.
Methods
Data collected prospectively on 2765 consecutive patients undergoing elective open and endovascular AAA repair from September 1999 to October 2009 in the North West of England were split randomly into development (1936 patients) and validation (829) data sets. Logistic regression analysis was undertaken to identify risk factors for 30-day mortality.
Results
Ninety-eight deaths (5·1 per cent) were recorded in the development data set. Variables associated with 30-day mortality included: increasing age (P = 0·005), female sex (P = 0·002), diabetes (P = 0·029), raised serum creatinine level (P = 0·006), respiratory disease (P = 0·031), antiplatelet medication (P < 0·001) and open surgery (P = 0·002). The area under the receiver operating characteristic (ROC) curve for predicted probability of 30-day mortality in the development and validation data sets was 0·73 and 0·70 respectively. Observed versus expected 30-day mortality was 3·2 versus 2·0 per cent (P = 0·272) in low-risk, 6·1 versus 5·1 per cent (P = 0·671) in medium-risk and 11·1 versus 10·7 per cent (P = 0·879) in high-risk patients.
Conclusion
This multivariable model for predicting 30-day mortality following elective AAA repair can be used clinically to calculate patient-specific risk and is useful for case-mix adjustment. The model predicted well across all risk groups in the validation data set.
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Affiliation(s)
- S W Grant
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
| | - A D Grayson
- Southport and Ormskirk NHS Hospitals, Southport, UK
| | - D Purkayastha
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
| | - S D Wilson
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
| | - C McCollum
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
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20
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Abstract
A series of fluorescein phosphoramidites (FAM) have been synthesized for use on automated DNA synthesizers. After coupling of the FAM reagents to the 5' hydroxyl of the oligonucleotide on the DNA synthesizer, the excess reagent is removed by washing the solid support. The dye, and its linkage to the oligonucleotide, are stable during the conditions of DNA synthesis and cleavage/deprotection conditions. Purification is attained with the OPC (Oligonucleotide Purification Cartridge), a polystyrene based affinity matrix, which selectively retains hydrophobic oligonucleotide conjugates. Analysis by MicroGel capillary electrophoresis effectively separates fluorescent dye labelled oligonucleotides from unlabelled products.
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Affiliation(s)
- P Theisen
- Applied Biosystems Inc., Foster City, CA 94404
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21
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Abstract
Simple, inexpensive dressings advocated
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Affiliation(s)
- M J Sultan
- Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - C McCollum
- Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
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22
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Sastry S, MacNab A, Daly K, Ray S, McCollum C. Transcranial Doppler detection of venous-to-arterial circulation shunts: criteria for patent foramen ovale. J Clin Ultrasound 2009; 37:276-280. [PMID: 19353576 DOI: 10.1002/jcu.20564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE As paradoxical embolism is associated with stroke in young adults, migraine, and decompression sickness, the detection of venous-to-arterial circulation shunt (v-aCS), such as patent foramen ovale (PFO), is increasingly important. We compared a rigorous transcranial Doppler (TCD) protocol with transesophageal echocardiography (TEE) to develop criteria for PFO. METHODS Standardized TCD was performed 2 weeks before simultaneous TEE and TCD in 39 patients aged 15-39 following ischemic stroke (n = 33) or myocardial infarction (n = 6). V-aCS was investigated by contrast sonography. During standardized TCD, contrast injections were performed twice, at rest and with cough and Valsalva maneuvers. TCD and TEE were recorded and analyzed independently by 'blinded' observers. RESULTS All 16 of the 39 patients with PFO on TEE had more than 15 micro-emboli on standardized TCD; in 14 of these 16, paradoxical embolization required no provocation. Three of 9 patients with 'major' v-aCS (>50 microbubble emboli at rest or >10 at rest with >80 on provocation) on standardized TCD were not identified by TEE as having large shunts. CONCLUSION The standardized TCD protocol is sensitive in the diagnosis of PFO and with the use of provocation maneuvers measures the functional importance of v-aCS more accurately than TEE.
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Affiliation(s)
- S Sastry
- Department of Academic Surgery, South Manchester University Hospital, Manchester, United Kingdom
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23
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Purkayastha D, McCollum C, Kane K. A model to predict risk in carotid surgery. Br J Surg 2009. [DOI: 10.1002/bjs.6518] [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] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - C McCollum
- University Hospital of South Manchester, Manchester
| | - K Kane
- University Hospital of South Manchester, Manchester
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24
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Purandare N, Oude Voshaar RC, McCollum C, Jackson A, Burns A. Paradoxical embolisation and cerebral white matter lesions in dementia. Br J Radiol 2008; 81:30-4. [DOI: 10.1259/bjr/90498392] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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25
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Daly K, Hutchinson S, McCollum C. Reply to the Letter by Morelli et al: Vertebrobasilar Recording with Contrast Transcranial Doppler in Right-to-Left Shunt Diagnosis. Cerebrovasc Dis 2008. [DOI: 10.1159/000164559] [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: 11/19/2022] Open
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26
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Sastry S, Daly K, Chengodu T, McCollum C. Is Transcranial Doppler for the Detection of Venous-to-Arterial Circulation Shunts Reproducible? Cerebrovasc Dis 2007; 23:424-9. [PMID: 17406112 DOI: 10.1159/000101466] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 10/18/2006] [Accepted: 12/04/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We investigated the reproducibility of contrast transcranial Doppler (TCD), a safe non-invasive test for investigation of venous-to-arterial circulation shunts (v-aCS), usually patent foramen ovale, in young stroke patients. We also investigated whether microbubble contrast was reproducible and whether the addition of blood to agitated saline contrast affected the number of microbubbles produced. METHODS TCD investigation for v-aCS was repeated in 42 patients using a standardised protocol (i) by the same investigator and (ii) by a different investigator. Agitated saline was produced by mixing saline and 1 ml of air between two 10-ml syringes. The effect of adding blood and increasing the number of agitations was evaluated by microscopy examination using a haemocytometer to assess bubble numbers and sizes. RESULTS TCD: no difference was found in the highest microbubble count for the same investigator and between different investigators (p > 0.05). Reproducibility for the detection of v-aCS consistent with a patent foramen ovale was also good (kappa values >0.8). Contrast: both the number of contrast mixes before injection and the presence of blood significantly increased the number of bubbles counted. On average, 18 agitations produced 1.86 (95% CI 1.62-2.13) times more bubbles than 6 agitations. Mixtures with blood produced on average 3.8 times more bubbles (3.08-4.69). The size of the bubbles was similar for all mixtures. CONCLUSIONS Contrast TCD is reproducible and reliable for the detection of v-aCS. The addition of blood and 18 mixes rather than 6 significantly increased the number of microbubbles produced and may increase the effectiveness of microbubble contrast.
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MESH Headings
- Adult
- Coronary Circulation
- Embolism, Paradoxical/complications
- Embolism, Paradoxical/diagnostic imaging
- Embolism, Paradoxical/etiology
- Embolism, Paradoxical/physiopathology
- Female
- Fourier Analysis
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Humans
- Intracranial Embolism/complications
- Intracranial Embolism/diagnostic imaging
- Intracranial Embolism/etiology
- Intracranial Embolism/physiopathology
- Male
- Microbubbles
- Middle Cerebral Artery/diagnostic imaging
- Middle Cerebral Artery/physiopathology
- Observer Variation
- Predictive Value of Tests
- Pulmonary Circulation
- Reproducibility of Results
- Stroke/diagnostic imaging
- Stroke/etiology
- Stroke/physiopathology
- Ultrasonography, Doppler, Transcranial/methods
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Affiliation(s)
- S Sastry
- Department of Academic Surgery, South Manchester University Hospital, Manchester, UK.
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27
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Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model. Health Technol Assess 2007; 10:iii-iv, ix-x, 1-210. [PMID: 17049141 DOI: 10.3310/hta10440] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. DATA SOURCES Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. REVIEW METHODS Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. RESULTS Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH). Twelve published studies reported full economic evaluations. All but two of the transfusion strategies significantly reduced exposure to allogeneic blood. The relative risk of exposure to allogeneic blood was 0.59 for the pooled trials of cell salvage (95% confidence interval: 0.48 to 0.73). This varied by the type and timing of cell salvage and type of surgical procedure. For cell salvage, the relative risk of allogeneic blood transfusion was higher in cardiac surgery than in orthopaedic surgery. Cell salvage had lower costs and slightly higher quality-adjusted life years compared with all of the alternative transfusion strategies except ANH. The likelihood that cell salvage is cost-effective compared with strategies other than ANH is over 50%. Most of the secondary analyses indicated similar results to the primary analysis. However, the primary and secondary analyses indicated that ANH may be more cost-effective than cell salvage. CONCLUSIONS The available evidence indicates that cell salvage may be a cost-effective method to reduce exposure to allogeneic blood transfusion. However, ANH may be more cost-effective than cell salvage. The results of this analysis are subject to the low quality and reliability of the data used and the use of indirect comparisons. This may affect the reliability and robustness of the clinical and economic results. There is a need for further research that includes adequately powered high-quality RCTs to compare directly various blood transfusion strategies. These should include measures of health status, health-related quality of life and patient preferences for alternative transfusion strategies. Observational and tracking studies are needed to estimate reliably the incidence of adverse events and infections transmitted during blood transfusion and to identify the lifetime consequences of the serious hazards of transfusion on mortality, health status and health-related quality of life.
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Affiliation(s)
- L Davies
- Health Economics Research, University of Manchester, UK
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28
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Malde DJ, Abidia A, McCollum C, Welch M. The success of routine MRSA screening in vascular surgery: a nine year review. INT ANGIOL 2006; 25:204-8. [PMID: 16763540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM Methicillin resistant Staphylococcus aureus (MRSA) infection in vascular patients is associated with increased morbidity and mortality. We investigated whether routine MRSA screening reduced complications related to MRSA infection. METHODS Data was analysed for all MRSA positive (+ve) vascular patients admitted before (1996-2000) and after (2001-2004) routine MRSA screening was introduced. Outcome measures compared included wound infection, major limb amputation and mortality rates. RESULTS There were 92 and 188 MRSA +ve patients in the pre- and postscreening periods, respectively. After the introduction of MRSA screening, MRSA wound infection in MRSA +ve elective admissions was significantly reduced from 55.6% (20/36) to 22.4% (15/67), (P=0.002, chi2 test); amputations were reduced from 27.8% (10/36) to 9% (6/67), P value 0.026, and mortality from 16.7% (6/36) to 9% (6/67), P value >0.05. In MRSA +ve emergency admissions wound infection was significantly reduced from 62.5% (35/56) to 43.8% (53/121), P value 0.042, amputations from 50% (28/56) to 38.8% (47/121), P value 0.26, and mortality from 25% (14/56) to 12.4% (15/121), P value 0.067. CONCLUSIONS While the incidence of MRSA infection continues to rise, we have successfully demonstrated that MRSA screening identifies patients at risk of serious complications and is associated with a reduction in these complications following both elective and emergency surgery. Routine screening of all vascular admissions should be part of the strategy to combat MRSA infection.
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Affiliation(s)
- D J Malde
- Department of Vascular Surgery, South Manchester University Hospital, Manchester, UK.
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29
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Patankar T, Widjaja E, Chant H, McCollum C, Baldwin R, Jeffries S, Sutcliffe C, Burns A, Jackson A. Relationship of deep white matter hyperintensities and cerebral blood flow in severe carotid artery stenosis. Eur J Neurol 2006; 13:10-6. [PMID: 16420388 DOI: 10.1111/j.1468-1331.2006.01115.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Leukoaraiosis (LA) has been associated with abnormalities of both large and small blood vessels. This study attempts to clarify the pathogenesis of LA by testing the hypothesis that increased frequency of LA with occlusive extra-cranial arterial disease results directly from global reduction in cerebral blood flow (CBF). Thirty-five normal subjects and 55 patients with carotid stenosis (>70%) were studied using MR. CBF was measured using phase contrast MR angiography and LA was scored using previously validated scoring system. Patients were divided into those with evidence of previous infarction on MRI and those without. LA was more severe in patients than in normal subjects (P<0.01) and correlated with age in normal subjects but not in patients. CBF in patients with (809+/-214 ml/min) and without infarction (mean 792+/-181 ml/min) was significantly lower than in normal subjects (mean 1073+/-194 ml/min). There was no correlation between the severity of LA and measured CBF in any group. The severity of LA is greater in patients with severe carotid stenosis but is not correlated to reductions in CBF. This suggests that microvascular abnormality is the dominant pathogenetic factor in LA even in the presence of severe stenotic/occlusive large vessel disease.
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Affiliation(s)
- T Patankar
- Imaging Science and Biomedical Engineering, School of Medicine, University of Manchester, Manchester, UK.
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30
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Chant H, Ashleigh R, McCollum C. Thrombectomy for Acute Internal Carotid Thrombosis: Five Thrombectomy Devices Compared. Eur J Vasc Endovasc Surg 2004; 27:403-8. [PMID: 15015191 DOI: 10.1016/j.ejvs.2003.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2003] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the safety and efficiency of commercially available thrombectomy catheters in clearing simulated internal carotid artery (ICA) thrombosis. DESIGN Comparative in vitro study. MATERIALS AND METHODS A model of the ICA was filled with human thrombus, the 'circle of Willis' back pressure was set at either 10 or 30 cm of water. Five thrombectomy devices (Hydrolyser, Clot Buster, Acolysis System, AngioJet and Fogarty embolectomy catheter) were compared for (i) efficiency at removing thrombus, (ii) pressure changes at the tip of each device, and (iii) distal embolisation by flow cytometry. RESULTS Thrombus clearance was greatest with the AngioJet (median 95%, range 92-97%) and least with the Acolysis System (median 34%, range 12-50%). The Clot Buster and Hydrolyser were safest as they produced only negative tip pressures, the AngioJet and Balloon catheter produced positive and negative pressures risking distal embolisation. The Acolysis system produced no pressure change during use. Distal embolisation (of particles between 5 and 40 microm diameter) was greatest with the Fogarty balloon catheter at 10 cm water (P<0.05) and least with the Hydrolyser and Clot Buster. CONCLUSION Balloon embolectomy for ICA thrombosis risks further embolic cerebral damage. The Hydrolyser and the Clot Buster show the greatest promise for ICA thrombectomy.
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Affiliation(s)
- H Chant
- Department of Vascular Surgery, Bristol Royal Infirmary, UK
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31
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Abstract
Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n=20) or knee (n=21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
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Affiliation(s)
- G. Riding
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - K. Daly
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - S. Hutchinson
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - S. Rao
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
| | | | - C. McCollum
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
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32
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Riding G, Daly K, Hutchinson S, Rao S, Lovell M, McCollum C. Paradoxical cerebral embolisation. An explanation for fat embolism syndrome. J Bone Joint Surg Br 2004; 86:95-8. [PMID: 14765873] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
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Affiliation(s)
- G Riding
- Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, England, UK
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33
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Abstract
This study examines the influence of wh-gaps on the prosodic contour of spoken utterances. A previous study (Nagel, Shapiro, & Nawy, 1994) claimed that the phonological representation of a sentence containing a filler-gap dependency explicitly encodes the location of the syntactic gap. In support of this hypothesis, Nagel et al. presented evidence that the word immediately preceding a gap is lengthened and that there is a reliable increase in pitch excursion across the gap location. Our study challenges Nagel et al.'s claim. We argue that their materials confounded the presence/ absence of a gap with other factors that are known to affect intonational phrasing independently. We show that, when these factors are separated, the evidence that syntactic gaps are explicitly encoded in the phonological representation of a sentence disappears.
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Affiliation(s)
- K Straub
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland 21218-2685, USA.
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34
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Abstract
BACKGROUND Dacron (polyester fiber) was largely abandoned for femoropopliteal bypass grafts 30 years ago because saphenous vein achieved better patencies. However, in patients taking aspirin, patency in above-knee femoropopliteal bypass grafts has recently been shown to be equivalent to that with saphenous vein. We compared heparin-bonded Dacron (HBD) and polytetrafluoroethylene (PTFE) in a randomized multicenter trial including below-knee popliteal or tibioperoneal trunk bypass graft where the long saphenous vein was absent or inadequate. METHODS Over 28 months, 209 patients undergoing femoropopliteal bypass grafts (180 above-knee, 29 below-knee) were randomized to HBD (n = 106) or PTFE (n = 103). Each patient was given aspirin (300 mg/d) before surgery, and this continued unless the patient had intolerance to the aspirin. RESULTS The mean follow-up was 42 months (range, 28-55). Fifteen (7.1%) patients died with patent grafts, and three (1.4%) infected grafts were removed. Patency (measured with Kaplan-Meier survival analysis) at 1, 2, and 3 years for HBD was 70%, 63%, and 55% compared with 56%, 46%, and 42%, respectively, for PTFE (P =.044). A total of 67 secondary interventions were performed on 48 thrombosed grafts; long-term patency was achieved in only three. Risk factors for arterial disease did not significantly influence patency. Amputations have been performed in 23 patients, six after HBD and 17 after PTFE bypass grafts (P =.015). CONCLUSIONS HBD achieved better patency than PTFE, which carried a high risk of subsequent amputation.
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Affiliation(s)
- C Devine
- South Manchester University Hospital, Department of Surgery, United Kingdom
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35
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Sastry S, McCollum C. Patent foramen ovale and stroke. Circulation 2001; 103:E46-7. [PMID: 11222488 DOI: 10.1161/01.cir.103.8.e46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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36
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Chant H, McCollum C. Stroke in young adults: the role of paradoxical embolism. Thromb Haemost 2001; 85:22-9. [PMID: 11204581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Stroke in young adults may be devastating and frequently no cause can be found. However, there is ample literature to suggest an association between cryptogenic stroke in young people and paradoxical embolisation via a venous to arterial circulation shunt (v-aCS), commonly due to patent foramen ovale (PFO). Although paradoxical embolisation is assumed to be a rare event, this review suggests that it is an important or even dominant cause of stroke in young people and that a transcranial Doppler (TCD) technique may be the investigation of choice to identify v-aCS.
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Affiliation(s)
- H Chant
- Department of Surgery, Withington Hospital, West Didsbury, Manchester, UK
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37
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Dunn NR, Arscott A, Thorogood M, Faragher B, de Caestecker L, MacDonald TM, McCollum C, Thomas S, Mann RD. Regional variation in incidence and case fatality of myocardial infarction among young women in England, Scotland and Wales. J Epidemiol Community Health 2000; 54:293-8. [PMID: 10827912 PMCID: PMC1731652 DOI: 10.1136/jech.54.4.293] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the regional variation in incidence and case fatality of myocardial infarction among young women. DESIGN Cross sectional survey, using population based incidence data. SETTING England, Scotland and Wales. SUBJECTS Subjects were women aged 16-44 with a diagnosis of myocardial infarction between 1 October 1993 and 15 October 1995. OUTCOME MEASURES Incidence of myocardial infarction per 100,000 women years, with case fatality as a percentage of total cases. RESULTS Incidence of myocardial infarction rose steeply from age 33 upwards, (maximum = 20.2 cases per 100,000 women years at age 44). The adjusted incidence rate for myocardial infarction was 3.7 (95% CI 3.2, 4.2) times greater in Scotland than in southern England. In contrast, case fatality was significantly lower in Scotland: 18.5% (95% CI 13.1%, 25.0%), compared with 31.0% (95% CI 25.9%, 36.0%) in southern England. CONCLUSIONS The incidence of myocardial infarction varied widely within the United Kingdom. Case fatality variation may reflect differences in ambulance response, or in diagnostic acumen, within the regions.
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Affiliation(s)
- N R Dunn
- London School of Hygiene and Tropical Medicine
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Brenner S, Williams SR, Vermaas EH, Storck T, Moon K, McCollum C, Mao JI, Luo S, Kirchner JJ, Eletr S, DuBridge RB, Burcham T, Albrecht G. In vitro cloning of complex mixtures of DNA on microbeads: physical separation of differentially expressed cDNAs. Proc Natl Acad Sci U S A 2000; 97:1665-70. [PMID: 10677516 PMCID: PMC26493 DOI: 10.1073/pnas.97.4.1665] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/1999] [Indexed: 11/18/2022] Open
Abstract
We describe a method for cloning nucleic acid molecules onto the surfaces of 5-micrometer microbeads rather than in biological hosts. A unique tag sequence is attached to each molecule, and the tagged library is amplified. Unique tagging of the molecules is achieved by sampling a small fraction (1%) of a very large repertoire of tag sequences. The resulting library is hybridized to microbeads that each carry approximately 10(6) strands complementary to one of the tags. About 10(5) copies of each molecule are collected on each microbead. Because such clones are segregated on microbeads, they can be operated on simultaneously and then assayed separately. To demonstrate the utility of this approach, we show how to label and extract microbeads bearing clones differentially expressed between two libraries by using a fluorescence-activated cell sorter (FACS). Because no prior information about the cloned molecules is required, this process is obviously useful where sequence databases are incomplete or nonexistent. More importantly, the process also permits the isolation of clones that are expressed only in given tissues or that are differentially expressed between normal and diseased states. Such clones then may be spotted on much more cost-effective, tissue- or disease-directed, low-density planar microarrays.
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Affiliation(s)
- S Brenner
- Lynx Therapeutics, Inc., 25861 Industrial Boulevard, Hayward, CA 94545, USA
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Abstract
OBJECTIVES To determine the extent of risk of myocardial infarction from cigarette smoking in young women, and to examine the relation of smoking with other putative risk factors. DESIGN Community based case control study. SETTING England, Scotland, and Wales. PATIENTS Women (n = 448) between 16 and 44 years old with a diagnosis of incident myocardial infarction between 1 October 1993 and 16 October 1995. Controls (n = 1728) were age and general practice matched women without a diagnosis of myocardial infarction. OUTCOMES MEASURES Odds ratios for risk of myocardial infarction associated with smoking and other risk factors. RESULTS Odds ratios for myocardial infarction in smokers versus non-smokers showed a strong dose response, from 2.47 (95% confidence interval (CI) 1.12 to 5.45) in smokers of 1-5 cigarettes per day to 74.6 (95% CI 33.0 to 169) in smokers of >/= 40 cigarettes per day. There was no interaction of smoking with use of oral contraceptives, but there were additive risks with other clinical risk factors such as hypertension and diabetes. It is estimated that if all women aged 16-44 years were able to stop smoking, 400 cases of myocardial infarction per annum (of whom 112 would die) would be prevented. CONCLUSIONS In young women the risk of myocardial infarction from smoking was considerable, and heavy smokers with other risk factors were especially at risk.
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Affiliation(s)
- N R Dunn
- Drug Safety Research Unit, Bursledon Hall, Southampton SO31 1AA, UK.
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40
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Rose K, Wright D, Ward T, McCollum C. Tension-free mesh hernia repair: recovery and recurrence after one year. Ann R Coll Surg Engl 1999; 81:329-32. [PMID: 10645175 PMCID: PMC2503279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The outcome of 200 consecutive patients with inguinal hernias repaired by the tension-free mesh technique at a specialist clinic was assessed one year after operation. There were no recurrences and no major complications. The wound infection rate was 1%. Less than 10% of patients had only minor complaints and 99% of patients were satisfied or very satisfied with the operation and its outcome. Low recurrence rates after one year imply low long-term recurrence and testify to the benefits of a specialist approach.
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Affiliation(s)
- K Rose
- Surgicare, Northenden, Manchester, UK
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41
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Blann A, Kumar P, Krupinski J, McCollum C, Beevers DG, Lip GY. Soluble intercelluar adhesion molecule-1, E-selectin, vascular cell adhesion molecule-1 and von Willebrand factor in stroke. Blood Coagul Fibrinolysis 1999; 10:277-84. [PMID: 10456619 DOI: 10.1097/00001721-199907000-00009] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated the role of endothelial cell and leukocyte adhesion in the pathophysiology of acute stroke. The immunocytochemical expression of adhesion molecules in brain tissue from six patients who died following acute ischaemic stroke showed weak endothelial expression of intercellular adhesion molecule-1 (ICAM-1), but intense expression of vascular cell adhesion molecule-1 (VCAM-1) by astrocytes and endothelial cells from the infarcted, but not the non-infarcted areas. We also measured soluble adhesion molecules E-selectin, ICAM-1, VCAM-1 and von Willebrand factor (all by enzyme-linked immunosorbent assay) in 21 patients after an acute ischaemic stroke (ictus < 12 h), and again 3 months later. Blood levels in the stroke patients were compared with 82 healthy controls and 22 subjects with carotid atherosclerosis. Compared with healthy controls, both patient groups had raised levels of von Willebrand factor (P < 0.02) but the level of soluble VCAM-1 was raised only in patients with acute stroke (P < 0.02). Levels of von Willebrand factor and soluble VCAM-1 in the stroke patients were still high at 3 months follow-up. We suggest that there might be changes in adhesion molecule expression and release in the acute and chronic stages of ischaemic stroke, where blood levels are related to immunocytochemical findings on infarcted brain. These changes may perhaps be part of the complex pathophysiological responses to infarction and repair of brain tissue following stroke.
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Affiliation(s)
- A Blann
- University Department of Medicine, City Hospital, Birmingham, UK.
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42
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Dunn N, Thorogood M, Faragher B, de Caestecker L, MacDonald TM, McCollum C, Thomas S, Mann R. Oral contraceptives and myocardial infarction: results of the MICA case-control study. BMJ 1999; 318:1579-83. [PMID: 10364115 PMCID: PMC28136 DOI: 10.1136/bmj.318.7198.1579] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the association between myocardial infarction and use of different types of oral contraception in young women. DESIGN Community based case-control study. Data from interviews and general practice records. SETTING England, Scotland, and Wales. PARTICIPANTS Cases (n=448) were recruited from women aged between 16 and 44 who had suffered an incident myocardial infarction between 1 October 1993 and 16 October 1995. Controls (n=1728) were women without a diagnosis of myocardial infarction matched for age and general practice. MAIN OUTCOME MEASURES Odds ratios for myocardial infarction in current users of all combined oral contraceptives stratified by their progestagen content compared with non-users; current users of third generation versus second generation oral contraceptives. RESULTS The adjusted odds ratio for myocardial infarction was 1.40 (95% confidence interval 0.78 to 2. 52) for all combined oral contraceptive users, 1.10 (0.52 to 2.30) for second generation users, and 1.96 (0.87 to 4.39) for third generation users. Subgroup analysis by progestagen content did not show any significant difference from 1, and there was no effect of duration of use. The adjusted odds ratio for third generation users versus second generation users was 1.78 (0.66 to 4.83). 87% of cases were not exposed to an oral contraceptive, and 88% had clinical cardiovascular risk factors or were smokers, or both. Smoking was strongly associated with myocardial infarction: adjusted odds ratio 12.5 (7.29 to 21.5) for smoking 20 or more cigarettes a day. CONCLUSIONS There was no significant association between the use of oral contraceptives and myocardial infarction. The modest and non-significant point estimates for this association have wide confidence intervals. There was no significant difference between second and third generation products.
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Affiliation(s)
- N Dunn
- Drug Safety Research Unit, Bursledon Hall, Southampton SO31 1AA
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43
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Rose K, Wright D, McCollum C. Laparoscopic versus open mesh repair of inguinal hernia. Recurrence rate is true test of hernia repair. BMJ 1999; 318:189. [PMID: 10068241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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44
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Notaras MJ, Rose K, Wright D, McCollum C, Kark AE, Kurzer MN, Belsham PA, Taylor RS, Naseef A, Brandt E, Jacob S, Anyanwu A, O'Riordan D, Kernick DP, Reinhold D, Johnson AG. Laparoscopic versus open mesh repair of inguinal hernia. BMJ 1999. [DOI: 10.1136/bmj.318.7177.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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45
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Jeziorska M, McCollum C, Wooley DE. Observations on bone formation and remodelling in advanced atherosclerotic lesions of human carotid arteries. Virchows Arch 1998; 433:559-65. [PMID: 9870690 DOI: 10.1007/s004280050289] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunolocalisation and histochemical techniques were used to examine mineralised bone deposits within late stage atherosclerotic plaques of human carotid arteries. These specimens showed characteristic features of osteogenesis. Large calcifications were often observed in close association with or integrated within mineralised bone. Smooth muscle cells (alpha-actin positive) were often located around osteoid-like matrix, together with focal accumulations of macrophages (CD68 and HAM56 positive). Local accumulations of mast cells (tryptase positive) were consistently observed in close association with the bone. Multinucleated giant cells in close apposition with mineralised bone demonstrated typical osteoclastic morphology, and were positively stained for acid phosphatase and the macrophage marker CD68. Thus, all the normal features of bone formation and resorption were observed in this microcosm of osteogenesis within atherosclerotic plaque; the term 'osteosome' seems appropriate for the structure. These osteosomes have numerous advantages for experimental studies of the various osteogenic factors responsible for bone metabolism, especially following short-term tissue culture. This ex vivo technique was used to demonstrate the distribution and the multiple cellular sources of bone morphogenetic protein 6.
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Affiliation(s)
- M Jeziorska
- University Department of Medicine, Manchester Royal Infirmary, UK
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46
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Chant H, Fearn S, McCollum C. Aspirin prophylaxis for vascular disease. Carotid endarterectomy should have been mentioned. BMJ 1998; 317:1318-9. [PMID: 9867385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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47
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McCollum C. Avoiding the consequences of deep vein thrombosis. Elevation and compression are important-and too often forgotten. BMJ 1998; 317:696. [PMID: 9732336 PMCID: PMC1113871 DOI: 10.1136/bmj.317.7160.696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Abstract
Plasma viscosity and fibrinogen are risk factors for cardiovascular disease and on rheological grounds, it is widely believed that the latter is a major determinant of the former. However, other plasma constituents may also be important determinants of plasma viscosity. Our aim was to determine whether or not levels of von Willebrand factor contributed to plasma viscosity. We measured plasma viscosity, fibrinogen, von Willebrand factor, immunoglobulins G, A and M, total, HDL- and LDL-cholesterol, triglycerides and albumin in 95 patients with peripheral arterial disease and in 120 healthy controls. A stepwise multivariate analysis was performed to determine the major influences of plasma viscosity. We also measured fibrinogen, von Willebrand factor, immunoglobulins G, A and M, total, HDL- and LDL-cholesterol, triglycerides, albumin and viscosity in 32 smokers as they successfully progressed to being non-smokers. The level of von Willebrand factor was an independent influence on plasma viscosity in the controls (P < 0.05), patients (P < 0.01) and in the combined group (P < 0.001). von Willebrand factor, fibrinogen and plasma viscosity, but not the immunoglobulins, lipoproteins or albumin, fell (P < 0.05) in smokers as they became non-smokers. We find that von Willebrand factor contributes to plasma viscosity, hence a reduction in levels of von Willebrand factor should result in a reduction in viscosity. These data may have implications for the pathogenesis of cardiovascular disease.
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Affiliation(s)
- A Blann
- Department of Medicine, The City Hospital, Birmingham, UK.
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49
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Abstract
Calcification has been examined in 250 samples of atherosclerotic lesions (types II to VI) of human carotid arteries using von Kossa and haematoxylin staining. Early calcification described as 'stippling' was first noted in stage III specimens, with intermediate and solid calcifications becoming increasingly prominent within advanced plaques, especially stages Vb and VI. Although the relative frequencies of stippling, intermediate and large calcified deposits varied between plaques of the same stage, the prevalent sites of calcification were recognized as the deeper regions of the intima and the atheroma. Immunolocalization and histochemical techniques were used to identify the associations of mast cells (MCs), macrophages, smooth muscle cells (SMCs), and elastin with the different stages of calcification. Early, dispersed stippling was commonly associated with local accumulations of macrophages (HAM56 and CD68-positive), MCs and extracellular MC tryptase, the presence of immunoreactive elastin, but the relative absence of SMCs. Intermediate stages of calcification described as 'morula' deposits were also associated with local increases in the numbers of macrophages and MCs. Larger calcified deposits, even within the same plaque specimen, showed no regular pattern of cellular or elastin associations. However, in the vast majority of specimens, macrophages represented the predominant cell type associated with different phases of calcification. By contrast, the calcification less frequently observed in the media beneath advanced plaques was commonly associated with SMCs and elastin; only rarely were macrophages or MCs present. These studies are the first to demonstrate that macrophages, MCs, and extracellular tryptase frequently occupy micro-environmental loci showing the first stages of calcification within the atherosclerotic plaque; similar associations with more advanced mineral deposits are discussed in relation to plaque rupture.
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Affiliation(s)
- M Jeziorska
- University Department of Medicine, Manchester Royal Infirmary, U.K
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50
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McCollum C, Chakerian V, Kaufman J, Wenz M, Andrus A. Rapid and efficient oligonucleotide synthesis with low reagent consumption via a new synthesis column design: preparation of fluorescent dye labelled primers for application in PCR. Biomed Pept Proteins Nucleic Acids 1997; 1:25-30. [PMID: 9346866] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A low dead-volume, 40 nmole scale column was designed for automated, solid-support oligonucleotide synthesis. The LV40 columns are filled with 1000A, high-cross link polystyrene beads at the 40 nmole scale. Reducing the unoccupied volume and optimizing the column dimensions allows efficient and fast synthesis on existing commercial synthesizers with low reagent consumption. Three spectrally distinct fluorescent dyes were applied as phosphoramidites in the synthesis of PCR primers. Fluorescent labelled PCR products of the Mfd11 microsatellite locus were analyzed.
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Affiliation(s)
- C McCollum
- Division of Perkin-Elmer Co, Foster City, CA 94404, USA
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