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Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, 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D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, 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Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, 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Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Norgate EL, Upton R, Hansen K, Bellina B, Brookes C, Politis A, Barran PE. Cold Denaturation of Proteins in the Absence of Solvent: Implications for Protein Storage. Angew Chem Int Ed Engl 2022; 61:e202115047. [PMID: 35313047 PMCID: PMC9325448 DOI: 10.1002/anie.202115047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/09/2021] [Indexed: 12/12/2022]
Abstract
The effect of temperature on the stability of proteins is well explored above 298 K, but harder to track experimentally below 273 K. Variable-temperature ion mobility mass spectrometry (VT IM-MS) allows us to measure the structure of molecules at sub-ambient temperatures. Here we monitor conformational changes that occur to two isotypes of monoclonal antibodies (mAbs) on cooling by measuring their collision cross sections (CCS) at discrete drift gas temperatures from 295 to 160 K. The CCS at 250 K is larger than predicted from collisional theory and experimental data at 295 K. This restructure is attributed to change in the strength of stabilizing intermolecular interactions. Below 250 K the CCS of the mAbs increases in line with prediction implying no rearrangement. Comparing data from isotypes suggest disulfide bridging influences thermal structural rearrangement. These findings indicate that in vacuo deep-freezing minimizes denaturation and maintains the native fold and VT IM-MS measurements at sub ambient temperatures provide new insights to the phenomenon of cold denaturation.
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Affiliation(s)
- Emma L Norgate
- Manchester Institute of Biotechnology, University of Manchester, Princess Street, Manchester, M1 7DN, UK
| | - Rosie Upton
- Manchester Institute of Biotechnology, University of Manchester, Princess Street, Manchester, M1 7DN, UK
| | - Kjetil Hansen
- Department of Chemistry, King's College London, 7 Trinity Street, London, SE1 1DB, UK
| | - Bruno Bellina
- Manchester Institute of Biotechnology, University of Manchester, Princess Street, Manchester, M1 7DN, UK
| | - C Brookes
- Bristol-Myers Squibb, Moreton, Wirral, CH46 1QW, UK
| | - Argyris Politis
- Department of Chemistry, King's College London, 7 Trinity Street, London, SE1 1DB, UK
| | - Perdita E Barran
- Manchester Institute of Biotechnology, University of Manchester, Princess Street, Manchester, M1 7DN, UK
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Norgate EL, Upton R, Hansen K, Bellina B, Brookes C, Politis A, Barran PE. Cold Denaturation of Proteins in the Absence of Solvent: Implications for Protein Storage. Angew Chem Weinheim Bergstr Ger 2022; 134:e202115047. [PMID: 38505418 PMCID: PMC10947158 DOI: 10.1002/ange.202115047] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/07/2022]
Abstract
The effect of temperature on the stability of proteins is well explored above 298 K, but harder to track experimentally below 273 K. Variable-temperature ion mobility mass spectrometry (VT IM-MS) allows us to measure the structure of molecules at sub-ambient temperatures. Here we monitor conformational changes that occur to two isotypes of monoclonal antibodies (mAbs) on cooling by measuring their collision cross sections (CCS) at discrete drift gas temperatures from 295 to 160 K. The CCS at 250 K is larger than predicted from collisional theory and experimental data at 295 K. This restructure is attributed to change in the strength of stabilizing intermolecular interactions. Below 250 K the CCS of the mAbs increases in line with prediction implying no rearrangement. Comparing data from isotypes suggest disulfide bridging influences thermal structural rearrangement. These findings indicate that in vacuo deep-freezing minimizes denaturation and maintains the native fold and VT IM-MS measurements at sub ambient temperatures provide new insights to the phenomenon of cold denaturation.
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Affiliation(s)
- Emma L. Norgate
- Manchester Institute of BiotechnologyUniversity of ManchesterPrincess StreetManchesterM1 7DNUK
| | - Rosie Upton
- Manchester Institute of BiotechnologyUniversity of ManchesterPrincess StreetManchesterM1 7DNUK
| | - Kjetil Hansen
- Department of ChemistryKing's College London7 Trinity StreetLondonSE1 1DBUK
| | - Bruno Bellina
- Manchester Institute of BiotechnologyUniversity of ManchesterPrincess StreetManchesterM1 7DNUK
| | - C. Brookes
- Bristol-Myers SquibbMoretonWirralCH46 1QWUK
| | - Argyris Politis
- Department of ChemistryKing's College London7 Trinity StreetLondonSE1 1DBUK
| | - Perdita E. Barran
- Manchester Institute of BiotechnologyUniversity of ManchesterPrincess StreetManchesterM1 7DNUK
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Brookes C, Bowker M, Gibson EK, Gianolio D, Mohammed KMH, Parry S, Rogers SM, Silverwood IP, Wells PP. Correction: In situ spectroscopic investigations of MoO x/Fe 2O 3 catalysts for the selective oxidation of methanol. Catal Sci Technol 2018. [DOI: 10.1039/c8cy90033g] [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: 11/21/2022]
Abstract
Correction for ‘In situ spectroscopic investigations of MoOx/Fe2O3 catalysts for the selective oxidation of methanol’ by Catherine Brookes et al., Catal. Sci. Technol., 2016, 6, 722–730.
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Affiliation(s)
- Catherine Brookes
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Michael Bowker
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Emma K. Gibson
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Diego Gianolio
- Diamond Light Source
- Harwell Science and Innovation Campus
- Didcot
- UK
| | | | - Stephen Parry
- Diamond Light Source
- Harwell Science and Innovation Campus
- Didcot
- UK
| | - Scott M. Rogers
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Ian P. Silverwood
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Peter P. Wells
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
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Francis A, Bartlett J, Billingham L, Bowden S, Brookes C, Dodwell D, Evans A, Fairbrother P, Fallowfield L, Gaunt C, Hanby A, Jenkins V, Matthews L, Pinder S, Pirrie S, Rea D, Reed M, Roberts T, Thomas J, Wallis M, Wilcox M, Young J. Abstract OT1-03-01: The UK LORIS trial: Randomizing patients with low or low intermediate grade ductal carcinoma in situ (DCIS) to surgery or active monitoring. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-03-01] [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: The independent review of the UK National Health Service Breast Screening Programme reported (The Lancet, Volume 380, Issue 9855, Page 1778, 17 Nov 2012) on the benefits and harms of breast screening. It concluded that breast screening saves lives and acknowledged the existence of overtreatment. It encouraged randomized trials to elucidate the appropriate treatment of screen-detected DCIS to gain a better understanding of its natural history. The LORIS trial addresses the possible overtreatment of low and low/intermediate grade screen-detected (low risk) DCIS by randomizing patients to standard surgical treatment or active monitoring, each with long term follow up.
Trial Design: LORIS is a phase III, multicentre, 2 arm study, with a built in 2 year Feasibility Phase, in patients confirmed to have low risk DCIS defined by strict criteria and determined by central pathology review. Patients will be randomized between standard surgery and active monitoring with annual mammography. Patients will be followed up for a minimum of 10 years.
Eligibility Criteria:
1) Female, age ≥ 46 years
2) Screen-detected or incidental microcalcification (with no mass lesion clinically or on imaging)
3) Low risk DCIS on large volume vacuum-assisted biopsy, confirmed by central pathology review
4) Patient fit to undergo surgery
5) No previous breast cancer or ipsilateral DCIS diagnosis
6) Written informed consent
Specific Aims: The LORIS Trial aims to establish whether patients with newly diagnosed low risk DCIS can safely avoid surgery without detriment to their wellbeing (psychological and physical) and whether those patients that do require surgery can be identified by pathological and radiological means.
Primary endpoint: Ipsilateral invasive breast cancer free survival time
Secondary endpoints: Overall survival; mastectomy rate; time to mastectomy; time to surgery; patient reported outcomes; health resource utilisation and assessment of predictive biomarkers.
A digital image data repository and tissue bank will provide a prospective resource for both translational and imaging studies.
Statistical Methods: A total of 932 patients will be randomized to a non-inferiority design to test the null hypothesis that active monitoring of women diagnosed with low risk DCIS is not non-inferior in terms of ipsilateral invasive breast cancer free survival (iiBCFS) time compared to treatment with surgery. The iiBCFS time will be compared across the two arms on a per protocol and intent-to-treat basis, using a 1-sided (α=0.05) log-rank test for non-inferiority. The iiBCFS rate is assumed to be 97.5% in the surgery arm at 5 years, utilizing 80% power to exclude a difference of more than 2.5% in the active monitoring arm.
Present Accrual and Target Accrual: 32 UK centres are open for the Feasibility Phase of the trial which is nearing completion. The web-based central pathology review process is functioning efficiently, with a one week maximum turn around. Registrations and sites randomizing patients are on or above target. Randomizations are currently approximately 70% of target. A total of 60 centres will open in the main trial.
Contact Information: For further information, please email the LORIS Trial Office LORIS@trials.bham.ac.uk.
Citation Format: Francis A, Bartlett J, Billingham L, Bowden S, Brookes C, Dodwell D, Evans A, Fairbrother P, Fallowfield L, Gaunt C, Hanby A, Jenkins V, Matthews L, Pinder S, Pirrie S, Rea D, Reed M, Roberts T, Thomas J, Wallis M, Wilcox M, Young J. The UK LORIS trial: Randomizing patients with low or low intermediate grade ductal carcinoma in situ (DCIS) to surgery or active monitoring [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-03-01.
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Affiliation(s)
- A Francis
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Bartlett
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Billingham
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Bowden
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C Brookes
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - D Dodwell
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Evans
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - P Fairbrother
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Fallowfield
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C Gaunt
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Hanby
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - V Jenkins
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Matthews
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Pinder
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Pirrie
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - D Rea
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Reed
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - T Roberts
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Thomas
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Wallis
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Wilcox
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Young
- University Hospital Birmingham, Birmingham, United Kingdom; Ontario Institute for Cancer Research, Toronto, Canada; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; University of Leicester, Leicester, United Kingdom; St James's Hospital, Leeds, United Kingdom; University of Dundee, Dundee, United Kingdom; Independent Cancer Patients' Voice, England, United Kingdom; SHORE-C, Brighton and Sussex Medical School, Brighton, United Kingdom; University of Leeds, Leeds, United Kingdom; King's College London, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Addenbrooke's Hospital, Cambridge, United Kingdom
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Bahruji H, Bowker M, Hutchings G, Dimitratos N, Wells P, Gibson E, Jones W, Brookes C, Morgan D, Lalev G. Pd/ZnO catalysts for direct CO2 hydrogenation to methanol. J Catal 2016. [DOI: 10.1016/j.jcat.2016.03.017] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khalifa N, Talbot E, Schneider J, Walker DM, Bates P, Bird Y, Davies D, Brookes C, Hall J, Völlm B. Individual placement and support (IPS) for patients with offending histories: the IPSOH feasibility cluster randomised trial protocol. BMJ Open 2016; 6:e012710. [PMID: 27449894 PMCID: PMC4964185 DOI: 10.1136/bmjopen-2016-012710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION People with involvement in forensic psychiatric services face many obstacles to employment, arising from their offending, as well as their mental health problems. This study aims to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of individual placement and support (IPS), in improving employment rates and associated psychosocial outcomes in forensic psychiatric populations. IPS has been found consistently to achieve employment rates above 50% in psychiatric patients without a history of involvement in criminal justice services. METHODS/DESIGN This is a single-centre feasibility cluster RCT. Clusters will be defined according to clinical services in the community forensic services of Nottinghamshire Healthcare NHS Foundation Trust (NHCT). IPS will be implemented into 2 of the randomly assigned intervention clusters in the community forensic services of NHCT. A feasibility cluster RCT will estimate the parameters required to design a full RCT. The primary outcome is the proportion of people in open employment at 12-month follow-up. Secondary outcome measures will include employment, educational activities, psychosocial and economic outcomes, as well as reoffending rates. Outcome measures will be recorded at baseline, 6 months and 12 months. In accordance with the UK Medical Research Council guidelines on the evaluation of complex interventions, a process evaluation will be carried out; qualitative interviews with patients and staff will explore general views of IPS as well as barriers and facilitators to implementation. Fidelity reviews will assess the extent to which the services follow the principles of IPS prior, during and at the end of the trial. ETHICS AND DISSEMINATION Ethical approval was obtained from the East Midlands Research Ethics Committee-Nottingham 1 (REC reference number 15/EM/0253). Final and interim reports will be prepared for project funders, the study sponsor and clinical research network. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. TRIAL REGISTRATION NUMBER NCT02442193; Pre-results.
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Affiliation(s)
- N Khalifa
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
| | - E Talbot
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - J Schneider
- University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
| | - D M Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - P Bates
- Patient and Public Involvement Lead, Nottingham, UK
| | - Y Bird
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - D Davies
- Leicestershire and Rutland Probation Trust, Leicestershire, UK
| | - C Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - J Hall
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - B Völlm
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
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10
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Abstract
The adsorption of methanol on haematite has been investigated using temperature programmed methods, combined with in situ DRIFTS. Model catalysts based on this material have then been made with a shell-core configuration of molybdenum oxide monolayers on top of the haematite core. These are used as models of industrial iron molybdate catalysts, used to selectively oxidise methanol to formaldehyde, one of the major chemical outlets for methanol. Haematite itself is completely ineffective in this respect since it oxidises it to CO2 and the DRIFTS shows that this occurs by oxidation of methoxy to formate at around 200 °C. The decomposition behaviour is affected by the absence or presence of oxygen in the gas phase; oxygen destabilises the methoxy and enhances formate production. In contrast, when a monolayer of molybdena is placed onto the surface by incipient wetness, and it remains there after calcination, the pathway to formate production is blocked and formaldehyde is the main gas phase product in TPD after methanol dosing.
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Affiliation(s)
- M Bowker
- UK Catalysis Hub, Research Complex at Harwell (RCaH), Rutherford Appleton Laboratory, Harwell, Oxon, OX11 0FA, UK. and Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
| | - E K Gibson
- UK Catalysis Hub, Research Complex at Harwell (RCaH), Rutherford Appleton Laboratory, Harwell, Oxon, OX11 0FA, UK. and Department of Chemistry, University College London, 20 Gordon St., London, WC1H 0AJ, UK
| | - I P Silverwood
- UK Catalysis Hub, Research Complex at Harwell (RCaH), Rutherford Appleton Laboratory, Harwell, Oxon, OX11 0FA, UK. and ISIS Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Science and Innovation Campus, Oxon OX11 0QX, UK
| | - C Brookes
- UK Catalysis Hub, Research Complex at Harwell (RCaH), Rutherford Appleton Laboratory, Harwell, Oxon, OX11 0FA, UK. and Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff, CF10 3AT, UK
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Chapman S, Brookes C, Bowker M, Gibson EK, Wells PP. Design and stabilisation of a high area iron molybdate surface for the selective oxidation of methanol to formaldehyde. Faraday Discuss 2016; 188:115-29. [PMID: 27067956 DOI: 10.1039/c5fd00153f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The performance of Mo-enriched, bulk ferric molybdate, employed commercially for the industrially important reaction of the selective oxidation of methanol to formaldehyde, is limited by a low surface area, typically 5-8 m(2) g(-1). Recent advances in the understanding of the iron molybdate catalyst have focused on the study of MoOx@Fe2O3 (MoOx shell, Fe2O3 core) systems, where only a few overlayers of Mo are present on the surface. This method of preparing MoOx@Fe2O3 catalysts was shown to support an iron molybdate surface of higher surface area than the industrially-favoured bulk phase. In this research, a MoOx@Fe2O3 catalyst of even higher surface area was stabilised by modifying a haematite support containing 5 wt% Al dopant. The addition of Al was an important factor for stabilising the haematite surface area and resulted in an iron molybdate surface area of ∼35 m(2) g(-1), around a 5 fold increase on the bulk catalyst. XPS confirmed Mo surface-enrichment, whilst Mo XANES resolved an amorphous MoOx surface monolayer supported on a sublayer of Fe2(MoO4)3 that became increasingly extensive with initial Mo surface loading. The high surface area MoOx@Fe2O3 catalyst proved amenable to bulk characterisation techniques; contributions from Fe2(MoO4)3 were detectable by Raman, XAFS, ATR-IR and XRD spectroscopies. The temperature-programmed pulsed flow reaction of methanol showed that this novel, high surface area catalyst (3ML-HSA) outperformed the undoped analogue (3ML-ISA), and a peak yield of 94% formaldehyde was obtained at ∼40 °C below that for the bulk Fe2(MoO4)3 phase. This work demonstrates how core-shell, multi-component oxides offer new routes for improving catalytic performance and understanding catalytic activity.
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Affiliation(s)
- Stephanie Chapman
- University of Southampton, Southampton, SO17 1BJ, UK and UK Catalysis Hub, Research Complex at Harwell, RAL, Oxford, OX11 0FA, UK.
| | - Catherine Brookes
- UK Catalysis Hub, Research Complex at Harwell, RAL, Oxford, OX11 0FA, UK. and Cardiff University, Cardiff, CF10 3XQ, UK
| | - Michael Bowker
- UK Catalysis Hub, Research Complex at Harwell, RAL, Oxford, OX11 0FA, UK. and Cardiff University, Cardiff, CF10 3XQ, UK
| | - Emma K Gibson
- UK Catalysis Hub, Research Complex at Harwell, RAL, Oxford, OX11 0FA, UK. and University College London, London, WC1H 0AJ, UK
| | - Peter P Wells
- UK Catalysis Hub, Research Complex at Harwell, RAL, Oxford, OX11 0FA, UK. and University College London, London, WC1H 0AJ, UK
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12
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Rea D, Francis A, Poole C, Brookes C, Stein R, Bartlett J, Dunn J, Canney P, Sutton R, Daoud R, Hallissey M, Achuthan R, Grant M, Babrah J, Smith S, Fraser J, Desai A, Al Dubaisi M, Patel A, Bristol J, Chandrasekharan S, Prest C, Jewkes A. Abstract PD2-02: NEO-EXCEL phase III neoadjuvant trial of pre-operative exemestane or letrozole +/- celecoxib in the treatment of ER positive postmenopausal early breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd2-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
COX2 has been implicated in breast tumorigenesis, tumour proliferation & invasion. The role of COX2 in carcinogenesis is thought to be related to its abilities to increase production of prostaglandins, convert pro-carcinogens to carcinogens, inhibit apoptosis, promote angiogenesis, modulate inflammation & immune function & increase tumour cell invasiveness. COX2 inhibition may synergise with aromatase inhibition in controlling endocrine responsive breast cancer. The COX2 product prostaglandin E2 (PGE2) & cytokines such as interleukin-6 (IL6) can up regulate aromatase expression suggesting that aromatase inhibition may be more effective in combination with a COX2 inhibitor. There may be additional COX2 mediated anticancer activity. The hypothesis addressed is that activity of aromatase inhibitors(AI) as neoadjuvant endocrine therapy for early breast cancer may be enhanced by the addition of a COX2 inhibitor.
TRIAL OBJECTIVES
To determine whether the activity of AIs as neo-adjuvant endocrine therapy for ER positive breast cancer in postmenopausal women may be enhanced by the addition of the selective COX2 inhibitor celecoxib.
TRIAL DESIGN
Prospective phase III multicentre randomised trial. Patients were randomised to receive 16 weeks of exemestane 25 mg daily or letrozole 2.5 mg daily (open label) and celecoxib 400 mg twice daily or matched placebo (double blinded). Translational research tumour samples were collected before, during & after therapy.
KEY ELIGIBILITY CRITERIA
Post menopausal, ER positive, invasive cancer, 2cms or greater with calipers & visible on USS.
PRIMARY OUTCOME MEASURE
Objective clinical response to neoadjuvant treatment by RECIST criteria.
RESULTS
Primary Outcome; Response to treatment has been calculated for 266 patients (Table 1). Response rate was 73% in the celecoxib arm & 55% in the placebo arm (p=0.0022). The response rates 4 arm comparison are shown in Table 2. After adjustment for AI effect the significant difference in response rates remained (p=0.0023); the difference in response rates was greater in the exemestane treated group (29%) compared to the letrozole group (7%) although heterogeneity between AI arms was statistically non-significant (p=0.06).
Table 1 Primary Outcome Results: response ratesOUTCOMEPLACEBO N (%)CELECOXIB N (%)TOTAL N (%)X2statisticP-valueRESPONSE73(55)97(73%)170 (64%)9.38820.0022NO RESPONSE60 (45%)36 (27%)96 (36%) TOTAL133133266
Table 2: Response Rates 4 Arm Comparison EXEMESTANELETROZOLERESPONSEPLACEBO n(%)CELECOXIB n(%)TOTAL n(%)PLACEBO n(%)CELECOXIB n(%)TOTAL n(%)RESPONSE33 (49)52(78)85(63)40(61)45(68)85(64)NO RESPONSE34(51)15(22)49(37)26(39)21(32)47(36)TOTAL67671346666132
Secondary outcome; There was an USS response rate of 42% v 37% for celecoxib & placebo arms respectively (p=0.2513)
CONCLUSION
The addition of the COX2 inhibitor celecoxib to an AI significantly & substantially increased the clinical response from 55% to 73%. Effect on tumour size assessed with USS is less marked with a non-significant increase in responses from 37% to 42%.
This work was supported by CRUK: CRUK/06/005 and Pfizer.
Citation Format: Rea D, Francis A, Poole C, Brookes C, Stein R, Bartlett J, Dunn J, Canney P, Sutton R, Daoud R, Hallissey M, Achuthan R, Grant M, Babrah J, Smith S, Fraser J, Desai A, Al Dubaisi M, Patel A, Bristol J, Chandrasekharan S, Prest C, Jewkes A. NEO-EXCEL phase III neoadjuvant trial of pre-operative exemestane or letrozole +/- celecoxib in the treatment of ER positive postmenopausal early breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD2-02.
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Affiliation(s)
- D Rea
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - A Francis
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - C Poole
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - C Brookes
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - R Stein
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - J Bartlett
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - J Dunn
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - P Canney
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - R Sutton
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - R Daoud
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - M Hallissey
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - R Achuthan
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - M Grant
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - J Babrah
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - S Smith
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - J Fraser
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - A Desai
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - M Al Dubaisi
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - A Patel
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - J Bristol
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - S Chandrasekharan
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - C Prest
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
| | - A Jewkes
- On behalf of All the NEO-EXCEL Investigators University Hospital Birmingham, Birmingham, West Midlands, United Kingdom; University Hospital, Coventry, Coventry, West Midlands, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University College London Hospital, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Warwick, Coventry, West Midlands, United Kingdom; Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom; Royal United Hospital, Bath, Somerset, United Kingdom; Frimley Park Hospital, Camberley, Surrey, United Kingdom; St James's University Hospital, Leeds, West Yorkshire, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; City Hospital, Birmingham, West Midlands, United Kingdom; Broomfield Hospital, Chelmsford, Essex, United Kingdom; Princess Royal University Hospital, Orpington, Kent, United Kingdom; Barnet Hospital, Barnet, Hertfordshire, United Kingdom; St Margaret's Hospita
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Francis A, Fallowfield L, Bartlett J, Thomas J, Wallis M, Hanby A, Pinder S, Evans A, Billingham L, Brookes C, Dodwell D, Fairbrother P, Gaunt C, Jenkins V, Matthews L, Pirrie S, Reed M, Roberts T, Wilcox M, Young J, Rea D. Abstract OT2-02-04: The LORIS trial: A multicentre, randomised phase III trial of standard surgery versus active monitoring in women with newly diagnosed low risk ductal carcinoma in situ. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot2-02-04] [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
Background: The independent review of the UK National Health Service Breast Screening Programme reported (The Lancet, Volume 380, Issue 9855, Pages 1778 - 1786, 17 November 2012) on the benefits & harms of breast screening. It concluded that breast screening saves lives & acknowledged overtreatment. It encouraged randomized trials to elucidate the appropriate treatment of screen-detected ductal carcinoma in situ (DCIS) to gain a better understanding of its natural history. The LORIS trial addresses overtreatment of low & low/Intermediate grade screen detected (low risk) DCIS by randomizing patients to standard surgical treatment or active monitoring.
Trial Design: LORIS is a phase III, multicentre, 2 arm study, with a 2 year feasibility phase, in patients confirmed to have low risk DCIS by central pathology review. Patients are randomised to standard surgery or active monitoring with annual mammography. Patients will be followed up for a minimum of 10 years.
Key Eligibility Criteria:
1) Female 46 years or over.
2) Screen-detected or incidental microcalcification (with no mass lesion clinically or on imaging)
3) Low risk DCIS on large volume vacuum-assisted biopsy, confirmed by central pathology review
4) Patient fit to undergo surgery
Specific Aims: The LORIS Trial aims to establish whether patients with newly diagnosed low risk DCIS can safely avoid surgery without detriment to their wellbeing (psychological and physical) & whether those patients that do require surgery can be identified by pathological and radiological means.
Primary endpoint: Ipsilateral invasive breast cancer free survival rate at 5 years
Secondary endpoints: Overall survival; mastectomy rate; time to mastectomy; time to surgery; patient reported outcomes & health resource utilisation.
A digital image data repository and tissue bank provide a prospective resource for both translational & imaging studies.
Statistical Methods: A total of 932 patients will be randomized to a non-inferiority design to test the null hypothesis that active monitoring of women diagnosed with low risk DCIS is not non-inferior in terms of 5 year ipsilateral invasive breast cancer free survival (iiBCFS) rate compared to treatment with surgery. The iiBCFS rate will be compared across the two arms on a per protocol and intent-to-treat basis, using a 1-sided (α=0.05) log-rank test for non-inferiority. The iiBCFS rate is assumed to be 97.5% in the surgery arm giving 80% power to exclude a difference of more than 2.5% in the active monitoring arm at 5 years.
Present Accrual and Target Accrual: 21 UK centres are open & the feasibility phase of the trial is recruiting to target. The web based central pathology review process is functioning well with a one week maximum turn around. A further 40 centres will be opened on completion of the feasibility phase.
Contact: LORIS@trials.bham.ac.uk
This project was funded by the National Institute for Health Research [Health Technology Assessment Programme] (project number 11/36/16)
Department of Health Disclaimer: The views & opinions expressed therein are those of the authors & do not necessarily reflect those of the Health Technology Assessment Programme, NIHR, NHS or the Department of Health.
Citation Format: Francis A, Fallowfield L, Bartlett J, Thomas J, Wallis M, Hanby A, Pinder S, Evans A, Billingham L, Brookes C, Dodwell D, Fairbrother P, Gaunt C, Jenkins V, Matthews L, Pirrie S, Reed M, Roberts T, Wilcox M, Young J, Rea D. The LORIS trial: A multicentre, randomised phase III trial of standard surgery versus active monitoring in women with newly diagnosed low risk ductal carcinoma in situ. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-02-04.
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Affiliation(s)
- A Francis
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - L Fallowfield
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - J Bartlett
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - J Thomas
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - M Wallis
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - A Hanby
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - S Pinder
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - A Evans
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - L Billingham
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - C Brookes
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - D Dodwell
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - P Fairbrother
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - C Gaunt
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - V Jenkins
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - L Matthews
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - S Pirrie
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - M Reed
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - T Roberts
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - M Wilcox
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - J Young
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - D Rea
- University Hospital Birmingham NHS Trust, Birmingham, West Midlands, United Kingdom; Sussex Health Outcomes Research & Education in Cancer (SHORE-C) Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; Western General Hospital, Edinburgh, Scotland, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University of Leeds, Leeds, Yorkshire, United Kingdom; King's College London, London, United Kingdom; Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom; University of Birmingham, Birmingham, West Midlands, United Kingdom; ICPV, London, United Kingdom; Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
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Brookes C, Bowker M, Gibson EK, Gianolio D, Mohammed KMH, Parry S, Rogers SM, Silverwood IP, Wells PP. In situ spectroscopic investigations of MoOx/Fe2O3 catalysts for the selective oxidation of methanol. Catal Sci Technol 2016. [DOI: 10.1039/c5cy01175b] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Methoxy adsorbed on MoOx/Fe2O3 surfaces.
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Affiliation(s)
- Catherine Brookes
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Michael Bowker
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Emma K. Gibson
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Diego Gianolio
- Diamond Light Source
- Harwell Science and Innovation Campus
- Didcot
- UK
| | | | - Stephen Parry
- Diamond Light Source
- Harwell Science and Innovation Campus
- Didcot
- UK
| | - Scott M. Rogers
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Ian P. Silverwood
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
| | - Peter P. Wells
- UK Catalysis Hub
- Research Complex at Harwell
- Rutherford Appleton Laboratory
- Harwell
- UK
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Bowker M, House M, Alshehri A, Brookes C, Gibson EK, Wells PP. Selectivity determinants for dual function catalysts: applied to methanol selective oxidation on iron molybdate. ACTA ACUST UNITED AC 2015. [DOI: 10.1179/2055075815y.0000000002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Michael Bowker
- Cardiff Catalysis InstituteSchool of Chemistry, Cardiff CF10 3AT, UK
- Rutherford Appleton Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, UK
| | - Matthew House
- Cardiff Catalysis InstituteSchool of Chemistry, Cardiff CF10 3AT, UK
| | | | - Catherine Brookes
- Cardiff Catalysis InstituteSchool of Chemistry, Cardiff CF10 3AT, UK
- Rutherford Appleton Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, UK
| | - Emma K. Gibson
- Rutherford Appleton Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, UK
| | - Peter P. Wells
- Rutherford Appleton Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, UK
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Brookes C, Wells PP, Cibin G, Dimitratos N, Jones W, Morgan DJ, Bowker M. Molybdenum Oxide on Fe2O3 Core–Shell Catalysts: Probing the Nature of the Structural Motifs Responsible for Methanol Oxidation Catalysis. ACS Catal 2013. [DOI: 10.1021/cs400683e] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Brookes
- Rutherford Appleton
Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, United Kingdom
- Cardiff
Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, United Kingdom
| | - P. P. Wells
- Rutherford Appleton
Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, United Kingdom
- Department
of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - G. Cibin
- Diamond Light
Source, Harwell Science and Innovation Campus, Didcot, Oxon OX11 0DE, United Kingdom
| | - N. Dimitratos
- Rutherford Appleton
Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, United Kingdom
- Department
of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - W. Jones
- Rutherford Appleton
Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, United Kingdom
- Cardiff
Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, United Kingdom
| | - D. J. Morgan
- Cardiff
Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, United Kingdom
| | - M. Bowker
- Rutherford Appleton
Laboratory, UK Catalysis Hub, Research Complex at Harwell (RCaH), Harwell, Oxon OX11 0FA, United Kingdom
- Cardiff
Catalysis Institute, School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, United Kingdom
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Guha K, Treibel TA, Roussin I, Prasad SK, Duncan AM, Brookes C, McDonagh TA, Sharma R. Treatment of left ventricular non-compaction with cardiac resynchronization therapy. QJM 2013; 106:575-9. [PMID: 22021572 DOI: 10.1093/qjmed/hcr201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- K Guha
- Division of Heart Failure, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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18
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Nikolousis E, Robinson S, Nagra S, Brookes C, Kinsella F, Tauro S, Jeffries S, Griffiths M, Mahendra P, Cook M, Paneesha S, Lovell R, Kishore B, Chaganti S, Malladi R, Raghavan M, Moss P, Milligan D, Craddock C. Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant. Leuk Res 2013; 37:561-5. [PMID: 23395505 DOI: 10.1016/j.leukres.2013.01.010] [Citation(s) in RCA: 22] [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: 11/12/2012] [Revised: 01/12/2013] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
Abstract
In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.
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Affiliation(s)
- E Nikolousis
- Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, UK.
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19
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Sherriff J, Tamangani J, Senthil L, Cruickshank G, Spooner D, Jones B, Brookes C, Sanghera P. Patterns of relapse in glioblastoma multiforme following concomitant chemoradiotherapy with temozolomide. Br J Radiol 2013; 86:20120414. [PMID: 23385995 PMCID: PMC3608050 DOI: 10.1259/bjr.20120414] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [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: 08/09/2012] [Revised: 10/18/2012] [Accepted: 10/29/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Different methods for contouring target volumes are currently in use in the UK when irradiating glioblastomas post operatively. Both one- and two-phase techniques are offered at different centres. 90% of relapses are recognised to occur locally when using radiotherapy alone. The objective of this evaluation was to determine the pattern of relapse following concomitant radiotherapy with temozolomide (RT-TMZ). METHODS A retrospective analysis of patients receiving RT-TMZ between 2006 and 2010 was performed. Outcome data including survival were calculated from the start of radiotherapy. Analysis of available serial cross-sectional imaging was performed from diagnosis to first relapse. The site of first relapse was defined by the relationship to primary disease. Central relapse was defined as progression of the primary enhancing mass or the appearance of a new enhancing nodule within 2 cm. RESULTS 105 patients were identified as receiving RT-TMZ. 34 patients were not eligible for relapse analysis owing to either lack of progression or unsuitable imaging. Patterns of first relapse were as follows: 55 (77%) patients relapsed centrally within 2 cm of the original gadolinium-enhanced mass on MRI, 13 (18%) patients relapsed >4 cm from the original enhancement and 3 (4%) relapsed within the contralateral hemisphere. CONCLUSION Central relapse remains the predominant pattern of failure following RT-TMZ. Single-phase conformal radiotherapy using a 2-cm margin from the original contrast-enhanced mass is appropriate for the majority of these patients. ADVANCES IN KNOWLEDGE Central relapse remains the predominant pattern of failure following chemoradiotherapy for glioblastomas.
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Affiliation(s)
- J Sherriff
- Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
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20
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Bowker M, Brookes C, Carley AF, House MP, Kosif M, Sankar G, Wawata I, Wells PP, Yaseneva P. Evolution of active catalysts for the selective oxidative dehydrogenation of methanol on Fe2O3 surface doped with Mo oxide. Phys Chem Chem Phys 2013; 15:12056-67. [DOI: 10.1039/c3cp50399b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Craddock C, Quek L, Goardon N, Freeman S, Siddique S, Raghavan M, Aztberger A, Schuh A, Grimwade D, Ivey A, Virgo P, Hills R, McSkeane T, Arrazi J, Knapper S, Brookes C, Davies B, Price A, Wall K, Griffiths M, Cavenagh J, Majeti R, Weissman I, Burnett A, Vyas P. Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia. Leukemia 2012; 27:1028-36. [PMID: 23223186 DOI: 10.1038/leu.2012.312] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.
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Affiliation(s)
- C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
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22
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Marzoa J, Sánchez S, Costoya L, Diéguez-Casal E, Freixeiro P, Brookes C, Allen L, Taylor S, Gorringe AR, Ferreirós CM, Criado MT. Induction of immune responses by purified outer membrane protein complexes from Neisseria meningitidis. Vaccine 2011; 30:2387-95. [PMID: 21911024 DOI: 10.1016/j.vaccine.2011.08.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/26/2011] [Accepted: 08/31/2011] [Indexed: 12/29/2022]
Abstract
A broad-spectrum vaccine against disease caused by serogroup B of Neisseria meningitidis is still a challenge due to antigenic variability. In the present study outer membrane protein complexes and their components were analysed using non-denaturing 2D electrophoresis and identified using LC/MS-MS and MALDI-TOF. Outer membrane protein complexes were purified from both the wild-type strain H44/76 and their knock-out mutants lacking PorA, PorB, RmpM or FetA. The immune responses elicited by the whole outer membrane vesicles (OMV) and the purified complexes were analysed for bactericidal activity, antibody surface binding, antibody-mediated C3b/iC3b deposition, membrane attack complex (MAC) deposition and induction of opsonophagocytosis, both on the homologous and several heterologous strains. The main antigenic complexes found were homomeric, formed by the 60 kDa chaperonin (MSP63) or PorB, or heteromeric, formed by different combinations of PorA, PorB and/or RmpM. The lack of some of these proteins in the OMVs from the knock-out mutants did not affect significantly the immune responses analysed except MAC, which was significantly reduced in the anti-PorA- and anti-PorB- sera, and bactericidal activity, which was absent in the anti-PorA- serum. The sera against purified native complexes showed variable activities against the homologous strain, with greatest responses observed for anti-chaperonin and anti-PorA/PorB/RmpM sera. When tested against heterologous strains, the only anti-complex serum showing consistent responses was that against the 60 kDa chaperonin. The comparison of the responses elicited by the different sera suggests an important role of conformational epitopes, present only in native complexes, in the induction of more effective responses against N. meningitidis.
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Affiliation(s)
- J Marzoa
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Campus Sur, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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23
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Bartlett JMS, Gustavson M, Stocken D, Rimm D, Christiansen J, van de Velde CJH, Hasenburg A, Kieback D, Putter H, Brookes C, Markopoulos C, Dirix L, Robson T, Seynaeve C, Dolled-Filhart M, Jones C, Graves L, McGuire J, Rea D. Abstract P4-08-02: A Comparison between AQUA Quantitative Fluorescent Immunohistochemistry and Conventional Immunohistochemistry for Hormone Receptors. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-08-02] [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
Background: We have previous data showing that quantitation of hormone receptors can be highly informative in determining risk of early relapse in ER positive early breast cancer treated with tamoxifen or exemestane. Both quantitative immunohistochemistry (QIHC) and flouresecent immunohistochemistry (F-IHC as measured by AQUA technology) are highly prognostic over a wide expression range. We have explored the results of both assays to determine if current assays provide maximum information using current approaches.
Patients &
Methods: Pathology blocks from 4598 TEAM patients were collected and tissue microarrays constructed. Quantitative AQUA and IHC analysis (using image quantitation) of ER and PgR was performed centrally (Edinburgh & HistoRx). Results from both assays were compared and their prognostic impact on DFS at 2.75 years examined.
Results: Both AQUA and QIHC demonstrated linear relationships between intensity of staining for either ER or PgR and DFS at 2.75 years. For both PgR and ER AQUA provided significantly greater prognostic information that QIHC. However AQUA staining explained only 29% and 68% of the variability in ER and PgR QIHC results by logistic regression. Using both AQUA and QIHC data in a forward stepwise selection survival model demonstrated that AQUA and QIHC provided similar prognostic information over 70% and 50% of the range for ER and PgR respectively. High ER QIHC and low ER AQUA scores, and low PgR IHC and high PgR AQUA scores provided prognostic information unique to either platform.
Conclusion: Both QIHC and AQUA analysis of HR expression provides significant and highly important information on DFS risk in early breast cancer. It appears that these two platforms provide overlapping prognostic information and that the range of ER and PgR expression which impacts patient outcome is wider than measured by either system alone. Further investigation of the clinical significance of this broader range of hormone receptor expression in treatment decisions is warranted.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-02.
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Affiliation(s)
- JMS Bartlett
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - M Gustavson
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - D Stocken
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - D Rimm
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - J Christiansen
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - CJH van de Velde
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - A Hasenburg
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - D Kieback
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - H Putter
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - C Brookes
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - C Markopoulos
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - L Dirix
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - T Robson
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - C Seynaeve
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - M Dolled-Filhart
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - C Jones
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - L Graves
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - J McGuire
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
| | - D. Rea
- Edinburgh University, Edinburgh, United Kingdom; HistoRx Inc, Branford, CT; Yale University, New Haven, CT; Leiden University Medical Center, Netherlands; University Hospital, Freiburg, Germany; Helios Medical Center, Aue, Germany; Athens University Medical School, Athens, Greece; Western Infirmary, Glasgow, United Kingdom; UZ Gasthuisberg, Leuven, Belgium; Erasmus MC, Rotterdam, Netherlands
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Grenfell RJP, Milton MJT, Harling AM, Vargha GM, Brookes C, Quincey PG, Woods PT. Standard mixtures of ambient volatile organic compounds in synthetic and whole air with stable reference values. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2009jd012933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bartlett J, Brookes C, Robson T, van de Velde C, Billingham L, Campbell F, Quintayo M, Lyttle N, Hasenburg A, Hille E, Kieback D, Putter H, Markopoulos C, Meershoek-Klein-Kranenbarg E, Paridaens R, Seynaeve C, Mallon E, Rea D. The TEAM Trial Pathology Study Identifies Potential Prognostic and Predictive Biomarker Models for Postmenopausal Patients Treated with Endocrine Therapy. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: The Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial included prospectively planned biomarker studies to identify prognostic and predictive biomarkers for patients receiving endocrine therapy. Quantitative IHC data for ER/PgR (Can Res 69:83S, SABCS2008), HER2, HER3 and Ki67 was available for the current analysis relative to outcome of estrogen receptor–positive (ER+) early postmenopausal breast cancer (BC) patients treated with exemestane versus tamoxifen.Patients & Methods: Pathology blocks from 4598 TEAM patients were collected and tissue microarrays constructed. Quantitative analysis of hormone receptors (HER2/3) by conventional IHC, and image analysis derived continuous scores for Ki67/ER/PgR were analyzed relative to disease-free survival and treatment on an intent to treat basis using survival data for the first 2.75 years of the TEAM trial. Data on HER2FISH and EGF Receptor IHC will be presented.Results: Of 4595 eligible cases samples received, 16 were excluded, 271 had incomplete biomarker data, leaving 4308 patients for the final biomarker analysis. 1275 (30%) cases were HER2/3 positive.A significant treatment by marker effect was observed for exemestane versus tamoxifen with HER2/3 negative cases deriving benefit from aromatase inhibitor treatment (HER2/3-ve HR=0.69 95%CI, 0.53-0.88; HER2/3 pos HR, 1.13; 95%CI, 0.82–1.55; p=0.016 for interaction in multivariate analysis). By conventional and STEPP analysis no predictive effect of Ki67 was observed. In multivariate regression analysis increased HER2 expression (P=0.0001) decreased PgR expression (P<0.0001) and increased percentage of Ki67 positive cells (P=0.004) as continuous IHC variables were independently prognostic as were size (P=0.0001), nodal status (P<0.0001), grade (P=0.03) and age (P<0.0001).Conclusion: Multiple biological parameters (HER2/PgR/Ki67) are independently prognostic in ER+ve early postmenopausal BC. Modelling will be explored to derive prognostic and potentially predictive biomarker signatures for application in BC. Preferential exemestane versus tamoxifen treatment benefit was seen in HER2/3 negative cases, whilst HER2/3 positive cases had a poor prognosis in this population receiving hormonal therapy (suggesting resistance to endocrine therapy), and no evidence of benefit from AIs versus tamoxifen. Type I receptor tyrosine kinases may identify breast cancers with relative resistance to all forms of endocrine therapy. Whilst Ki67 alone was not predictive of benefit from Ais, Ki67, HER2 and PgR were independent prognostic variables and modelling of predictive/prognostic effects may further inform treatment selection in early postmenopausal breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 75.
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Affiliation(s)
| | - C. Brookes
- 2University of Birmingham, United Kingdom
| | - T. Robson
- 1University of Edinburgh, United Kingdom
| | | | | | | | | | - N. Lyttle
- 1University of Edinburgh, United Kingdom
| | | | - E. Hille
- 3Leiden University Medical Centre, The Netherlands
| | | | - H. Putter
- 3Leiden University Medical Centre, The Netherlands
| | | | | | | | - C. Seynaeve
- 9Erasmus MC-Daniel-den Hoed Cancer Centre, The Netherlands
| | - E. Mallon
- 7Western Infirmary Glasgow, United Kingdom
| | - D. Rea
- 2University of Birmingham, United Kingdom
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26
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Preston RC, Brookes C, Clutterbuck FWJ. Vacuum ultraviolet radiance transfer standard based on an argon mini-arc with integral differential pumping unit. ACTA ACUST UNITED AC 2000. [DOI: 10.1088/0022-3735/13/11/016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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Brookes C, Ravn H, White P, Moeldrup U, Oldershaw P, Redington A. Acute right ventricular dilatation in response to ischemia significantly impairs left ventricular systolic performance. Circulation 1999; 100:761-7. [PMID: 10449700 DOI: 10.1161/01.cir.100.7.761] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular (RV) dilatation that occurs as a consequence of RV infarction is thought to produce hemodynamic instability by reducing left ventricular (LV) preload and compliance. We hypothesized that these geometric changes may also adversely affect LV systolic performance. METHODS AND RESULTS Twelve 40-kg pigs were studied. Integrated conductance catheters and micromanometers were placed in both the LV and RV to allow simultaneous recordings of pressure and volume and derivation of indices of contractile function. RV ischemia was induced by balloon occlusion of the proximal right coronary artery (RCA) under 3 conditions: 1) with the pericardium intact, 2) with the pericardium intact and inotropic support, and 3) with the pericardium wide open. With an intact pericardium, RCA occlusion produced a decrease in LV end-diastolic volume associated with a marked decline in the contractile function. With the pericardium open, the same ischemic insult resulted in both LV and RV dilatation, which produced a significantly smaller negative effect on cardiac output (P=0.03), LV systolic pressure (P=0.02), LV preload-recruitable stroke work (P<0. 01), and LV end-systolic pressure-volume relations (P<0.01). Similarly, administration of dobutamine during RCA occlusion decreased the ventricular volume changes and produced a relative improvement in LV contractile performance. CONCLUSIONS The hemodynamic compromise seen in association with acute RV dilatation within an intact pericardium is partly attributable to impaired LV systolic performance and cannot be wholly ascribed to changes in LV preload or compliance.
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Affiliation(s)
- C Brookes
- Royal Brompton Hospital, London, England, UK
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Brookes C. Simultaneous Left and Right Ventricular Contractile Dysfunction Induced by Right Coronary Ischaemia Is Partly Relieved by Pericardiectomy. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)88013-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bishop A, White P, Groves P, Chaturvedi R, Brookes C, Redington A, Oldershaw P. Right ventricular dysfunction during coronary artery occlusion: pressure-volume analysis using conductance catheters during coronary angioplasty. Heart 1997; 78:480-7. [PMID: 9415008 PMCID: PMC1892286 DOI: 10.1136/hrt.78.5.480] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To study the effects of coronary artery occlusion on the pressure-volume relations of the right ventricle. DESIGN Right ventricular pressure-volume cycles were studied using conductance catheters and micromanometers in 19 subjects undergoing coronary angioplasty in a tertiary referral cardiac centre. RESULTS Catheter occlusions of either the left anterior descending coronary artery or the right coronary artery were associated with a decline in stroke work (mean change (SD): left-13.3 (15.8)%, p = 0.008; right -13.5(16.5)%, p = 0.04). Two patterns of change were evident: an upward shift usually associated with occlusion in the left coronary artery, and a rightward shift in the right coronary artery. In the former there was an increase in maximum ventricular volume (mean change: 3.0(2.7)%, p = 0.004) and in minimum ventricular volume (mean change: 2.3(2.7)%, p = 0.01) and a fall in peak pressure (mean change: -4.8 (5.1)%, p = 0.04). In the latter there was an increase in peak pressure (mean change 9.9(16.3)%, p = 0.04) and an increase in minimum ventricular volume (mean change 3.7(5.0)%, p = 0.02) leading to a fall in stroke volume (mean change -13.3(15.8)%, p = 0.008). CONCLUSIONS Occlusion of the left anterior descending coronary artery or the right coronary artery is associated with a decline in right ventricular work. However, different patterns of change in indices of preload and afterload lead to different effects on overall right ventricular pump function.
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Affiliation(s)
- A Bishop
- Royal Brompton Hospital, London, UK
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Abstract
This study examines the use of conductance catheters to assess human right ventricular volume. Ten patients undergoing diagnostic cardiac catheterisation underwent right heart catheterisation with a conductance catheter and micromanometer, and a thermodilution catheter before and after fluid loading. Parallel wall conductance (Vc), and the multiplication factor relating conductance and thermodilution derived stroke volumes (å) were derived at each steady state. Pressure-volume cycles were analyzed at steady state and during fluid loading. Fluid loading resulted in a significant increase in cardiac output, and change in maximum and minimum cycle volume. There was no significant change in å (mean 0.40 S.D. 0.20) or Vc (mean 126.4 S.D. 59.6 ml) at higher cardiac outputs or ventricular volumes. Right ventricular pressure-volume cycles were formed demonstrating characteristic lack of clear isovolumic contraction and relaxation phases, and low cycle efficiencies (mean 0.62 S.D. 0.16). Serial cycles recorded during volume loading defined an end systolic pressure-volume relation more reliably than a stroke work end diastolic volume relation. Thus, a conductance derived volume signal can be obtained in the human right ventricle which can be interpreted as a continuous and instantaneous index of right ventricular volume, allowing the construction of real time pressure-volume cycles.
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Affiliation(s)
- A Bishop
- Department of Cardiology, Royal Brompton Hospital, London, UK
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Bishop A, White P, Chaturvedi R, Brookes C, Redington A, Oldershaw P. Resting right ventricular function in patients with coronary artery disease: pressure volume analysis using conductance catheters. Int J Cardiol 1997; 58:223-8. [PMID: 9076548 DOI: 10.1016/s0167-5273(96)02849-5] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Right ventricular pressure volume cycles from patients with coronary artery disease were created in order to assess their characteristics and the effects of peak ventricular pressure and right and left artery coronary disease. Thirty-three patients undergoing diagnostic catheterisation for ischaemic heart disease underwent right ventricular catheterisation with a micromanometer and a conductance catheter. Simultaneous pressure and volume signals were recorded and analysed as functions of time, and of each other, forming pressure volume cycles. A total of 19/33 (58%) patients had an abnormal pressure volume loop with a clear end systolic shoulder, and an isovolumic relaxation phase. The mean peak ventricular pressure for all patients was raised (35.2 S.D. 11.8 mmHg), but there was no correlation between indices of shape and peak systolic pressure. Values of dP/dtmax were also raised, but there was no significant difference in this or any other index between patients with left or right coronary artery disease. Thus, in patients with coronary artery disease, the right ventricular pressure volume loop is frequently abnormal in a pattern that is recognised as a feature of an increased ventricular afterload.
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Affiliation(s)
- A Bishop
- Royal Brompton Hospital, London, UK
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Abstract
Five cases of scapholunate instability are reported. The condition is commonly misdiagnosed in accident and emergency departments. The importance of a complete clinical assessment of the suspected scaphoid injury and the need to measure the scapholunate distance and the scapholunate angle on the radiographs is stressed.
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Affiliation(s)
- A P Gleeson
- University Department of Emergency Medicine, Hope Hospital, Salford, United Kingdom
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Dwarakanath AD, Yu LG, Brookes C, Pryce D, Rhodes JM. 'Sticky' neutrophils, pathergic arthritis, and response to heparin in pyoderma gangrenosum complicating ulcerative colitis. Gut 1995; 37:585-8. [PMID: 7489951 PMCID: PMC1382916 DOI: 10.1136/gut.37.4.585] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pyoderma gangrenosum is strongly associated with inflammatory bowel disease and exhibits pathergy, occurring at sites of previous minor trauma. A patient is presented with a 21 year history of extensive ulcerative colitis, who developed pyoderma gangrenosum and arthralgia while receiving high dose corticosteroids for active ulcerative colitis. The arthralgia exhibited pathergy affecting particularly the left temporomandibular joint, which was stressed by an asymmetric bite, and the left elbow, which had been fractured many years previously. This prompted the hypothesis that neutrophils in this condition may be marginated, as a result of increased stickiness of either the neutrophil or the vascular endothelium. The introduction of heparin therapy was associated with rapid resolution of the arthralgia, pyoderma gangrenosum, and ulcerative colitis.
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Brown L, Nunez D, Brookes C, Wilkins M. Selective increase in endothelin-1 and endothelin A receptor subtype in the hypertrophied myocardium of the aorto-venacaval fistula rat. Cardiovasc Res 1995. [DOI: 10.1016/s0008-6363(96)88611-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Of 141 women with twin pregnancies, 72 were randomly assigned to outpatient care and 69 to hospital admission between 26 and 30 weeks' gestation. There were no differences between the groups in the frequencies of major maternal complications in pregnancy and labour but more of those admitted to hospital than of the outpatient group had to be admitted after 30 weeks. There were no differences between the groups in the mean birthweights of the twins by birth order, or in their mean gestation at birth whether analysed by intention to treat or by the treatment given. 22 infants were delivered before 32 weeks' gestation in the inpatient group compared with 10 in the outpatient group. With the exception of small-for-dates infants, any trend towards greater morbidity or mortality was seen in the inpatient group. The policy of routine hospital admission of women with twin pregnancies from 26 weeks' gestation is not beneficial to mother or babies and should be abandoned.
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Affiliation(s)
- A H MacLennan
- University of Adelaide Department of Obstetrics and Gynaecology, Queen Victoria Hospital, South Australia
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Abstract
The ferning test for the detection of amniotic fluid, when first described, was reported to have no false positive results. Despite this and after initial enthusiasm it has never achieved widespread use. The test is easy to perform but interpretation requires care, and it is necessary to identify potentially confusing crystallization patterns to avoid false positive results. A reevaluation of the test is presented and a hitherto unrecognized false positive reaction due to an antiseptic solution is reported.
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Brookes C, Wright A, Evans PJ, Mayer RJ. Aflatoxin B1: effect on the synthesis and degradation of mitochondrial proteins in hepatocyte monolayers. Carcinogenesis 1984; 5:759-65. [PMID: 6144403 DOI: 10.1093/carcin/5.6.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The effect of aflatoxin B1 (AFB1), a hepatocarcinogen, on mitochondrial and general protein synthesis and degradation has been studied. AFB1 (0.003, 0.03, 0.25 micrograms ml-1) inhibited total protein synthesis over a 5 h period by 30, 64 and 82%, respectively, measured by incorporation of [3H]leucine. After 24 h in the presence of AFB1 inhibition was 23, 77 and 100%, respectively. AFB1 inhibited total hepatocyte protein degradation in a concentration independent manner by approximately 50% i.e., from 1.4% h-1 to 0.7% h-1. The immediate effect of AFB1 on mitoribosomal and total mitochondrial protein synthesis and mitochondrial degradation has been assessed by two methods. Mitoribosomal synthesis of proteins was inhibited over a 5 h period by AFB1 in a concentration independent manner by approximately 43%. Total mitochondrial protein synthesis showed a 23 and 45% inhibition by AFB1 (0.003 and 0.03 micrograms AFB1 ml-1) over a 4 h period and 25 and 72% inhibition, respectively, after 24 h in culture. The rate of mitochondrial protein degradation was not altered. AFB1 inhibits dibutyryl cyclic AMP-induced tyrosine amino transferase (TAT) activity in hepatocytes by 57% at 0.003 micrograms ml-1 and 100% at 0.03 micrograms ml-1 over a 24 h period. Dibutyryl cyclic AMP increases the rate of degradation of proteins in hepatocyte monolayers from 1.4% h-1 to 2.7% h-1 and was inhibited at both concentrations of AFB1 used. AFB1 causes a rapid inhibition of total hepatocyte protein synthesis, synthesis of proteins in hepatocyte mitochondria and the synthesis of imported mitochondrial proteins. General hepatocyte and dibutyryl cyclic AMP-induced protein degradation are significantly inhibited by AFB1 whereas the degradation of mitochondrial proteins is unaffected.
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