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Keelan S, Dowling GP, Roche T, Hegarty A, Davey MG, Dhannoon AA, O’Grady S, Downey E, Bolger J, Boland M, Sorensen J, Power C, Butt A, Baban C, Hill ADK. Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial. Br J Surg 2024; 111:znae029. [PMID: 38498075 PMCID: PMC10946413 DOI: 10.1093/bjs/znae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Electrosurgical devices are commonly used during mastectomy for simultaneous dissection and haemostasis, and can provide potential benefits regarding vessel and lymphatic ligation. The aim of this prospective RCT was to assess whether using a vessel-sealing device (LigaSure™) improves perioperative outcomes compared with monopolar diathermy when performing simple mastectomy. METHODS Patients were recruited prospectively and randomized in a 1 : 1 manner to undergo simple mastectomy using either LigaSure™ or conventional monopolar diathermy at a single centre. The primary outcome was the number of days the drain remained in situ after surgery. Secondary outcomes of interest included operating time and complications. RESULTS A total of 86 patients were recruited (42 were randomized to the monopolar diathermy group and 44 were randomized to the LigaSure™ group). There was no significant difference in the mean number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group (7.75 days versus 8.23 days; P = 0.613) and there was no significant difference in the mean total drain output between the monopolar diathermy group and the LigaSure™ group (523.50 ml versus 572.80 ml; P = 0.694). In addition, there was no significant difference in the mean operating time between the groups, for simple mastectomy alone (88.25 min for the monopolar diathermy group versus 107.20 min for the LigaSure™ group; P = 0.078) and simple mastectomy with sentinel lymph node biopsy (107.20 min for the monopolar diathermy group versus 114.40 min for the LigaSure™ group; P = 0.440). CONCLUSION In this double-blinded single-centre RCT, there was no difference in the total drain output or the number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group. REGISTRATION NUMBER EudraCT 2018-003191-13 BEAUMONT HOSPITAL REC 18/66.
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Affiliation(s)
- Stephen Keelan
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Gavin P Dowling
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Trudi Roche
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Matthew G Davey
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Sorcha O’Grady
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Eithne Downey
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jarlath Bolger
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Michael Boland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jan Sorensen
- Health Outcomes Research Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Colm Power
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Abeeda Butt
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Chwanrow Baban
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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Butt A, Hayes C, Boland M, Abdulhadi A, Sorenson J, Dowling G, Khalifa M, Keelan S, Giblin K, Downey E, Allen M, Power C, Hill ADK. Effect of the Covid-19 pandemic on breast cancer presentation - a single unit study over 5 years. Ir Med J 2024; 117:912. [PMID: 38446109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Dowling GP, Toomey S, Bredin P, Parker I, Mulroe E, Marron J, McLoughlin O, Teiserskiene A, Power C, O'Shea AM, Greally M, Morris PG, Duke D, Hill ADK, Hennessy BT. Neoadjuvant trastuzumab deruxtecan (T-DXd) with response-directed definitive therapy in early stage HER2-positive breast cancer: a phase II study protocol (SHAMROCK study). BMC Cancer 2024; 24:91. [PMID: 38233810 PMCID: PMC10792949 DOI: 10.1186/s12885-024-11851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The current standard of care in the neoadjuvant setting for high-risk HER2-positive (HER2 +) breast cancer is to combine systemic chemotherapy with dual HER2 blockade, trastuzumab and pertuzumab. Targeted therapies have significantly improved outcomes for patients with HER2-positive breast cancer. To improve treatment-associated toxicity, chemotherapy-sparing approaches are currently being investigated. Trastuzumab deruxtecan (T-DXd) is an HER2-directed antibody-drug-conjugate (ADC) with promising results in the metastatic setting for HER2-positive breast cancer. The SHAMROCK study investigates neoadjuvant T-DXd in early stage HER2-positive breast cancer, using pathological complete response (pCR) rate as the primary endpoint. METHODS This is a phase II open-label, single arm, adaptive multi-centre trial of T-DXd in the neoadjuvant setting in stage 2-3 HER2-positive breast cancer. Eligible patients will receive 5.4 mg/kg of T-DXd intravenously every 3 weeks for up to 6 cycles. A repeat biopsy will performed after 2 cycles for the RNA disruption index (RDI) score assessment. According to their likelihood of pCR, as determined by the RDI score, patients will either undergo 4 or 6 cycles of T-DXd prior to imaging. Patients with imaging complete response (iCR) after either 4 or 6 cycles will proceed to surgery. Patients who do not achieve iCR will either undergo further systemic therapy or proceed to surgery. DISCUSSION The SHAMROCK study is a chemotherapy-sparing approach to curative intent treatment, investigating neoadjuvant T-DXd. We hypothesise that neoadjuvant T-DXd will have a high pCR rate and be associated low toxicity in early stage HER2-positive breast cancer. TRIAL REGISTRATION EudraCT Number: 2022-002485-32; ClinicalTrials.gov identifier: NCT05710666; Cancer Trials Ireland study number: CTRIAL-IE 22-01.
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Affiliation(s)
- Gavin P Dowling
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland.
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland.
| | - Sinead Toomey
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Philip Bredin
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | | | | | | | | | - Colm Power
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Megan Greally
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Duke
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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Zaborowski AM, Doogan K, Clifford S, Dowling G, Kazi F, Delaney K, Yadav H, Brady A, Geraghty J, Evoy D, Rothwell J, McCartan D, Heeney A, Barry M, Walsh SM, Stokes M, Kell MR, Allen M, Power C, Hill ADK, Connolly E, Alazawi D, Boyle T, Corrigan M, O’Leary P, Prichard RS. Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study. Br J Surg 2024; 111:znad401. [PMID: 38055888 PMCID: PMC10763529 DOI: 10.1093/bjs/znad401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+). METHODS A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy. RESULTS A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease. CONCLUSION The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.
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Affiliation(s)
| | - Katie Doogan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Siobhan Clifford
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gavin Dowling
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Farah Kazi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Karina Delaney
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Himanshu Yadav
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Aaron Brady
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
| | - Anna Heeney
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mitchel Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Allen
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Dhafir Alazawi
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Terence Boyle
- Department of Breast Surgery, St James’s Hospital, Dublin, Ireland
| | - Mark Corrigan
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Peter O’Leary
- Department of Breast Surgery, Bon Secours Hospital Cork, Cork, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
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5
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Horan J, Reid C, Boland MR, Daly GR, Keelan S, Lloyd AJ, Downey E, Walmsley A, Staunton M, Power C, Butt A, Duke D, Hill ADK. Assessing Mode of Recurrence in Breast Cancer to Identify an Optimised Follow-Up Pathway: 10-Year Institutional Review. Ann Surg Oncol 2023; 30:6117-6124. [PMID: 37479843 PMCID: PMC10495471 DOI: 10.1245/s10434-023-13885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/06/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Breast cancer surveillance programmes ensure early identification of recurrence which maximises overall survival. Programmes include annual clinical examination and radiological assessment. There remains debate around the value of annual clinical exam in diagnosing recurrent disease/second primaries. The aim was to assess diagnostic modalities for recurrent breast cancer with a focus on evaluating the role of annual clinical examination. PATIENTS AND METHODS A prospectively maintained database from a symptomatic breast cancer service between 2010-2020 was reviewed. Patients with biopsy-proven recurrence/second breast primary were included. The primary outcome was the diagnostic modality by which recurrences/secondary breast cancers were observed. Diagnostic modalities included (i) self-detection by the patient, (ii) clinical examination by a breast surgeon or (iii) radiological assessment. RESULTS A total of 233 patients were identified and, following application of exclusion criteria, a total of 140 patients were included. A total of 65/140 (46%) patients were diagnosed clinically, either by self-detection or clinical examination, while 75/140 (54%) were diagnosed radiologically. A total of 59/65 (91%) of patients clinically diagnosed with recurrence presented to the breast clinic after self-detection of an abnormality. Four (6%) patients had cognitive impairment and recurrence was diagnosed by a carer. Two (3%) patients were diagnosed with recurrence by a breast surgeon at clinical examination. The median time to recurrence in all patients was 48 months (range 2-263 months). CONCLUSION Clinical examination provides little value in diagnosing recurrence (< 5%) and surveillance programmes may benefit from reduced focus on such a modality. Regular radiological assessment and ensuring patients have urgent/easy access to a breast clinic if they develop new symptoms/signs should be the focus of surveillance programmes.
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Affiliation(s)
- Jack Horan
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Conor Reid
- Department Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Michael R Boland
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland.
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland.
| | - Gordon R Daly
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Stephen Keelan
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Angus J Lloyd
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Eithne Downey
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Adam Walmsley
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Marie Staunton
- Department of Pathology, Beaumont Hospital, Dublin 9, Ireland
| | - Colm Power
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Abeeda Butt
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Deirdre Duke
- Department Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Arnold D K Hill
- Department of Breast Surgery, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
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6
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Bakal JA, Rivera R, Charlton C, Plitt S, Power C. Evolving etiologies, comorbidities, survival, and costs of care in adult encephalitis. J Neurovirol 2023; 29:605-613. [PMID: 37581843 DOI: 10.1007/s13365-023-01165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
Encephalitis is a central nervous system disorder, often caused by infectious agents or aberrant immune responses. We investigated causes, comorbidities, costs, and outcomes of encephalitis in a population-based cohort. ICD-10 codes corresponding to encephalitis were used to identify health services records for all adults from 2004 to 2019. Data were cross-validated for identified diagnoses based on laboratory confirmation using univariate and multivariate statistical analyses. We identified persons with a diagnosis of encephalitis and abnormal cerebrospinal fluid (CSF) results (n = 581) in whom viral genome was detected (n = 315) in a population of 3.2 million adults from 2004 to 2019. Viral genome-positive CSF samples included HSV-1 (n = 133), VZV (n = 116), HSV-2 (n = 34), enterovirus (n = 4), EBV (n = 5), and CMV (n = 3) with the remaining viruses included JCV (n = 12) and HHV-6 (n = 1). The mean Charlson Comorbidity Index (2.0) and mortality rate (37.6%) were significantly higher in the CSF viral genome-negative encephalitis group although the mean costs of care were significantly higher for the CSF viral genome-positive group. Cumulative incidence rates showed increased CSF VZV detection in persons with encephalitis, which predominated in persons over 65 years with a higher mean Charlson index. We detected HSV-2 and VZV more frequently in CSF from encephalitis cases with greater material-social deprivation. The mean costs of care were significantly greater for HSV-1 encephalitis group. Encephalitis remains an important cause of neurological disability and death with a viral etiology in 54.2% of affected adults accompanied by substantial costs of care and mortality. Virus-associated encephalitis is evolving with increased VZV detection, especially in older persons.
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Affiliation(s)
- J A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - R Rivera
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - C Charlton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Li Ka Shing Institute of Virology, Edmonton, AB, Canada
| | - S Plitt
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
| | - C Power
- Division of Neurology, Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada.
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AB, Canada.
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7
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Cosgrove N, Eustace AJ, O'Donovan P, Madden SF, Moran B, Crown J, Moulton B, Morris PG, Grogan L, Breathnach O, Power C, Allen M, Walshe JM, Hill AD, Blümel A, O'Connor D, Das S, Milewska M, Fay J, Kay E, Toomey S, Hennessy BT, Furney SJ. Predictive modelling of response to neoadjuvant therapy in HER2+ breast cancer. NPJ Breast Cancer 2023; 9:72. [PMID: 37758711 PMCID: PMC10533568 DOI: 10.1038/s41523-023-00572-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
HER2-positive (HER2+) breast cancer accounts for 20-25% of all breast cancers. Predictive biomarkers of neoadjuvant therapy response are needed to better identify patients with early stage disease who may benefit from tailored treatments in the adjuvant setting. As part of the TCHL phase-II clinical trial (ICORG10-05/NCT01485926) whole exome DNA sequencing was carried out on normal-tumour pairs collected from 22 patients. Here we report predictive modelling of neoadjuvant therapy response using clinicopathological and genomic features of pre-treatment tumour biopsies identified age, estrogen receptor (ER) status and level of immune cell infiltration may together be important for predicting response. Clonal evolution analysis of longitudinally collected tumour samples show subclonal diversity and dynamics are evident with potential therapy resistant subclones detected. The sources of greater pre-treatment immunogenicity associated with a pathological complete response is largely unexplored in HER2+ tumours. However, here we point to the possibility of APOBEC associated mutagenesis, specifically in the ER-neg/HER2+ subtype as a potential mediator of this immunogenic phenotype.
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Affiliation(s)
- Nicola Cosgrove
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alex J Eustace
- School of Biotechnology, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Peter O'Donovan
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Bruce Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Brian Moulton
- Clinical Oncology Development Europe, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael Allen
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Blümel
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Darren O'Connor
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sudipto Das
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Małgorzata Milewska
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Joanna Fay
- RCSI Biobank Service, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Elaine Kay
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland.
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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8
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Roczkowsky A, Limonta D, Fernandes JP, Branton WG, Clarke M, Hlavay B, Noyce RS, Joseph JT, Ogando NS, Das SK, Elaish M, Arbour N, Evans DH, Langdon K, Hobman TC, Power C. COVID-19 Induces Neuroinflammation and Suppresses Peroxisomes in the Brain. Ann Neurol 2023; 94:531-546. [PMID: 37190821 DOI: 10.1002/ana.26679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Peroxisome injury occurs in the central nervous system (CNS) during multiple virus infections that result in neurological disabilities. We investigated host neuroimmune responses and peroxisome biogenesis factors during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using a multiplatform strategy. METHODS Brain tissues from coronavirus disease 2019 (COVID-19) (n = 12) and other disease control (ODC) (n = 12) patients, as well as primary human neural cells and Syrian hamsters, infected with a clinical variant of SARS-CoV-2, were investigated by droplet digital polymerase chain reaction (ddPCR), quantitative reverse transcriptase PCR (RT-qPCR), and immunodetection methods. RESULTS SARS-CoV-2 RNA was detected in the CNS of 4 patients with COVID-19 with viral protein (NSP3 and spike) immunodetection in the brainstem. Olfactory bulb, brainstem, and cerebrum from patients with COVID-19 showed induction of pro-inflammatory transcripts (IL8, IL18, CXCL10, NOD2) and cytokines (GM-CSF and IL-18) compared to CNS tissues from ODC patients (p < 0.05). Peroxisome biogenesis factor transcripts (PEX3, PEX5L, PEX11β, and PEX14) and proteins (PEX3, PEX14, PMP70) were suppressed in the CNS of COVID-19 compared to ODC patients (p < 0.05). SARS-CoV-2 infection of hamsters revealed viral RNA detection in the olfactory bulb at days 4 and 7 post-infection while inflammatory gene expression was upregulated in the cerebrum of infected animals by day 14 post-infection (p < 0.05). Pex3 transcript levels together with catalase and PMP70 immunoreactivity were suppressed in the cerebrum of SARS-CoV-2 infected animals (p < 0.05). INTERPRETATION COVID-19 induced sustained neuroinflammatory responses with peroxisome biogenesis factor suppression despite limited brainstem SARS-CoV-2 neurotropism in humans. These observations offer insights into developing biomarkers and therapies, while also implicating persistent peroxisome dysfunction as a contributor to the neurological post-acute sequelae of COVID-19. ANN NEUROL 2023;94:531-546.
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Affiliation(s)
- A Roczkowsky
- Department of Medicine, University of Alberta, Edmonton, AB, USA
| | - D Limonta
- Department of Cell Biology, University of Alberta, Edmonton, AB, USA
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, USA
| | - J P Fernandes
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB, USA
| | - W G Branton
- Department of Medicine, University of Alberta, Edmonton, AB, USA
| | - M Clarke
- Department of Medicine, University of Alberta, Edmonton, AB, USA
| | - B Hlavay
- Department of Medicine, University of Alberta, Edmonton, AB, USA
| | - R S Noyce
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB, USA
| | - J T Joseph
- Department of Pathology, University of Calgary, Calgary, AB, USA
| | - N S Ogando
- Department of Medicine, University of Alberta, Edmonton, AB, USA
| | - S K Das
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, USA
| | - M Elaish
- Department of Cell Biology, University of Alberta, Edmonton, AB, USA
| | - N Arbour
- Department of Neuroscience, University of Montreal, and CHUM, Montreal, QC, Canada
| | - D H Evans
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB, USA
| | - K Langdon
- Department of Pathology, University of Calgary, Calgary, AB, USA
| | - T C Hobman
- Department of Cell Biology, University of Alberta, Edmonton, AB, USA
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, USA
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB, USA
| | - C Power
- Department of Medicine, University of Alberta, Edmonton, AB, USA
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB, USA
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9
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Hlavay BA, Zhuo R, Ogando N, Charlton C, Stapleton JT, Klein MB, Power C. Human pegivirus viremia in HCV/HIV co-infected patients: Direct acting antivirals exert anti-pegivirus effects. J Clin Virol 2023; 162:105445. [PMID: 37043902 DOI: 10.1016/j.jcv.2023.105445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Human pegivirus (HPgV) is a single-stranded RNA virus that is closely related to hepatitis C virus (HCV). HPgV has also been shown to infect patients with human immunodeficiency virus (HIV). The mechanisms and disease outcomes of HPgV infections are largely unknown, although it has been implicated in both cancer and neurological diseases. There are no established therapies for HPgV. OBJECTIVES To estimate the prevalence of HPgV in a cohort of HCV/HIV co-infected patients undergoing treatment for HCV with direct acting antivirals (DAA) and investigate the effect of DAA therapy on HPgV infection. STUDY DESIGN RNA was extracted from plasma samples collected at time points before, during, and after DAA. HPgV RNA abundance was quantified by droplet digital PCR assays targeting the NS5A and 5'UTR domains and confirmed by RT-qPCR. Clinical, demographic and treatment data were analysed. RESULTS HPgV RNA was detected and quantified in 26 of 100 patients' plasma (26%) before starting DAA. Patients with detectable HPgV were more likely to be male, had higher peak HIV plasma levels, and a history of injection drug use. Patients receiving sofosbuvir/ledipasvir (n = 9) displayed significantly lower HPgV levels at time of DAA completion and had lower post-DAA HPgV rebound levels compared to patients receiving sofosbuvir/velpatasvir (n = 11) although both regimens significantly reduced viremia directly following DAA completion. Sustained suppression of HPgV was also observed among patients (n = 2) receiving pegylated-interferon. CONCLUSIONS HPgV RNA was frequently detected in HCV/HIV co-infected patients and was supressed by DAA and pegylated interferon therapies with sofosbuvir-ledipasvir showing greatest antiviral activity. These findings suggest potential treatment strategies for HPgV infections.
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Affiliation(s)
- B A Hlavay
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Zhuo
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
| | - N Ogando
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Charlton
- Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada; Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
| | - J T Stapleton
- Departments of Internal Medicine and Microbiology, University of Iowa, Iowa City, Iowa, USA
| | - M B Klein
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - C Power
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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10
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Perret LC, Geoffroy MC, Barr E, Parnet F, Provencal N, Boivin M, O’Donnell KJ, Suderman M, Power C, Turecki G, Ouellet-Morin I. Associations between epigenetic aging and childhood peer victimization, depression, and suicidal ideation in adolescence and adulthood: A study of two population-based samples. Front Cell Dev Biol 2023; 10:1051556. [PMID: 36712964 PMCID: PMC9879289 DOI: 10.3389/fcell.2022.1051556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Prior studies indicate that peer victimization (including bullying) is associated with higher risk for depression and suicidal ideation across the life course. However, molecular mechanisms underlying these associations remain unclear. This two-cohort study proposes to test whether epigenetic aging and pace of aging, as well as a DNA methylation marker of responsive to glucocorticoids, are associated to childhood peer victimization and later depressive symptoms, or suicidal ideation. Methods: Cohort 1: Epigenome-wide DNA methylation (EPIC array) was measured in saliva collected when participants were 10.47 years (standard deviation = 0.35) in a subsample of the Quebec Longitudinal Study of Child Development (QLSCD, n = 149 participants), with self-reported peer victimization at 6-8 years, depressive symptoms (mean symptoms, and dichotomized top 30% symptoms) and suicidal ideation at 15-17 years. Cohort 2: Epigenome-wide DNA methylation (EPIC array) was measured in blood collected from participants aged 45.13 years (standard deviation = 0.37) in a subsample of the 1958 British Birth cohort (1958BBC, n = 238 participants) with information on mother-reported peer victimization at 7-11 years, self-reported depressive symptoms at 50 years, and suicidal ideation at 45 years. Five epigenetic indices were derived: three indicators of epigenetic aging [Horvath's pan-tissue (Horvath1), Horvath's Skin-and-Blood (Horvath2), Pediatric-Buccal-Epigenetic age (PedBE)], pace of aging (DunedinPACE), and stress response reactivity (Epistress). Results: Peer victimization was not associated with the epigenetic indices in either cohort. In the QLSCD, higher PedBE epigenetic aging and a slower pace of aging as measured by DunedinPACE predicted higher depressive symptoms scores. In contrast, neither the Horvath1, or Horvath2 epigenetic age estimates, nor the Epistress score were associated with depressive symptoms in either cohort, and none of the epigenetic indices predicted suicidal ideation. Conclusion: The findings are consistent with epigenome-wide and candidate gene studies suggesting that these epigenetic indices did not relate to peer victimization, challenging the hypothesis that cumulative epigenetic aging indices could translate vulnerability to depressive symptoms and suicidal ideation following peer victimization. Since some indices of epigenetic aging and pace of aging signaled higher risk for depressive symptoms, future studies should pursue this investigation to further evaluate the robustness and generalization of these preliminary findings.
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Affiliation(s)
- L. C. Perret
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - M-C. Geoffroy
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - E. Barr
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - F. Parnet
- School of Criminology, Research Center of the Montreal Mental Health University Institute, Université de Montréal, Montreal, QC, Canada
| | - N. Provencal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M. Boivin
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - K. J. O’Donnell
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States,Child and Brain Development Program, CIFAR, Toronto, ON, Canada
| | - M. Suderman
- MRC Integrative Epidemiology Unit, Bristol Medical School, Bristol Population Health Science Institute, Bristol, United Kingdom
| | - C. Power
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - G. Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - I. Ouellet-Morin
- School of Criminology, Research Center of the Montreal Mental Health University Institute, Université de Montréal, Montreal, QC, Canada,*Correspondence: I. Ouellet-Morin,
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11
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Alameer A, Common M, Elwahab SA, Boland M, Allen M, Power C, Hambly N, Kerr J, Ni Mhuircheartaigh N, Staunton M, Hill ADK, Duke D. Clinically guided core biopsy and cutaneous punch biopsy in the evaluation of breast lesions: a necessary test or an obsolete skill? Ir J Med Sci 2023; 192:317-319. [PMID: 35132568 PMCID: PMC9892099 DOI: 10.1007/s11845-022-02937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The vast majority of breast cancers are diagnosed via image-guided procedures yet despite significant advances, imaging does not identify all breast malignancies. Clinically suspicious breast lesions with normal breast imaging remain a cause for concern. The aim of this study is to determine the diagnostic value of clinical core and cutaneous punch biopsies in the diagnosis of breast malignancy in clinically suspicious lesions with normal breast imaging. METHODS All patients with suspicious clinical breast findings and normal imaging who underwent a clinical core and/or cutaneous punch biopsy from 2012 to 2019 were reviewed retrospectively. Patients with subsequent breast malignant diagnosis were analysed. RESULTS A total of 283 biopsies (166 clinical core, 117 cutaneous punch) performed over the 7-year period were included in the analysis. A total of 263/283 (93%) yielded a benign outcome. A total of 2/283 (0.7%) yielded B3 lesions (probably benign). These lesions were benign on final surgical excision. A total of 18/283 (6.3%) yielded a malignant histopathology. Sixteen out of 18 were cutaneous punch biopsies, and 2/18 were clinical core biopsies. A total of 14/18 patients presented with nipple changes, while 4/18 had a palpable area of concern. Histopathological analysis demonstrated Paget's disease of the nipple in 8/18, invasive carcinoma in 9/18 out of which two represented a recurrence of breast malignancy. Cutaneous squamous cell carcinoma was diagnosed in 1/18. CONCLUSION Clinical core and cutaneous punch biopsies remain a valuable tool in the diagnosis of breast cancer particularly in the management of clinically suspicious radiographically occult malignancies.
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Affiliation(s)
- Aqeel Alameer
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland ,grid.416266.10000 0000 9009 9462Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Matthew Common
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sami Abd Elwahab
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Boland
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Allen
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Niamh Hambly
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Marie Staunton
- grid.414315.60000 0004 0617 6058Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Arnold D. K. Hill
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Duke
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
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12
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Hennessy G, Boland M, Bambrick M, Crone L, Lloyd A, Abdelwahab S, Downey E, Staunton M, Hambly N, Mhuircheartaigh NN, Kerr J, Power C, Duke D, Hill ADK. Value of long-term follow-up in surgically excised lesions of uncertain malignant potential in the breast – Is 5 years necessary? Clin Breast Cancer 2022; 22:699-704. [DOI: 10.1016/j.clbc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
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13
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Lloyd A, Abd Elwahab S, Boland M, Elfadul A, Hill A, Power C. Acute complicated appendicitis caused by an ingested toothpick – A case report. Int J Surg Case Rep 2022; 92:106872. [PMID: 35259701 PMCID: PMC8902606 DOI: 10.1016/j.ijscr.2022.106872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction and importance Acute appendicitis is one of the most common presentations to the emergency department, particularly in young adults. A combination of clinical suspicion, inflammatory blood markers and imaging modalities such as ultrasound and CT are used for its definitive diagnosis. Early detection and intervention are paramount to reduce morbidity and mortality. Laparoscopic appendicectomy is the current gold standard in the management of appendicitis, especially if complicated according to EAES guidelines. There are few documented cases in the literature of acute appendicitis secondary to foreign body ingestion. On account of this, there are currently no guidelines for its management. Our literature review highlights the importance of surgical management of foreign body acute appendicitis. Case presentation This case report describes the rare presentation of acute complicated appendicitis caused by an ingested toothpick in a 64 year old woman. The patient was admitted with a 3 day history of lower abdominal pain, localizing to the right iliac fossa with raised inflammatory markers. CT imaging reported acute complicated appendicitis. Laparoscopic appendicectomy was performed during which a toothpick was seen protruding through the appendiceal wall. Post operatively the patient was treated with IV antibiotics for 5 days prior to discharge. Clinical discussion Due to the rare nature of foreign body appendicitis there are no specific guidelines on the respective surgical approach. A literature review showed that in the setting of foreign body appendicitis, surgical intervention is paramount with no scope for conservative management. Conclusion Surgical approach is based on the clinical judgement and skillset of the operating surgeon. Remember foreign body ingestion as a cause of appendicitis Management of foreign body appendicitis is surgical intervention. Open vs laparoscopic approach depends on the surgeons clinical judgement, preference and skillset.
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14
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O'Leary DP, Walsh SM, Bolger J, Baban C, Humphreys H, O'Grady S, Hegarty A, Lee AM, Sheehan M, Alderson J, Dunne R, Morrin MM, Lee MJ, Power C, McNamara D, McCawley N, Robb W, Burke J, Sorensen J, Hill AD. A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial. Ann Surg 2021; 274:240-247. [PMID: 33534226 DOI: 10.1097/sla.0000000000004785] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis. SUMMARY BACKGROUND DATA Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life. METHODS Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy. RESULTS One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001). CONCLUSIONS Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.
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Affiliation(s)
- D Peter O'Leary
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Siun M Walsh
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jarlath Bolger
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chwanrow Baban
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sorcha O'Grady
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife M Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sheehan
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jack Alderson
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth Dunne
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martina M Morrin
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Power
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah McNamara
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh McCawley
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Will Robb
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Burke
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
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15
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Alluqmani M, Roda W, Qqrmli M, Blevins G, Giuliani F, Power C. Differential disease phenotypes and progression in relapsing-remitting multiple sclerosis: comparative analyses of single Canadian and Saudi Arabian clinics. BMC Neurol 2021; 21:295. [PMID: 34311734 PMCID: PMC8314572 DOI: 10.1186/s12883-021-02317-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/02/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Relapsing–remitting multiple sclerosis (RR-MS) phenotypes differ widely although the variables contributing to this heterogeneity remain uncertain. To assess geographic and ethnic effects on RR-MS phenotypes, we investigated RR-MS patients in Canada and Saudi Arabia. Methods A retrospective analysis of patients followed in two MS Clinics was performed in Medina, Saudi Arabia and Edmonton, Canada. Demographic and clinical data were collected for each patient and analyzed using univariable and multivariable statistics. Univariable and multivariable linear regression were used to distinguish the significant clinical and demographic features and neurological systems associated with the change in expanded disability status scale (EDSS) between clinical assessments. Results Patients with treated RR-MS were recruited (n = 51, Saudi; n = 47, Canada) although the disease duration was longer in the Canadian cohort (5.6 ± 2.2 yr.) compared to the Saudi cohort (4.4 ± 1.4 yr.) (P < 0.05), annual relapse rate and EDSS change were higher in the Saudi cohort (P < 0.05). Infratentorial lesion-associated presentation differed (Canada, n = 23; Saudi, n = 13) among groups (P < 0.05). Spinal cord lesions on MRI were more frequently detected in Canadian (n = 23) compared to Saudi (n = 1) patients (P < 0.05). Patients within the Saudi cohort displayed a significantly greater change in Expanded Disability Status Scale (EDSS) between first and second assessments. Conclusions Despite differences in geographic location, ethnicity, and predominance of infratentorial lesions in the Canadian group, the RR-MS phenotypes were similar although the Saudi cohort displayed a more severe disease course. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02317-2.
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Affiliation(s)
- M Alluqmani
- Department of Medicine (Neurology), University of Alberta, 6-11 Heritage Medical Research Centre, Edmonton, AB, Canada.,Department of Medicine, University of Taibah, Medina, Saudi Arabia
| | - W Roda
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - M Qqrmli
- Department of Medicine, University of Taibah, Medina, Saudi Arabia
| | - G Blevins
- Department of Medicine (Neurology), University of Alberta, 6-11 Heritage Medical Research Centre, Edmonton, AB, Canada
| | - F Giuliani
- Department of Medicine (Neurology), University of Alberta, 6-11 Heritage Medical Research Centre, Edmonton, AB, Canada
| | - C Power
- Department of Medicine (Neurology), University of Alberta, 6-11 Heritage Medical Research Centre, Edmonton, AB, Canada.
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16
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Bakal JA, Charlton CL, Hlavay B, Jansen GH, Svenson LW, Power C. Progressive multifocal leukoencephalopathy and Creutzfeldt-Jakob disease: population-wide incidences, comorbidities, costs of care, and outcomes. J Neurovirol 2021; 27:476-481. [PMID: 33978904 DOI: 10.1007/s13365-021-00983-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Neurological disorders associated with chronic infections are often progressive as well as challenging to diagnose and manage. Among 4.4 million persons from 2004 to 2019 receiving universal health, progressive multifocal leukoencephalopathy (PML, n = 58) and Creutzfeldt-Jakob disease (CJD, n = 93) cases were identified, revealing stable yearly incidence rates with divergent comorbidities: HIV/AIDS affected 37.8% of PML cases while cerebrovascular disease affected 26.9% of CJD cases. Most CJD cases died within 1 year (73%) although PML cases lived beyond 5 years (34.1%) despite higher initial costs of care. PML and CJD represent important neurological disorders with evolving risk variables and impact on health care.
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Affiliation(s)
- J A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, AB, Canada
| | - C L Charlton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Li Ki Sheng Institute of Virology, Edmonton, AB, Canada
| | - B Hlavay
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
| | - G H Jansen
- Division of Anatomical Pathology, University of Ottawa, Ottawa, ON, Canada
| | - L W Svenson
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
- Analytics & Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - C Power
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada.
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17
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Eustace AJ, Madden SF, Fay J, Collins DM, Kay EW, Sheehan KM, Furney S, Moran B, Fagan A, Morris PG, Teiserskiene A, Hill AD, Grogan L, Walshe JM, Breathnach O, Power C, Duke D, Egan K, Gallagher WM, O'Donovan N, Crown J, Toomey S, Hennessy BT. The role of infiltrating lymphocytes in the neo-adjuvant treatment of women with HER2-positive breast cancer. Breast Cancer Res Treat 2021; 187:635-645. [PMID: 33983492 PMCID: PMC8197702 DOI: 10.1007/s10549-021-06244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Pre-treatment tumour-associated lymphocytes (TILs) and stromal lymphocytes (SLs) are independent predictive markers of future pathological complete response (pCR) in HER2-positive breast cancer. Whilst studies have correlated baseline lymphocyte levels with subsequent pCR, few have studied the impact of neoadjuvant therapy on the immune environment. Methods We performed TIL analysis and T-cell analysis by IHC on the pretreatment and ‘On-treatment’ samples from patients recruited on the Phase-II TCHL (NCT01485926) clinical trial. Data were analysed using the Wilcoxon signed-rank test and the Spearman rank correlation. Results In our sample cohort (n = 66), patients who achieved a pCR at surgery, post-chemotherapy, had significantly higher counts of TILs (p = 0.05) but not SLs (p = 0.08) in their pre-treatment tumour samples. Patients who achieved a subsequent pCR after completing neo-adjuvant chemotherapy had significantly higher SLs (p = 9.09 × 10–3) but not TILs (p = 0.1) in their ‘On-treatment’ tumour biopsies. In a small cohort of samples (n = 16), infiltrating lymphocyte counts increased after 1 cycle of neo-adjuvant chemotherapy only in those tumours of patients who did not achieve a subsequent pCR. Finally, reduced CD3 + (p = 0.04, rho = 0.60) and CD4 + (p = 0.01, rho = 0.72) T-cell counts in 'On-treatment' biopsies were associated with decreased residual tumour content post-1 cycle of treatment; the latter being significantly associated with increased likelihood of subsequent pCR (p < 0.01). Conclusions The immune system may be ‘primed’ prior to neoadjuvant treatment in those patients who subsequently achieve a pCR. In those patients who achieve a pCR, their immune response may return to baseline after only 1 cycle of treatment. However, in those who did not achieve a pCR, neo-adjuvant treatment may stimulate lymphocyte influx into the tumour. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06244-1.
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Affiliation(s)
- A J Eustace
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
| | - S F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - E W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S Furney
- Department of Physiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - A Fagan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - A D Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - J M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - O Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - C Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Duke
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - W M Gallagher
- Conway Institute, University College Dublin, Dublin, Ireland
| | - N O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - J Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Cancer Trials Ireland, Dublin, Ireland
| | - S Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B T Hennessy
- Cancer Trials Ireland, Dublin, Ireland.,Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Keelan S, Sorensen J, Downey E, Hegarty A, Nelson T, Duke D, Power C, Hill A. O30: EVALUATION OF AXILLARY LYMPH NODE METASTATIC BURDEN BY PREOPERATIVE ULTRASOUND. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Sentinel lymph node biopsy (SLNB) is the gold standard for determining axillary nodal status. There is growing interest in using preoperative axillary ultrasound (AUS) as a non-invasive means of assessing the axilla. However, AUS has limited sensitivity and is subject to operator dependency. This study aimed to quantify axillary nodal burden in preoperative AUS.
Method
This retrospective study used an institutional database of all primary invasive breast carcinomas from 2006–2019. Those with pathologically proven axillary metastatic disease were included. Patients were considered in two groups, low nodal burden/LNB(1-2LN) and high nodal burden/HNB(≥3LN) based on total positive lymph node count(SLNB+ALND). Preoperative AUS reports were assessed to determine those suspicious for axillary metastasis.
Result
Of the 347 patients (n=349 axillae), 77.9% had LNB and 22.1% had HNB. In patients with LNB, 228(83.8%) had a normal AUS versus 44(16.2%) suspicious AUS. In those with HNB 60(77.9%) had normal AUS findings versus 17(22.1%) suspicious findings. On multivariate analysis Nottingham Grade-3 was associated with suspicious AUS findings (p=0.02). However, receptor status, SLN macro-metastasis and extra-nodal extension were not associated with abnormal AUS.
Conclusion
As the surgical approach to the axilla becomes increasingly conservative, detection of axillary involvement by non-invasive means is an area of increasing research. In this cohort, AUS did not reliably identify patients with axillary metastasis. These results highlight the challenges in accurately assessing the axilla using preoperative AUS, which may result in axillary undertreatment if used as an alternative to surgical staging.
Take-home message
As the surgical approach to the axilla becomes increasingly conservative, detection of axillary involvement by non-invasive means is an area of increasing research. This study highlights the challenges in accurately assessing the axilla using preoperative AUS, which may result in axillary undertreatment if used as an alternative to surgical staging.
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Affiliation(s)
- S Keelan
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - J Sorensen
- Royal College of Surgeons in Ireland, Department of Surgery, Healthcare Outcomes Research Centre (HORC), Beaux Lane House, Mercer Street Lower, Dublin 2
| | - E Downey
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - A Hegarty
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - T Nelson
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - D Duke
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
| | - C Power
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
| | - A Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
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Patel PG, Keen P, McManus H, Duck T, Callander D, Selvey C, Power C, Gray RT, Knight V, Asselin J, Read P, Johnson K, Bavinton BR, Bowden VJ, Grulich AE, Guy R. Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men. HIV Med 2021; 22:605-616. [PMID: 33876526 DOI: 10.1111/hiv.13102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia. DESIGN We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. METHODS Six indicators were measured: (1) state-wide total HIV laboratory tests; (2) number of GBM attending publicly-funded clinics; (3) 12-monthly testing uptake; (4) annual testing frequency; (5) HIV testing with a STI diagnosis; and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas-born. RESULTS Overall, 43,560 GBM attended participating clinics (22,662 Australian-born, 20,834 overseas-born) from 2010-2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p<0.001 for all) in testing uptake (83.9% to 95.1%); testing with a STI diagnosis (68.7% to 94.0%); annual HIV testing frequency (1.4 to 2.7); and a decreasing trend (p<0.01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian-born and overseas-born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian-born GBM (7.1% to 2.8%), but an increasing trend in overseas-born GBM (15.3% to 16.9%) (p<0.001 for all).
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Affiliation(s)
- P G Patel
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - P Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - H McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - T Duck
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | - D Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,New York University Spatial Epidemiology Lab, School of Medicine, New York University, New York, NY, USA
| | - C Selvey
- Health Protection NSW, Sydney, Australia
| | - C Power
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | - R T Gray
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - V Knight
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - J Asselin
- Burnet Institute, Melbourne, NSW, Australia
| | - P Read
- Kirketon Road Centre, Kings Cross, NSW, Australia
| | | | - B R Bavinton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - V J Bowden
- Health Protection NSW, Sydney, Australia
| | - A E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - R Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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20
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Keelan S, Heeney A, Downey E, Hegarty A, Roche T, Power C, Mhuircheartaigh NN, Duke D, Kerr J, Hambly N, Hill A. Breast cancer patients with a negative axillary ultrasound may have clinically significant nodal metastasis. Breast Cancer Res Treat 2021; 187:303-310. [PMID: 33837870 DOI: 10.1007/s10549-021-06194-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/12/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The non-invasive nature of the preoperative axillary ultrasound (AUS) fits the current trend of increasingly conservative axillary management. Recent publications suggest that early disease patients with clinically and radiologically negative axillae do not require sentinel lymph node biopsy (SLNB). This study aims to determine the true extent of axillary node disease in negative preoperative AUS patients. METHODS A 10-year breast cancer registry was reviewed to identify women with pathologically confirmed T1-2 invasive breast cancer and a negative preoperative AUS. Patients who received neoadjuvant chemotherapy were excluded. Combined positive lymph node count of SLNB ± ALND was used to determine total nodal burden (TNB). Axillae were classified into low nodal burden (LNB) defined as 1-2 positive nodes and high nodal burden (HNB) defined as ≥ 3 positive nodes. RESULTS 762 patients with negative AUS were included. There were 46.9% and 53.0% T1 and T2 tumours, respectively. 76.9% were node negative (0 LN +), 18.9% had LNB (1-2 LN +) and 4.2% had HNB (≥ 3LN +). Specifically, HNB disease was seen in 2% of T1 tumours and 6.2 % of T2 tumours with a negative AUS. In multivariate analysis, T2 strongly associated with ≥ 3 positive ALNs (OR 2.66 CI 1.09-6.51 p = 0.03) as did lymphovascular invasion (OR 3.56 CI 1.52-8.30 p = < 0.01). CONCLUSION This study shows that AUS in its current form cannot exclude HNB axillary metastasis to the extent of eliminating the need for surgical staging of the axilla. This may impact axillary local-regional recurrence and disease-free survival. We caution that a negative AUS has a rate of 4.2% of HNB. Therefore, in cases of negative AUS with a T2 tumour, we advocate continued use of SLNB.
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Affiliation(s)
- Stephen Keelan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Anna Heeney
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Eithne Downey
- Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Aisling Hegarty
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Trudi Roche
- Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Deirdre Duke
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Niamh Hambly
- Department of Radiology, Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
| | - Arnold Hill
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
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21
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Cheng C, Gomez D, McCombe JA, Smyth P, Giuliani F, Blevins G, Baker GB, Power C. Disability progression in multiple sclerosis is associated with plasma neuroactive steroid profile. Neurol Sci 2021; 42:5241-5247. [PMID: 33829329 DOI: 10.1007/s10072-021-05203-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neuroactive steroids (NASs) exert multiple biological effects on development and inflammation. The effects of NASs on disease progression in multiple sclerosis (MS) are uncertain, prompting analyses of NAS profiles during the transition from clinically isolated syndrome (CIS) to relapsing-remitting (RR) MS. METHODS Subjects with CIS or RRMS and healthy controls (HCs) were recruited; demographic and clinical data as well as disability scores measured by the Expanded Disability Status Scale (EDSS) were recorded. Matched plasma NAS and amino acid (AA) concentrations were measured. RESULTS HC (n = 17), CIS (n = 31), and RRMS (n = 33) groups showed similar ages and sex distribution although disability scores were higher in the RRMS group. The conversion rate of CIS to RRMS group was 51.6% (n = 16) during a mean follow-up period of 1.85 years. The RRMS group showed significantly higher mean allopregnanolone, aspartate, and taurine concentrations with lower epiallopregnanolone concentrations than CIS patients, and higher L-serine-O-phosphate and lower alanine, arginine, and glutamine concentrations than the HC group. Among CIS and RRMS groups, multivariate hierarchical regressions revealed that higher concentrations of plasma tetrahydrodeoxycorticosterone (THDOC) may predict disability worsening. CONCLUSIONS RRMS and CIS patients exhibited differing concentrations of both NASs and AAs in plasma while both THDOC and pregnanolone might serve as biomarkers of disability worsening.
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Affiliation(s)
- C Cheng
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D Gomez
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - J A McCombe
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - P Smyth
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - F Giuliani
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - G Blevins
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - G B Baker
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - C Power
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada. .,Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada.
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22
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Crone LN, Boland M, Elwahab SMA, Allen M, Power C, Hill ADK. AB191. SOH21AS243. Prevention of venous thromboembolism in breast cancer surgery: a systematic review. Mesentery Peritoneum 2021; 5:AB191-AB191. [DOI: 10.21037/map-21-ab191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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23
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O'Brien MMC, Hannigan O, Power C, Lawlor B, Robinson D. Family members' attitudes towards telling the patient with Alzheimer's disease their diagnosis: a 20-year repeat study. Eur Geriatr Med 2021; 12:881-885. [PMID: 33609267 DOI: 10.1007/s41999-021-00464-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/30/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Exploring family members' attitudes to an Alzheimer's disease diagnosis compared to that of a study 20 years prior by Maguire et al. (BMJ 313:529-530, 1996). METHODS The survey was a replica of that completed 20 years prior in the same department by Maguire et al. (BMJ 313:529-530, 1996). With ethics approval and consent, family members were surveyed regarding their attitudes towards a dementia diagnosis. Completed by doctors with 100 consecutive respondents accompanying patients to scheduled memory clinic appointments. Themes were generated, results compiled and compared to the previous study. RESULTS Respondents are now over four times more likely to favour disclosure over non-disclosure to a patient (chi-squared 68.142, p < 0.0001). A substantial decrease is evident in those listing fear of evoking a negative reaction. Accordingly, there is an increase in those referring to the benefits of disclosure. CONCLUSION The emerged theme was that of autonomy versus paternalism, with attitude shift reflecting that patient privacy is an established patient right, taking precedence over paternalistic preferences.
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Affiliation(s)
- M M C O'Brien
- Memory Clinic, Mercer's Institute for Research on Ageing, St. James's Hospital, James's Street, Dublin 8., Dublin, Ireland.
| | - O Hannigan
- Memory Clinic, Mercer's Institute for Research on Ageing, St. James's Hospital, James's Street, Dublin 8., Dublin, Ireland
| | - C Power
- Memory Clinic, Mercer's Institute for Research on Ageing, St. James's Hospital, James's Street, Dublin 8., Dublin, Ireland
| | - B Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital, James's Street, Dublin 8., Dublin, Ireland
| | - D Robinson
- Mercer's Institute for Research on Ageing, St. James's Hospital, James's Street, Dublin 8., Dublin, Ireland
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24
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Christiansen C, Castillo-Fernandez JE, Domingo-Relloso A, Zhao W, El-Sayed Moustafa JS, Tsai PC, Maddock J, Haack K, Cole SA, Kardia SLR, Molokhia M, Suderman M, Power C, Relton C, Wong A, Kuh D, Goodman A, Small KS, Smith JA, Tellez-Plaza M, Navas-Acien A, Ploubidis GB, Hardy R, Bell JT. Novel DNA methylation signatures of tobacco smoking with trans-ethnic effects. Clin Epigenetics 2021; 13:36. [PMID: 33593402 PMCID: PMC7888173 DOI: 10.1186/s13148-021-01018-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking remains one of the leading preventable causes of death. Smoking leaves a strong signature on the blood methylome as shown in multiple studies using the Infinium HumanMethylation450 BeadChip. Here, we explore novel blood methylation smoking signals on the Illumina MethylationEPIC BeadChip (EPIC) array, which also targets novel CpG-sites in enhancers. METHOD A smoking-methylation meta-analysis was carried out using EPIC DNA methylation profiles in 1407 blood samples from four UK population-based cohorts, including the MRC National Survey for Health and Development (NSHD) or 1946 British birth cohort, the National Child Development Study (NCDS) or 1958 birth cohort, the 1970 British Cohort Study (BCS70), and the TwinsUK cohort (TwinsUK). The overall discovery sample included 269 current, 497 former, and 643 never smokers. Replication was pursued in 3425 trans-ethnic samples, including 2325 American Indian individuals participating in the Strong Heart Study (SHS) in 1989-1991 and 1100 African-American participants in the Genetic Epidemiology Network of Arteriopathy Study (GENOA). RESULTS Altogether 952 CpG-sites in 500 genes were differentially methylated between smokers and never smokers after Bonferroni correction. There were 526 novel smoking-associated CpG-sites only profiled by the EPIC array, of which 486 (92%) replicated in a meta-analysis of the American Indian and African-American samples. Novel CpG sites mapped both to genes containing previously identified smoking-methylation signals and to 80 novel genes not previously linked to smoking, with the strongest novel signal in SLAMF7. Comparison of former versus never smokers identified that 37 of these sites were persistently differentially methylated after cessation, where 16 represented novel signals only profiled by the EPIC array. We observed a depletion of smoking-associated signals in CpG islands and an enrichment in enhancer regions, consistent with previous results. CONCLUSION This study identified novel smoking-associated signals as possible biomarkers of exposure to smoking and may help improve our understanding of smoking-related disease risk.
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Affiliation(s)
- C Christiansen
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - A Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Department of Statistics and Operative Research, University of Valencia, Valencia, Spain
| | - W Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - J S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - P-C Tsai
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - J Maddock
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - K Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, USA
| | - S A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, USA
| | - S L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - M Molokhia
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - M Suderman
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - C Power
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - C Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - A Wong
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - A Goodman
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - K S Small
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - J A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - M Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - A Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - G B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - R Hardy
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - J T Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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25
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Somers K, Abd Elwahab S, Raza MZ, O'Grady S, DeMarchi J, Butt A, Burke J, Robb W, Power C, McCawley N, McNamara D, Kearney D, Hill ADK. Impact of the COVID-19 pandemic on management and outcomes in acute appendicitis: Should these new practices be the norm? Surgeon 2021; 19:e310-e317. [PMID: 33750630 PMCID: PMC7879062 DOI: 10.1016/j.surge.2021.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/01/2020] [Accepted: 01/12/2021] [Indexed: 02/09/2023]
Abstract
Background In early 2020, the COVID-19 pandemic significantly altered management of surgical patients globally. International guidelines recommended that non-operative management be implemented wherever possible (e.g. in proven uncomplicated appendicitis) to reduce pressure on healthcare services and reduce risk of peri-operative viral transmission. We sought to compare our management and outcomes of appendicitis during lockdown vs a non-pandemic period. Methods All presentations to our department with a clinical diagnosis of acute appendicitis between 12/03/2020 and 30/06/2020 were compared to the same 110-day period in 2019. Quantity and severity of presentations, use of radiological investigations, rate of operative intervention and histopathological findings were variables collected for comparison. Results There was a reduction in appendicitis presentations (from 74 to 56 cases), and an increase in radiological imaging (from 70.27% to 89.29%) (P = 0.007) from 2019 to 2020. In 2019, 93.24% of patients had appendicectomy, compared to 71.42% in 2020(P < 0.001). This decrease was most pronounced in uncomplicated cases, whose operative rates dropped from 90.32% to 62.5% (P = 0.009). Post-operative histology confirmed appendicitis in 73.9% in 2019, compared to 97.5% in 2020 (P = 0.001). Normal appendiceal pathology was reported for 17 cases (24.64%) in 2019, compared to none in 2020 (P < 0.001) – a 0% negative appendicectomy rate (NAR). Discussion The 0% NAR in 2020 is due to a combination of increased CT imaging, a higher threshold to operate, and is impacted by increased disease severity due to delayed patient presentation. This study adds to growing literature promoting routine use of radiological imaging to confirm appendicitis diagnosis. As we enter a second lockdown, patients should be encouraged to avoid late presentations, and surgical departments should continue using radiological imaging more liberally in guiding appendicitis management.
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Affiliation(s)
- Kate Somers
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland.
| | - Sami Abd Elwahab
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | | | - Sorcha O'Grady
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Joshua DeMarchi
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Abeeda Butt
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - John Burke
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - William Robb
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Colm Power
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Niamh McCawley
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Deborah McNamara
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - David Kearney
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
| | - Arnold D K Hill
- Department of Surgery, Beaumont Hospital, Beaumont Rd, Beaumont, Dublin 9, Ireland
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26
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Rutherford E, Noray R, Ó hEarráin C, Quinlan K, Hegarty A, Ekpotu L, Arize C, Fabamwo F, Alrubaiaan A, Bhupalan A, Alshehhi A, Power C, Hill ADK. Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study. JMIR Perioper Med 2020; 3:e12491. [PMID: 33932277 PMCID: PMC7728406 DOI: 10.2196/12491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/05/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Escalating demand for specialist health care puts considerable demand on hospital services. Technology offers a means by which health care providers may increase the efficiency of health care delivery. Objective The aim of this study was to conduct a pilot study of the feasibility, benefits, and drawbacks of a virtual clinic (VC) in the general surgical service of a busy tertiary center. Methods Patient satisfaction with current care and attitudes to VC were surveyed prospectively in the general surgical outpatient department (OPD; n=223). A subset of patients who had undergone endoscopy and day surgery were recruited to follow-up in a VC and subsequently surveyed with regard to their satisfaction (20/243). Other outcomes measured included a comparison of consultation times in traditional and virtual outpatient settings and financial cost to both patients and the institution. Results Almost half of the patients reported barriers to prospective use of VCs. However, within the cohort who had been followed-up in the VC, satisfaction was higher than the traditional OPD (100% as compared with 187/223, 83.9%). Significant savings in both time (P=.003) and financial costs to patients and the institution were found. Conclusions For an appropriately selected group of patients, VCs offer a viable alternative to traditional OPD. This alternative can improve both patient satisfaction and efficiency of patient care.
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Affiliation(s)
- Emily Rutherford
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roghinio Noray
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caolán Ó hEarráin
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin Quinlan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lenin Ekpotu
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chinedum Arize
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiyinfoluwa Fabamwo
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Avinash Bhupalan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abdulla Alshehhi
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Power C, Williams C, Brown A. Does childbirth experience affect infant behaviour? Exploring the perceptions of maternity care providers. Midwifery 2019; 78:131-139. [PMID: 31437757 DOI: 10.1016/j.midw.2019.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE High levels of childbirth interventions are known to increase risk of health complications for mother and infant, alongside having a negative impact upon maternal wellbeing. However less is understood about how childbirth experience may affect infant behaviour (e.g. how calm or unsettled an infant is). This study explores maternity care provider perceptions of how and why childbirth experience may affect infant behaviour. DESIGN A qualitative semi-structured interview study. SETTING Bristol, Swansea and West Wales, UK. PARTICIPANTS 18 maternity care providers. MEASUREMENTS AND FINDINGS A semi-structured interview schedule was developed to explore maternity care providers' perceptions of how maternal experience of childbirth could influence infant behaviour. Findings highlighted how maternity care providers perceived childbirth experience to sometimes impact positively or negatively on infant behaviour. A calmer birth and postnatal experience was believed to lead to a calmer infant, whilst physical and emotional stress was associated with more challenging infant behaviours such as crying and being unsettled. Pathways were perceived to be direct (pain and stress during birth might physiologically affect the infant) and indirect (birth was perceived to affect maternal wellbeing and subsequently her interactions with her baby). However, postnatal factors such as skin to skin, postnatal environment and emotional support were believed to mediate these impacts. KEY CONCLUSIONS Birth experience was considered to affect infant behaviour. Promoting as positive a birth experience as possible, including postnatal care, was viewed as significant in supporting positive infant behaviours. Maternity care providers believed this could help facilitate bonding, attachment, and mother-infant wellbeing in the postnatal period. IMPLICATIONS FOR PRACTICE The findings highlight maternity care providers' views concerning supporting normal birth and protecting emotional wellbeing during birth and postnatally. Where interventions are necessary, ensuring a calm environment, and enabling normal postnatal behaviours such as skin to skin and breastfeeding were perceived as important. Midwives, it was claimed, need time to nurture mothers alongside providing physical care. LIMITATIONS Participants were self-selecting and might therefore have been biased.
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Affiliation(s)
- C Power
- Department of Public Health, Policy and Social Sciences, Swansea University, Wales, UK
| | - C Williams
- Department of Psychology, Swansea University, Wales, UK
| | - A Brown
- Department of Public Health, Policy and Social Sciences, Swansea University, Wales, UK; Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Wales, UK.
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Balcom EF, Roda WC, Cohen EA, Li MY, Power C. HIV-1 persistence in the central nervous system: viral and host determinants during antiretroviral therapy. Curr Opin Virol 2019; 38:54-62. [PMID: 31390580 DOI: 10.1016/j.coviro.2019.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/30/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
Despite remarkable therapeutic advances in the past two decades, the elimination of human immunodeficiency virus type 1 (HIV-1) from latent reservoirs constitutes a major barrier to eradication and preventing neurological disease associated with HIV/AIDS. Invasion of the central nervous system (CNS) by HIV-1 occurs early in infection, leading to viral infection and productive persistence in brain macrophage-like cells (BMCs) including resident microglia and infiltrating macrophages. HIV-1 persistence in the brain and chronic neuroinflammation occur despite effective treatment with antiretroviral therapy (ART). This review examines the evidence from clinical studies, in vivo and in vitro models for HIV-1 CNS persistence, as well as therapeutic considerations in targeting latent CNS reservoirs.
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Affiliation(s)
- E F Balcom
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - W C Roda
- Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - E A Cohen
- Departments of Microbiology and Immunology, University of Montreal, Montreal Clinical Research Institute, Montreal, QC, Canada
| | - M Y Li
- Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - C Power
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada.
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Abdullah N, O’Leary DP, Hegarty A, Albathali M, Mushtaque M, Ajmal N, Power C, Hill ADK. The effect of surgical site infection in immediate breast reconstruction on breast cancer recurrence. Breast J 2019; 25:166-168. [DOI: 10.1111/tbj.13180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nassreen Abdullah
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
| | - D. Peter O’Leary
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
| | - Aisling Hegarty
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
| | | | - Muhammad Mushtaque
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
| | - Nadeem Ajmal
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Plastic and Reconstructive Surgery Beaumont Hospital Dublin Ireland
| | - Colm Power
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
| | - Arnold D. K. Hill
- Royal College of Surgeons in Ireland Dublin Ireland
- Department of Breast and Endocrine Surgery Beaumont Hospital Dublin Ireland
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30
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Li L, Pinto Pereira SM, Power C. Childhood maltreatments, child-to-adult BMI and cardiometabolic disease risk in mid-adulthood. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Li
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - SM Pinto Pereira
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - C Power
- University College London Great Ormond Street Institute of Child Health, London, UK
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31
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Hannan E, Peter O’Leary D, Cheung C, Buhamad F, O’Donoghue G, Manning A, Oliver Murphy J, Hill A, Power C. Knowledge of breast cancer risk factors, screening, and treatment methods in patients attending the breast clinic: A survey of 1,018 women. Breast J 2018; 24:1094-1096. [DOI: 10.1111/tbj.13082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
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32
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Hanley BP, Walsh S, O'Leary DP, MacNally SP, Power C, Farrell M, Hill A. Reply Letter to the Editor. Breast J 2018; 24:1141. [PMID: 30051549 DOI: 10.1111/tbj.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Brian P Hanley
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Siun Walsh
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Donal P O'Leary
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Colm Power
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Arnold Hill
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
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33
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Hanley BP, Walsh SM, O'Leary DP, MacNally SP, Power C, Farrell M, Hill AD. The significance of receptor status discordance between breast cancer primary and brain metastasis. Breast J 2018. [PMID: 29517180 DOI: 10.1111/tbj.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Brian P Hanley
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Siun M Walsh
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | - Donal P O'Leary
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Colm Power
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Arnold D Hill
- Breast and Endocrine Surgery, Beaumont Hospital, Dublin, Ireland
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34
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Nüesch E, Dale C, Palmer TM, White J, Keating BJ, van Iperen EP, Goel A, Padmanabhan S, Asselbergs FW, Verschuren WM, Wijmenga C, Van der Schouw YT, Onland-Moret NC, Lange LA, Hovingh GK, Sivapalaratnam S, Morris RW, Whincup PH, Wannamethe GS, Gaunt TR, Ebrahim S, Steel L, Nair N, Reiner AP, Kooperberg C, Wilson JF, Bolton JL, McLachlan S, Price JF, Strachan MW, Robertson CM, Kleber ME, Delgado G, März W, Melander O, Dominiczak AF, Farrall M, Watkins H, Leusink M, Maitland-van der Zee AH, de Groot MC, Dudbridge F, Hingorani A, Ben-Shlomo Y, Lawlor DA, Amuzu A, Caufield M, Cavadino A, Cooper J, Davies TL, Drenos F, Engmann J, Finan C, Giambartolomei C, Hardy R, Humphries SE, Hypponen E, Kivimaki M, Kuh D, Kumari M, Ong K, Plagnol V, Power C, Richards M, Shah S, Shah T, Sofat R, Talmud PJ, Wareham N, Warren H, Whittaker JC, Wong A, Zabaneh D, Davey Smith G, Wells JC, Leon DA, Holmes MV, Casas JP. Adult height, coronary heart disease and stroke: a multi-locus Mendelian randomization meta-analysis. Int J Epidemiol 2018; 45:1927-1937. [PMID: 25979724 PMCID: PMC5841831 DOI: 10.1093/ije/dyv074] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/12/2022] Open
Abstract
Background: We investigated causal effect of completed growth, measured by adult height, on coronary heart disease (CHD), stroke and cardiovascular traits, using instrumental variable (IV) Mendelian randomization meta-analysis. Methods: We developed an allele score based on 69 single nucleotide polymorphisms (SNPs) associated with adult height, identified by the IBCCardioChip, and used it for IV analysis against cardiovascular risk factors and events in 21 studies and 60 028 participants. IV analysis on CHD was supplemented by summary data from 180 height-SNPs from the GIANT consortium and their corresponding CHD estimates derived from CARDIoGRAMplusC4D. Results: IV estimates from IBCCardioChip and GIANT-CARDIoGRAMplusC4D showed that a 6.5-cm increase in height reduced the odds of CHD by 10% [odds ratios 0.90; 95% confidence intervals (CIs): 0.78 to 1.03 and 0.85 to 0.95, respectively],which agrees with the estimate from the Emerging Risk Factors Collaboration (hazard ratio 0.93; 95% CI: 0.91 to 0.94). IV analysis revealed no association with stroke (odds ratio 0.97; 95% CI: 0.79 to 1.19). IV analysis showed that a 6.5-cm increase in height resulted in lower levels of body mass index (P < 0.001), triglycerides (P < 0.001), non high-density (non-HDL) cholesterol (P < 0.001), C-reactive protein (P = 0.042), and systolic blood pressure (P = 0.064) and higher levels of forced expiratory volume in 1 s and forced vital capacity (P < 0.001 for both). Conclusions: Taller individuals have a lower risk of CHD with potential explanations being that taller people have a better lung function and lower levels of body mass index, cholesterol and blood pressure.
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Affiliation(s)
- Eveline Nüesch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Caroline Dale
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom M Palmer
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Jon White
- UCL Genetics Institute, Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Brendan J Keating
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Surgery.,Division of Genetics, University of Pennsylvania, Philadelphia
| | - Erik Pa van Iperen
- Department of Biostatistics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anuj Goel
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | | | | | | | | | | | - Leslie A Lange
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G K Hovingh
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Suthesh Sivapalaratnam
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Richard W Morris
- Department of Primary Care & Population Health, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Goya S Wannamethe
- Department of Primary Care & Population Health, University College London, London, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shah Ebrahim
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Steel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Nair
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA / Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James F Wilson
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer L Bolton
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Stela McLachlan
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jacqueline F Price
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Christine M Robertson
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Marcus E Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Winfried März
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Germany, Synlab Academy, Synlab Services GmbH, Mannheim and Augsburg, Germany, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | | | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Farrall
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Maarten Leusink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mark Ch de Groot
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Dudbridge
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aroon Hingorani
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - D Zabaneh
- UCLEB, London, Edinburgh and Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Community Medicine, Arctic University of Norway, UiT
| | - Michael V Holmes
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Department of Surgery and Clinical Epidemiology Unit, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Juan P Casas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
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Geoffroy MC, Gunnell D, Clark C, Power C. Are early-life antecedents of suicide mortality associated with psychiatric disorders and suicidal ideation in midlife? Acta Psychiatr Scand 2018; 137:116-124. [PMID: 29270976 DOI: 10.1111/acps.12844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish whether previously identified early-life antecedents of suicide mortality (i.e. low birthweight, younger maternal age, higher birth order, externalizing problems and adversities) are associated with proximal psychiatric disorders and suicidal ideation, which are themselves associated with an increased risk of suicide. METHODS Participants were from the 1958 British birth-cohort (N = 8905) with information on prenatal/childhood experiences and the Clinical Interview Schedule-Revised at age 45 years. Outcomes were as follows: any internalizing disorder (anxiety disorder/depressive episode), depressive episode, alcohol use disorder and suicidal ideation. RESULTS After adjustment, higher birth order (Ptrend = 0.043), younger maternal age (Ptrend = 0.017) and increased number of childhood adversities (Ptrend = 0.026) were associated with an increased risk of internalizing disorders. For example, the OR (95% CI) in fourth- or later-born children was 1.48 (1.06-2.07) and for young maternal age (<19 years) was 1.31 (0.89-1.91). Effect sizes were similar in magnitude for depressive episode and suicidal ideation, although associations did not reach conventional significance levels. No associations were found for low birthweight and externalizing problems (in males) and investigated outcomes. CONCLUSION Associations for younger maternal age, higher birth order and adversities with adult internalizing disorders suggest that psychiatric disorders may be on the pathway linking some early-life factors and suicide.
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Affiliation(s)
- M-C Geoffroy
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - D Gunnell
- Department of Population Health Sciences and National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - C Clark
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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Hill A, Martin S, Power C, McDermott E, O’Higgins N, Murphy K, Kavanagh D. Life threatening haemorrhagic events associated with the administration of low-molecular-weight-heparin. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614277] [Citation(s) in RCA: 4] [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: 10/28/2022]
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37
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Yostos M, Hill ADK, Power C, O'Leary DP, Doyle F. The 100 most influential manuscripts in parathyroidectomy surgery: A bibliometric analysis. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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38
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Hooks T, McCarthy O, Power C, Macken-Walsh Á. A co-operative business approach in a values-based supply chain: A case study of a beef co-operative. Journal of Co-operative Organization and Management 2017. [DOI: 10.1016/j.jcom.2017.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quinlan K, Mushtaque M, O'Leary DP, Dhannoon A, Broe P, Agha A, Smith D, Thompson C, Baban C, Pritchard R, McDermott E, Lowery A, Quill D, Majeed M, Redmond HP, Power C, Hill A. Challenging the rule of 10% in phaeochromocytoma. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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40
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Toomey S, Eustace AJ, Fay J, Sheehan KM, Carr A, Milewska M, Madden SF, Teiserskiene A, Kay EW, O'Donovan N, Gallagher W, Grogan L, Breathnach O, Walshe J, Kelly C, Moulton B, Kennedy MJ, Gullo G, Hill AD, Power C, Duke D, Hambly N, Crown J, Hennessy BT. Impact of somatic PI3K pathway and ERBB family mutations on pathological complete response (pCR) in HER2-positive breast cancer patients who received neoadjuvant HER2-targeted therapies. Breast Cancer Res 2017; 19:87. [PMID: 28750640 PMCID: PMC5530949 DOI: 10.1186/s13058-017-0883-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 04/21/2017] [Accepted: 07/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background The Cancer Genome Atlas analysis revealed that somatic EGFR, receptor tyrosine-protein kinase erbB-2 (ERBB2), Erb-B2 receptor tyrosine kinase 3 (ERBB3) and Erb-B2 receptor tyrosine kinase 4 (ERBB4) gene mutations (ERBB family mutations) occur alone or co-occur with somatic mutations in the gene encoding the phosphatidylinositol 3-kinase (PI3K) catalytic subunit (PIK3CA) in 19% of human epidermal growth factor receptor 2 (HER2)-positive breast cancers. Because ERBB family mutations can activate the PI3K/AKT pathway and likely have similar canonical signalling effects to PI3K pathway mutations, we investigated their combined impact on response to neoadjuvant HER2-targeted therapies. Methods Baseline tumour biopsies were available from 74 patients with HER2-positive breast cancer who were enrolled in the phase II TCHL neoadjuvant study (ICORG 10-05) assessing TCH (docetaxel, carboplatin, trastuzumab) (n = 38) versus TCL (docetaxel, carboplatin, lapatinib) (n = 10) versus TCHL (docetaxel, carboplatin, trastuzumab, lapatinib) (n = 40), each for six cycles. Activating mutations in PIK3CA and ERBB family genes were identified using mass spectrometry-based genotyping. Phosphatase and tensin homolog (PTEN) expression was assessed by immunohistochemistry. Results PIK3CA and/or ERBB family mutations were detected in 23 (31.1%) tumour samples tested, whereas PTEN expression was low in 31.1% of cases tested. Mutation frequency was similar in each treatment arm (31.3% in TCH arm, 30% in TCL arm and 31.3% in TCHL arm) and was not influenced by oestrogen receptor (ER) status (27.6% in ER-negative patients, 33.3% in ER-positive patients) or progesterone receptor (PR) status (32.6% in PR-negative patients, 29% in PR-positive patients). There was no significant difference in pathological complete response (pCR) rates between 47 patients with wild-type (WT) tumours and 22 patients whose tumours carried mutations (in either PIK3CA or ERBB family genes) (42.5% vs. 54.5%; p = 0.439). Similarly, there was no significant difference in pCR rates between patients with PIK3CA/ERBB family mutated/PTEN-low (i.e., PI3K-activated) tumours and patients without PI3K activation (50% vs. 44%; p = 0.769). However, in the TCHL (but not the TCH) group, the pCR rate was higher for 9 patients with PIK3CA/ERBB family mutated tumours than for 20 patients with PIK3CA/ERBB family WT tumours (77.8% vs. 35%; p = 0.05). Conclusions Our results indicate that patients who receive neoadjuvant TCHL and have PIK3CA/ERBB family mutated tumours may be more likely to have a pCR than patients with WT tumours. Trial registration ClinicalTrials.gov, NCT01485926. Registered on 2 December 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0883-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland.
| | - Alexander J Eustace
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Joanna Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Katherine M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Malgorzata Milewska
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Stephen F Madden
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | | | - Elaine W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Norma O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - William Gallagher
- Cancer Biology and Therapeutics Laboratory, UCD School of Biomolecular and Biomedical Science, UCD Conway Institute,, University College Dublin, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Janice Walshe
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Catherine Kelly
- Department of Medical Oncology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - M John Kennedy
- Department of Medical Oncology, St. James Hospital, Dublin, Ireland
| | - Guiseppe Gullo
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, Royal College of Surgeons In Ireland, Dublin, Ireland
| | - Colm Power
- Department of Surgery, Royal College of Surgeons In Ireland, Dublin, Ireland
| | - Deirdre Duke
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Niamh Hambly
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - John Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland.,Cancer Trials Ireland, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Keegan NM, Toomey S, Fay J, Madden SF, Moran B, Milewska M, Das S, O'Connor D, Kennedy MJ, Power C, Hill AD, Egan K, Teiserskiene A, Kay E, Crown J, Eustace AJ, Hennessy B. Effect of TCHL-based therapy on immune cell content in on-treatment, neoadjuvant-treated HER2-positive breast cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.583] [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: 11/20/2022] Open
Abstract
583 Background: In the TCHL trial (NCT01485926) 78 women with HER2-positive breast cancer (BC) underwent neo-adjuvant treatment with either TCH (Docetaxel, Carboplatin, Trastuzumab) or TCHL (TCH + Lapatinib) therapy. Of the 78 patients, 24 consented to an optional on-treatment biopsy 20 days after 1 cycle of therapy. We analysed the impact of tumour infiltrating lymphocytes (TILs) on pathological complete response (pCR) and also determined the impact of TCH/TCHL therapy on immune cell modulation after 20 days of treatment. Methods: We assessed TIL and stromal lymphocytes (SL) counts using immunohistochemical staining with Haemotoxalyin+Eosin, AE1/AE3 and CD45 in formalin fixed paraffin embedded (FFPE) baseline biopsy samples and in fresh frozen (FF) biopsies taken 20-days post cycle 1 (Day-20) of TCH/TCHL. RNA libraries were generated, using the Truseq mRNA library prep kit on the Neoprep platform and sequenced on the NextSeq 500. We measured the transcriptomic profile of 8 pre and on-treatment sample pairs and then used the Microenvironment Cell Populations (MCP)-counter method to measure the abundance of 10 immune cell populations (T cells, CD8 T cells, cytotoxic lymphocytes, NK cells, B lineage, myeloid dendritic cells, neutrophils, endothelial cells and fibroblasts). Results: We found that higher baseline levels of TILs (p = 0.045) but not SL were associated with an increased likelihood of a patient achieving a pCR to TCH/L based therapy. We found in day 20 on-treatment biopsies of women that subsequently went onto have a pCR that levels of SLs but not TILs were significantly higher (p = 0.049) than in those women who did not have a pCR. Finally we found significant increases in the level of monocytes (p = 0.05) and fibroblasts (p = 0.01), but not other immune cell populations, in the day 20 on-treatment biopsies in comparison with the mutated pre-treatment biopsies. Conclusions: In our study baseline TILs but not SLs have a predictive role in the likelihood of a patient achieving a pCR. We also found that TCHL based therapy significantly altered both monocytes and fibroblasts, indicating a possible role for these immune subtypes in response to TCHL therapy.
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Affiliation(s)
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joanna Fay
- Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen F. Madden
- Population Health Sciences, Department of Psychology, Royal College of Surgeons, Dublin, Ireland
| | | | | | - Sudipto Das
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Darran O'Connor
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Colm Power
- LRCP and SI MB BCh NUI, Beaumont Hospital, Dublin, Ireland
| | - Arnold D. Hill
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Keith Egan
- Department of Medical Oncology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Elaine Kay
- Royal College of Surgeons in Ireland, Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - John Crown
- Irish Cooperative Oncology Research Group, Dublin, Ireland
| | - Alex J Eustace
- Medical Oncology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bryan Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Abdullah N, O'Leary P, Albathli M, Mustaque M, Power C, Hill A. The effect of surgical site infection in immediate breast reconstruction on breast cancer recurrence. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
BACKGROUND Childhood adversity predicts adolescent suicidal ideation but there are few studies examining whether the risk of childhood adversity extends to suicidal ideation in midlife. We hypothesized that childhood adversity predicts midlife suicidal ideation and this is partially mediated by adolescent internalizing disorders, externalizing disorders and adult exposure to life events and interpersonal difficulties. METHOD At 45 years, 9377 women and men from the UK 1958 British Birth Cohort Study participated in a clinical survey. Childhood adversity was prospectively assessed at the ages of 7, 11 and 16 years. Suicidal ideation at midlife was assessed by the depressive ideas subscale of the Revised Clinical Interview Schedule. Internalizing and externalizing disorders were measured by the Rutter scales at 16 years. Life events, periods of unemployment, partnership separations and alcohol dependence were measured through adulthood. RESULTS Illness in the household, paternal absence, institutional care, parental divorce and retrospective reports of parental physical and sexual abuse predicted suicidal ideation at 45 years. Three or more childhood adversities were associated with suicidal ideation at 45 years [odds ratio (OR) 4.31, 95% confidence interval (CI) 2.67-6.94]. Psychological distress at 16 years partially mediated the associations of physical abuse (OR 3.41, 95% CI 2.29-5.75), sexual abuse (OR 4.99, 95% CI 2.90-11.16) with suicidal ideation. Adult life events partially mediated the association of parental divorce (OR 6.34, 95% CI -7.16 to 36.75) and physical (OR 9.59, 95% CI 4.97-27.88) and sexual abuse (OR 6.59, 95% CI 2.40-38.36) with suicidal ideation at 45 years. CONCLUSIONS Adversity in childhood predicts suicidal ideation in midlife, partially mediated by adolescent internalizing and externalizing disorders, adult life events and interpersonal difficulties. Understanding the pathways from adversity to suicidal ideation can inform suicide prevention and the targeting of preventive interventions.
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Affiliation(s)
- S. A. Stansfeld
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Clark
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - M. Smuk
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Power
- Population, Policy and
Practice, University College London,
Institute of Child Health, 30 Guilford
Street, London WC1N 1EH, UK
| | - T. Davidson
- Centre for Gambling Research,
School of Sociology, Beryl Rawson Building,
The Australian National University,
Acton, ACT 2601, Australia
| | - B. Rodgers
- School of Demography, The
Australian National University, Acton, ACT
2601, Australia
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Branton WG, Lu JQ, Surette MG, Holt RA, Lind J, Laman JD, Power C. Brain microbiota disruption within inflammatory demyelinating lesions in multiple sclerosis. Sci Rep 2016; 6:37344. [PMID: 27892518 PMCID: PMC5125007 DOI: 10.1038/srep37344] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022] Open
Abstract
Microbial communities reside in healthy tissues but are often disrupted during disease. Bacterial genomes and proteins are detected in brains from humans, nonhuman primates, rodents and other species in the absence of neurological disease. We investigated the composition and abundance of microbiota in frozen and fixed autopsied brain samples from patients with multiple sclerosis (MS) and age- and sex-matched nonMS patients as controls, using neuropathological, molecular and bioinformatics tools. 16s rRNA sequencing revealed Proteobacteria to be the dominant phylum with restricted diversity in cerebral white matter (WM) from MS compared to nonMS patients. Both clinical groups displayed 1,200–1,400 bacterial genomes/cm3 and low bacterial rRNA:rDNA ratios in WM. RNAseq analyses showed a predominance of Proteobacteria in progressive MS patients’ WM, associated with increased inflammatory gene expression, relative to a broader range of bacterial phyla in relapsing-remitting MS patients’ WM. Although bacterial peptidoglycan (PGN) and RNA polymerase beta subunit immunoreactivities were observed in all patients, PGN immunodetection was correlated with demyelination and neuroinflammation in MS brains. Principal component analysis revealed that demyelination, PGN and inflammatory gene expression accounted for 86% of the observed variance. Thus, inflammatory demyelination is linked to an organ-specific dysbiosis in MS that could contribute to underlying disease mechanisms.
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Affiliation(s)
- W G Branton
- Department of Medicine, University of Alberta, Edmonton AB Canada.,Department of Laboratory Medicine &Pathology, University of Alberta, Edmonton AB Canada
| | - J Q Lu
- Department of Laboratory Medicine &Pathology, University of Alberta, Edmonton AB Canada.,Department of Psychiatry, University of Alberta, Edmonton AB Canada
| | - M G Surette
- Department of Medicine, McMaster University, Hamilton ON Canada
| | - R A Holt
- Genome Sciences Centre, Vancouver BC, Canada
| | - J Lind
- Department of Neurosciences, Section of Medical Physiology, Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen Netherlands
| | - J D Laman
- Multiple Sclerosis Centre, University of Alberta, Edmonton AB Canada
| | - C Power
- Department of Medicine, University of Alberta, Edmonton AB Canada.,Department of Laboratory Medicine &Pathology, University of Alberta, Edmonton AB Canada.,Department of Neurosciences, Section of Medical Physiology, Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen Netherlands
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Pinto Pereira SM, Li L, Power C. Child maltreatment and living standards in mid-adulthood: findings from the 1958 British birth cohort. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pinto Pereira SM, Li L, Power C. OP04 Associations between child maltreatment and mid-adulthood labour market participation, living standards and social mobility: findings from a British birth cohort. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Mackey LM, Blake C, Power C, Casey MB, Hearty C, Victory R, Fullen BM. Abstract PR326. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492722.73851.fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Li L, Pinto Pereira S, Power C. P32 Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Toomey S, Eustace AJ, Fay J, Milewska M, Teiserkiene A, Kay E, O'Connor D, Young LS, O'Donovan N, Grogan W, Breathnach OS, Walshe JM, Kennedy MJ, Hill AD, Power C, Duke D, Hambly N, Gallagher WM, Crown J, Hennessy B. Impact of somatic PIK3CA and ERBB family mutations on pathological complete reponse (pCR) in HER2-positive breast cancer patients who received neoadjuvant HER2-targeted therapies. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sinead Toomey
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Alex J Eustace
- Medical Oncology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joanna Fay
- Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Elaine Kay
- Royal College of Surgeons in Ireland, Centre for Systems Medicine, Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | | | - Leonie S Young
- Endocrine Oncology Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Norma O'Donovan
- Molecular Therapeutics for Cancer Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | | | | | - Arnold D. Hill
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Power
- LRCP & SI MB BCh NUI, Beaumont Hospital, Dublin, Ireland
| | | | | | | | - John Crown
- Irish Cooperative Oncology Research Group, Dublin, Ireland
| | - Bryan Hennessy
- Royal College of Surgeons in Ireland, Centre for Systems Medicine, Department of Medical Oncology, Dublin, Ireland
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