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Verdon M, Hunt I, Rawnsley R. The effectiveness of a virtual fencing technology to allocate pasture and herd cows to the milking shed. J Dairy Sci 2024:S0022-0302(24)00761-6. [PMID: 38642655 DOI: 10.3168/jds.2023-24537] [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: 12/12/2023] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
Virtual fencing technology provides an opportunity to rethink the management of intensive grazing systems in general, yet most studies have used products developed and applied to more extensive livestock systems. This research aimed to assess the application of a virtual fencing technology developed for the intensive pastoral dairy industry. The Halter system uses 2 primary cues, sound and vibration, and one aversive secondary cue, a low energy electrical pulse, to confine cows to a pasture allocation and remotely herd cows. Two groups of 40 mid-lactation multiparous dairy cows were studied (Bos taurus, predominantly Friesian and Friesian × Jersey, parity 1-8). Cows were milked twice per day and provided 9 kg pasture DM/day in a 24-h allocation, supplemented with 7 kg silage and 6 kg grain DM/day. Training to the Halter system occurred over 10 d after which cows were managed with the technology for a further 28 d. The type and time of cues delivered was recorded by each collar and communicated via a base-station to cloud data storage. Cows took less than a day to start responding to the sound cues delivered while held on a pasture allocation and were moving to the milking parlor without human intervention by d 4 of training. On training d 1, at least 60% of sound cues resulted in an electrical pulse. Across training d 2-10, 6.4% of sound cues resulted in a pulse. After the 10-d training period, 2.6% of sound cues resulted in a pulse. During the management period, 90% of cows spent ≤1.7 min/d beyond the virtual fence, received ≤ 0.71 pulse/d in the paddock and received ≤ 1 pulse/d during virtual herding to the parlor. By the final week of the management period, 50% of cows received zero pulses/week in the paddock and 35% received zero pulses/week during virtual herding. The number of pulses delivered per day and the pulse:sound cue ratio was lower in this study than that previously reported using other virtual fencing technologies. We conclude that the Halter technology is successful at containing lactating dairy cows in an intensive grazing system as well as at remotely herding animals to the milking parlor.
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Affiliation(s)
- Megan Verdon
- Tasmanian Institute of Agriculture, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia, 7320..
| | - Ian Hunt
- Tasmanian Institute of Agriculture, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia, 7320
| | - Richard Rawnsley
- Tasmanian Institute of Agriculture, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia, 7320
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Gabriel L, McVeigh T, Macmahon S, Avila Z, Donovan L, Hunt I, Draper A, Minchom A, Popat S, Davidson M, Bhosle J, Milner Watts C, Hubank M, Yuan L, O'Brien M. Familial rare EGFR-mutant lung cancer syndrome: Review of literature and description of R776H family. Lung Cancer 2024; 191:107543. [PMID: 38569279 DOI: 10.1016/j.lungcan.2024.107543] [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: 02/22/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Interest in hereditary lung cancer is increasing, in particular germline mutations in the Epidermal Growth Factor Receptor (EGFR) gene. We review the current literature on this topic, discuss risk of developing lung cancer, treatment and screening options and describe a family of 3 sisters with lung cancer and their unaffected mother all with a rare EGFR germline mutation (EGFR p.R776H). METHODS We searched PubMed, Medline, Embase, the Cochrane Library, Google Scholar and scanned reference lists of articles. Search terms included "EGFR germline" and "familial lung cancer" or "EGFR familial lung cancer". We also describe our experience of managing a family with rare germline EGFR mutant lung cancer. RESULTS Although the numbers are small, the described cases in the literature show several similarities. The patients are younger and usually have no or light smoking history. 50% of the patients were treated with a tyrosine kinase inhibitor (TKIs) with OS over six months. CONCLUSION Although rare, germline p.R776H EGFR lung cancer mutations are over-represented in light or never smoking female patients who often also possess an additional somatic EGFR mutation. Treatment with TKIs appears suitable but further research is needed into the appropriate screening regime for unaffected carriers or light/never smokers.
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Affiliation(s)
- L Gabriel
- Royal Marsden NHS Foundation Trust, London, England, UK.
| | - T McVeigh
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - S Macmahon
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - Z Avila
- St George's NHS Foundation Trust, London, England, UK
| | - L Donovan
- St George's NHS Foundation Trust, London, England, UK
| | - I Hunt
- St George's NHS Foundation Trust, London, England, UK
| | - A Draper
- St George's NHS Foundation Trust, London, England, UK
| | - A Minchom
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - S Popat
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - M Davidson
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - J Bhosle
- Royal Marsden NHS Foundation Trust, London, England, UK
| | | | - M Hubank
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - L Yuan
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - Mer O'Brien
- Royal Marsden NHS Foundation Trust, London, England, UK
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Dilena E, Close DC, Hunt I, Garland SM. Author Correction: Investigating how nitrogen nutrition and pruning impacts on CBD and THC concentration and plant biomass of Cannabis sativa. Sci Rep 2024; 14:7426. [PMID: 38548841 PMCID: PMC10978995 DOI: 10.1038/s41598-024-57679-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Affiliation(s)
- Enrico Dilena
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd,, Sandy Bay, TAS, 7005, Australia.
| | - Dugald C Close
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd,, Sandy Bay, TAS, 7005, Australia
| | - Ian Hunt
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd,, Sandy Bay, TAS, 7005, Australia
- Tasmanian Institute of Agriculture, University of Tasmania, Private Bag 1375, Prospect, TAS, 7250, Australia
| | - Sandra M Garland
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd,, Sandy Bay, TAS, 7005, Australia
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Dilena E, Close DC, Hunt I, Garland SM. Investigating how nitrogen nutrition and pruning impacts on CBD and THC concentration and plant biomass of Cannabis sativa. Sci Rep 2023; 13:19533. [PMID: 37945596 PMCID: PMC10636206 DOI: 10.1038/s41598-023-46369-5] [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: 04/04/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
Precise crop fertilization requires an in-depth understanding of plant uptake and utilisation to optimise sustainable production. This study investigated the influence of nitrogen (N) nutrition and pruning on the cannabinoid concentrations and biomass of a commercial cannabis cultivar; the rationale for this study is how N supply and pruning affect cannabinoid yields and concentration in a commercial setting. Clones of a Cannabis sativa L. (CBD-type) were grown in a controlled-environment glasshouse in pots with coarse sand. After five weeks of vegetative growth under 210 mg/L N and an 18 h light regime, rates of 30, 60, 210, and 500 mg/L N were applied to plants for twelve weeks and a light regime set at 12 h. Double stem pruning was applied as an additional treatment to investigate efficacy on biomass increase. Biomass, N concentrations, and cannabinoid concentrations were measured after the final harvest. Pruning treatment did not increase cannabinoid concentrations or affect biomass. It was coincidentally found that plants on the glasshouse edge with higher exposure to sunlight developed more biomass and higher cannabinoid concentrations. Only biomass in leaves was increased significantly via higher nitrogen nutrition. Cannabinoid concentration, as well as cannabinoid yield per plant were decreased with the increase in N supply. High rates of fertilizer are not recommended because of reduced cannabinoid concentration and biomass yield: the ideal N supply is likely to be between 60 and 210 mg/L. This research will benefit growers and advisors in understanding the complexity of effects of nitrogen fertiliser and pruning practices on plant biomass and secondary metabolite production in medicinal cannabis.
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Affiliation(s)
- Enrico Dilena
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd, Sandy Bay, TAS, 7005, Australia.
| | - Dugald C Close
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd, Sandy Bay, TAS, 7005, Australia
| | - Ian Hunt
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd, Sandy Bay, TAS, 7005, Australia
- Tasmanian Institute of Agriculture, University of Tasmania, Private Bag 1375, Prospect, TAS, 7250, Australia
| | - Sandra M Garland
- Tasmanian Institute of Agriculture (TIA), University of Tasmania, Life Sciences Building, Level 2, College Rd, Sandy Bay, TAS, 7005, Australia
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Sarkar D, Hunt I, Macdonald C, Wang B, Bowman JP, Tamplin ML. Modelling growth of Bacillus cereus in paneer by one-step parameter estimation. Food Microbiol 2023; 112:104231. [PMID: 36906319 DOI: 10.1016/j.fm.2023.104231] [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: 10/25/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
Bacillus cereus phylogenetic group III and IV strains are commonly associated with food products and cause toxin mediated foodborne diseases. These pathogenic strains have been identified from milk and dairy products, such as reconstituted infant formula and several cheeses. Paneer is a fresh, soft cheese originating from India that is prone to foodborne pathogen contamination, such as by Bacillus cereus. However, there are no reported studies of B. cereus toxin formation in paneer or predictive models quantifying growth of the pathogen in paneer under different environmental conditions. This study assessed enterotoxin-producing potential of B. cereus group III and IV strains, isolated from dairy farm environments, in fresh paneer. Growth of a four-strain cocktail of toxin-producing B. cereus strains was measured in freshly prepared paneer incubated at 5-55 °C and modelled using a one-step parameter estimation combined with bootstrap re-sampling to generate confidence intervals for model parameters. The pathogen grew in paneer between 10 and 50 °C and the developed model fit the observed data well (R2 = 0.972, RMSE = 0.321 log10 CFU/g). The cardinal parameters for B. cereus growth in paneer along with the 95% confidence intervals were: μopt 0.812 log10 CFU/g/h (0.742, 0.917); Topt is 44.177 °C (43.16, 45.49); Tmin is 4.405 °C (3.973, 4.829); Tmax is 50.676 °C (50.367, 51.144). The model developed can be used in food safety management plans and risk assessments to improve safety of paneer while also adding to limited information on B. cereus growth kinetics in dairy products.
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Affiliation(s)
- Dipon Sarkar
- Centre of Food Safety & Innovation, University of Tasmania, Private Bag 54, Sandy Bay, Tasmania, 7005, Australia.
| | - Ian Hunt
- Centre of Food Safety & Innovation, University of Tasmania, Private Bag 54, Sandy Bay, Tasmania, 7005, Australia.
| | - Cameron Macdonald
- Centre of Food Safety & Innovation, University of Tasmania, Private Bag 54, Sandy Bay, Tasmania, 7005, Australia.
| | - Bing Wang
- Department of Food Science and Technology, University of Nebraska-Lincoln, 1901 N 21st St, Lincoln, NE, 68588, United States.
| | - John P Bowman
- Centre of Food Safety & Innovation, University of Tasmania, Private Bag 54, Sandy Bay, Tasmania, 7005, Australia.
| | - Mark L Tamplin
- Centre of Food Safety & Innovation, University of Tasmania, Private Bag 54, Sandy Bay, Tasmania, 7005, Australia.
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Hirth MJ, Hunt I, Briody K, Milner Z, Sleep K, Chu A, Donovan E, O'Brien L. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: A randomized equivalence trial. J Hand Ther 2023; 36:347-362. [PMID: 34400031 DOI: 10.1016/j.jht.2021.06.006] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/28/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Multi--center randomized controlled trial with two intervention parallel groups. An equivalence trial. INTRODUCTION Relative motion extension (RME) orthoses are widely used in the postoperative management of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions to the RME only (without a wrist orthosis) approach has not been verified in clinical studies. PURPOSE OF THE STUDY To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes. METHODS Thirty-two adult (>18 years) participants (25 males, 7 females) were randomized to one of two intervention groups receiving either 1) a relative motion extension orthosis for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or 2) a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group); both groups for a period of four postoperative weeks. RESULTS Using a series of linear mixed models we found no differences between the intervention groups for the primary (ROM including TAM, TAM as a percentage of the contralateral side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength, QuickDASH and PRWHE scores. The models did identify several covariates that are correlated with outcome measures. The covariate 'Age' influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM and recovery of TAM compared to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates for some outcomes. DISCUSSION With similar outcomes between both intervention groups, the decision to include an additional night orthosis should be individually tailored for patients rather than protocol-based. As the covariates of 'Age' and 'Sex' influenced outcomes, these should be considered in clinical practice. CONCLUSIONS A relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded clinically similar results whilst allowing early functional hand use, without tendon rupture.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia.
| | - Ian Hunt
- TIA, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia
| | - Kelly Briody
- Occupational Therapy Department, Monash Health, Dandenong, Victoria, Australia
| | - Zoe Milner
- Occupational Therapy Department, Melbourne Health, Parkville, Victoria, Australia
| | - Kate Sleep
- Malvern Hand Therapy, Malvern, Victoria, Australia
| | - Angela Chu
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Emily Donovan
- Occupational Therapy Department, Western Health, Footscray, Victoria, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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D'Costa I, Hunt I, Russell L, Adams K. A racial bias test with tertiary cancer centre employees: why anti-racist measures are required for First Nations Australians cancer care equity. AUST HEALTH REV 2023; 47:5-12. [PMID: 35477644 DOI: 10.1071/ah21113] [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] [Received: 03/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023]
Abstract
Objective To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal-white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11-0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65-24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01-9.09). Conclusions Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it.
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Affiliation(s)
- I D'Costa
- School of Medicine, Nursing and Health Science, Monash University, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia; and Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia
| | - I Hunt
- University of Tasmania, Launceston, Australia
| | - L Russell
- Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, and Australian Research Council Centre of Excellence in Australian Biodiversity and Heritage, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
| | - K Adams
- Gukwonderuk Indigenous Health Unit, The Faculty of Medicine, Nursing and Health Sciences School, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
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Johnson B, Roumpf S, Kline J, Dandamudi G, Schaffer J, Flack T, Gallaher W, Weaver A, Hunt I, Thinnes E. 115 A Novel Order Set Driven Emergency Department Atrial Fibrillation Algorithm Drives Compliance With Risk-Appropriate Thromboembolic Prophylaxis and Increases the Frequency of Discharge to Home. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.139] [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: 11/01/2022]
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Chavoin JP, Facchini F, Leyx P, Hunt I, Benjoar MD, Molins L, Tiffet O, Ratdke C, Dornseifer U, Giovannini M, Chaput B, Redmond K. [Place of 3D custom-made implants after failure of modeling steno-chondro-plasties]. ANN CHIR PLAST ESTH 2022; 67:414-424. [PMID: 35933312 DOI: 10.1016/j.anplas.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Most common congenital malformation of the thorax, Pectus Excavatum affects about one in 500 people. Several surgical or medical techniques have been proposed. Some are followed by complications or insufficient results even though their constant functional value is highly controversial. Secondary surgery with a deep customized 3D elastomer implant, may be an elegant effective and safe solution compared to others; it allows a good aesthetic result expected by patients in the absence of any respiratory or cardio-vascular functional context.
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Affiliation(s)
- J-P Chavoin
- Service de chirurgie plastique reconstructrice et esthétique, CHU Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| | - F Facchini
- Service de chirurgie infantile, Hopital pédiatrique Meyer, Viale Gaetano Pieraccini 24, 50139 Florence, Italie
| | - P Leyx
- Recherche et développement, Anatomik Modeling SAS, 19, rue Jean Mermoz, 31100 Toulouse, France
| | - I Hunt
- Pectus Clinic, service de chirurgie thoraciqueSpire St. Anthony's Hospital Worcester Park, Sutton SM3, 9DW Londres, Royaume Uni
| | | | - L Molins
- Hôpital Clinique universitaire du Sacré-cœur, C. de Viladomat 288, 08029 Barcelone, Espagne
| | - O Tiffet
- Service de chirurgie Thoracique, CHU de St.Etienne, hôpital Nord, avenue Albert Raimond, 42270 Saint-Etienne, France
| | - C Ratdke
- Service de chirurgie plastique reconstructrice et esthétique, clinique universitaire de Vienne, 18-20 Waringer Gurtel, 1090 Vienne, Autriche
| | - U Dornseifer
- Service de chirurgie plastique reconstructrice et esthétique, Isar Klinikum, Sonnenstrasse 24-26, 80331 Munich, Allemagne
| | - M Giovannini
- Chirurgie Générale et thoracique, via di Roncrio 25, 40100 Bologne, Italie
| | - B Chaput
- Service de chirurgie plastique reconstructrice et esthétique, CHU Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - K Redmond
- Service de Chirurgie cardio-thoracique Hôpital Universitaire Mater Misericordia, Ecole street, Dublin 7, Irlande
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Kapoor M, Hunt I, Spillane J, Bonnett LJ, Hutton EJ, McFadyen J, Westwood JP, Lunn MP, Carr AS, Reilly MM. IVIg-exposure and thromboembolic event risk: findings from the UK Biobank. J Neurol Neurosurg Psychiatry 2022; 93:876-885. [PMID: 35688633 DOI: 10.1136/jnnp-2022-328881] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Arterial and venous thromboembolic events (TEEs) have been associated with intravenous Ig use, but the risk has been poorly quantified. We aimed to calculate the risk of TEEs associated with exposure to intravenous Ig. METHODS We included participants from UK Biobank recruited over 3 years, data extracted September 2020.The study endpoints were incidence of myocardial infarction, other acute ischaemic heart disease, stroke, pulmonary embolism and other venous embolism and thrombosis.Predictors included known TEE risk factors: age, sex, hypertension, smoking status, type 2 diabetes mellitus, hypercholesterolaemia, cancer and past history of TEE. Intravenous Ig and six other predictors were added in the sensitivity analysis.Information from participants was collected prospectively, while data from linked resources, including death, cancer, hospital admissions and primary care records were collected retrospectively and prospectively. FINDINGS: 14 794 of 502 492 individuals had an incident TEE during the study period. The rate of incident events was threefold higher in those with prior history of TEE (8 .7%) than those without previous history of TEE (3.0%).In the prior TEE category, intravenous Ig exposure was independently associated with increased risk of incident TEE (OR=3.69 (95% CI 1.15 to 11.92), p=0.03) on multivariate analysis. The number needed to harm by exposure to intravenous Ig in those with a history of TEE was 5.8 (95% CI 2.3 to 88.3).Intravenous Ig exposure did not increase risk of TEE in those with no previous history of TEE. INTERPRETATION Intravenous Ig is associated with increased risk of further TEE in individuals with prior history of an event with one further TEE for every six people exposed. In practice, this will influence how clinicians consent for and manage overall TEE risk on intravenous Ig exposure.
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Affiliation(s)
- Mahima Kapoor
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK .,Department of Neurosciences, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Ian Hunt
- Tasmanian Institute of Agriculture, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer Spillane
- Neurology, Royal Free Hospital Foundation Trust, London, UK.,MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | | | - Elspeth Jane Hutton
- Neurology, Alfred Health, Melbourne, Victoria, Australia.,Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - James McFadyen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Clinical Hematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - John-Paul Westwood
- Department of Haematology, University College London Hospital, London, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Disease and Department of Molecular Neuroscience, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.,NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling S Carr
- MRC Centre for Neuromuscualr Diseases, National Hospital of Neurology and Neurosurgery, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Santhirakumaran G, Abbasi A, Shah M, Hunt I. Reply to Romano et al.. Interact Cardiovasc Thorac Surg 2022; 35:6641982. [PMID: 35822604 PMCID: PMC9282267 DOI: 10.1093/icvts/ivac172] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ali Abbasi
- Radiology Department, University College Hospital , London, UK
| | - Mohammad Shah
- Radiology Department, St George’s University Hospital , London, UK
| | - Ian Hunt
- Cardiothoracic Surgery, St George’s University Hospital , London, UK
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Hunt I. Ian Hunt's contribution to the Discussion of ‘Assumption‐lean inference for generalised linear model parameters’ by Vansteelandt and Dukes. J R Stat Soc Series B Stat Methodol 2022. [DOI: 10.1111/rssb.12525] [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: 11/27/2022]
Affiliation(s)
- Ian Hunt
- University of Tasmania Hobart TAS Australia
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13
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Kar A, Baghai M, Hunt I. Reshaping the Evidence for Surgical Correction of Pectus Excavatum Using Cardiopulmonary Exercise Testing. J Am Heart Assoc 2022; 11:e025273. [PMID: 35377161 PMCID: PMC9075475 DOI: 10.1161/jaha.122.025273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashok Kar
- Department of Thoracic Surgery St Georges Hospital NHS Foundation Trust London United Kingdom
| | - Max Baghai
- Department of Cardiothoracic Surgery King's College Hospital NHS Foundation Trust London United Kingdom
| | - Ian Hunt
- Department of Thoracic Surgery St Georges Hospital NHS Foundation Trust London United Kingdom
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Manik SMN, Quamruzzaman M, Zhao C, Johnson P, Hunt I, Shabala S, Zhou M. Genome-Wide Association Study Reveals Marker Trait Associations (MTA) for Waterlogging-Triggered Adventitious Roots and Aerenchyma Formation in Barley. Int J Mol Sci 2022; 23:ijms23063341. [PMID: 35328762 PMCID: PMC8954902 DOI: 10.3390/ijms23063341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022] Open
Abstract
Waterlogging is an environmental stress, which severely affects barley growth and development. Limited availability of oxygen in the root zone negatively affects the metabolism of the whole plant. Adventitious roots (AR) and root cortical aerenchyma (RCA) formation are the most important adaptive traits that contribute to a plant's ability to survive in waterlogged soil conditions. This study used a genome-wide association (GWAS) approach using 18,132 single nucleotide polymorphisms (SNPs) in a panel of 697 barley genotypes to reveal marker trait associations (MTA) conferring the above adaptive traits. Experiments were conducted over two consecutive years in tanks filled with soil and then validated in field experiments. GWAS analysis was conducted using general linear models (GLM), mixed linear models (MLM), and fixed and random model circulating probability unification models (FarmCPU model), with the FarmCPU showing to be the best suited model. Six and five significant (approximately -log10 (p) ≥ 5.5) MTA were identified for AR and RCA formation under waterlogged conditions, respectively. The highest -log10 (p) MTA for adventitious root and aerenchyma formation were approximately 9 and 8 on chromosome 2H and 4H, respectively. The combination of different MTA showed to be more effective in forming RCA and producing more AR under waterlogging stress. Genes from major facilitator superfamily (MFS) transporter and leucine-rich repeat (LRR) families for AR formation, and ethylene responsive factor (ERF) family genes and potassium transporter family genes for RCA formation were the potential candidate genes involved under waterlogging conditions. Several genotypes, which performed consistently well under different conditions, can be used in breeding programs to develop waterlogging-tolerant varieties.
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Affiliation(s)
- S. M. Nuruzzaman Manik
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
| | - Md Quamruzzaman
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
| | - Chenchen Zhao
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
| | - Peter Johnson
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
| | - Ian Hunt
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
| | - Sergey Shabala
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
- International Research Centre for Environmental Membrane Biology, Foshan University, Foshan 528000, China
| | - Meixue Zhou
- Tasmanian Institute of Agriculture, University of Tasmania, Launceston, TAS 7250, Australia; (S.M.N.M.); (M.Q.); (C.Z.); (P.J.); (I.H.); (S.S.)
- Correspondence:
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Chung J, Mundy ME, Hunt I, Coxon A, Dyer KR, McKenzie S. An Evaluation of an Online Brief Mindfulness-Based Intervention in Higher Education: A Pilot Conducted at an Australian University and a British University. Front Psychol 2021; 12:752060. [PMID: 34777149 PMCID: PMC8582350 DOI: 10.3389/fpsyg.2021.752060] [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: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 12/30/2022] Open
Abstract
Mental ill health among higher education students is a well-established problem; therefore, it is imperative to implement preventative approaches to support wellbeing. Blended and fully online education programmes widens access for mature or returning students; however, the psychological wellbeing of this sub-group of students is under-researched. Finally, evaluating wellbeing interventions that meet the needs of university students as well as accessible for online students is required. The aim of this study was to evaluate a brief, online and mindfulness-based intervention to assist the self-management of wellbeing and stress for both online and on-campus higher education students. The total sample included 427 participants (96% psychology students) at Monash University, Australia (n=283) and King’s College London (n=144), with 152 participants completing the whole study. Participants were allocated to a brief, self-guided, online and mindfulness-based intervention (over the course of one study period; n=297), or to a wait-list control group (n=148). Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 15-item Mindful Attention Awareness Scale. Regression modelling revealed the intervention condition accounted for up to 12% of the variability in change in student wellbeing, stress and mindfulness between the start and end of semester (when controlling for baseline). These findings support the implementation of a brief, online and asynchronous mindfulness-based intervention for supporting student mental health and psychological wellbeing. An on-going challenge in practice includes engaging and maintaining student engagement in wellbeing initiatives.
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Affiliation(s)
- Jennifer Chung
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Matthew Edward Mundy
- Monash Centre for Professional Development and Monash Online Education, Monash University, Melbourne, VIC, Australia
| | - Ian Hunt
- Statistical Consulting Service, Monash University, Melbourne, VIC, Australia
| | - Astrid Coxon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Kyle R Dyer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephen McKenzie
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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16
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Kargupta W, Browne C, Verdugo L, Hunt I, Stack K, Batchelor W, Tanner J. Flotation as a separation technology for recovering pulp fines and sustainable nanocellulose production. Sep Purif Technol 2021. [DOI: 10.1016/j.seppur.2021.118810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Fraser S, Baranowski R, Patrini D, Nandi J, Al-Sahaf M, Smelt J, Hoffman R, Santhirakumaran G, Lee M, Wali A, Dickinson H, Jadoon M, Harrison-Phipps K, King J, Pilling J, Bille A, Okiror L, Stamenkovic S, Waller D, Wilson H, Jordan S, Begum S, Buderi S, Tan C, Hunt I, Vaughan P, Jenkins M, Hayward M, Lawrence D, Beddow E, Anikin V, Mani A, Finch J, Maheswaran H, Lim E, Routledge T, Lau K, Harling L. Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city. EClinicalMedicine 2021; 39:101085. [PMID: 34430839 PMCID: PMC8376626 DOI: 10.1016/j.eclinm.2021.101085] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. METHODS This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. FINDINGS 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35-86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3-4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). INTERPRETATION SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients. FUNDING This work did not receive funding.
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Affiliation(s)
- Stephanie Fraser
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Ralitsa Baranowski
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospital, London, United Kingdom
| | - Jay Nandi
- Department of Thoracic Surgery, Hammersmith Hospital, London, United Kingdom
| | - May Al-Sahaf
- Department of Thoracic Surgery, Hammersmith Hospital, London, United Kingdom
| | - Jeremy Smelt
- Department of Thoracic Surgery, St George's Hospital, London, United Kingdom
| | - Ross Hoffman
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | | | - Michelle Lee
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Anuj Wali
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | | | - Mehmood Jadoon
- Department of Thoracic Surgery, Hammersmith Hospital, London, United Kingdom
| | | | - Juliet King
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - John Pilling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Sasha Stamenkovic
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - David Waller
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Henrietta Wilson
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Simon Jordan
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Sofina Begum
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Silviu Buderi
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Carol Tan
- Department of Thoracic Surgery, St George's Hospital, London, United Kingdom
| | - Ian Hunt
- Department of Thoracic Surgery, St George's Hospital, London, United Kingdom
| | - Paul Vaughan
- Department of Thoracic Surgery, St George's Hospital, London, United Kingdom
| | - Melanie Jenkins
- Department of Thoracic Surgery, St George's Hospital, London, United Kingdom
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital, London, United Kingdom
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospital, London, United Kingdom
| | - Emma Beddow
- Department of Thoracic Surgery, Harefield Hospital, London, United Kingdom
| | - Vladimir Anikin
- Department of Thoracic Surgery, Harefield Hospital, London, United Kingdom
| | - Aleksander Mani
- Department of Thoracic Surgery, Harefield Hospital, London, United Kingdom
| | - Jonathan Finch
- Department of Thoracic Surgery, Harefield Hospital, London, United Kingdom
| | | | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Kelvin Lau
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Leanne Harling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, United Kingdom
- Corresponding author.
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18
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Affiliation(s)
- Andrew R. T. Bain
- Radiology Department St George's University Hospitals Tooting London UK
| | - Ian Hunt
- Cardiothoracic Surgery St George's University Hospitals Tooting London UK
| | - Mohammad Ali Shah
- Radiology Department St George's University Hospitals Tooting London UK
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19
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Hussain A, Hunt I. Acute Diaphragmatic Injuries Associated with Traumatic Rib Fractures: Experiences of a Major Trauma Centre and the Importance of Intra-Pleural Assessment. J Chest Surg 2021; 54:59-64. [PMID: 33767010 PMCID: PMC7946519 DOI: 10.5090/kjtcs.20.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/28/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%) . A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5–10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK
| | - Ian Hunt
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK
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20
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Sahdev N, Smelt J, Avila Z, Tennent D, Hunt I. Tophaceous gout in the sternoclavicular joint. J Surg Case Rep 2020; 2020:rjaa398. [PMID: 33224465 PMCID: PMC7657335 DOI: 10.1093/jscr/rjaa398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Gouty arthritis commonly occurs in peripheral synovial joints and involvement in the thoracic cage is extremely rare. We report a case of a 52-year-old presenting with a painful bony mass in her sternal notch. Imaging demonstrated a lobulated calcified and necrotic lesion causing mass effect on adjacent structures. Excision biopsy confirmed a benign cystic lesion with amorphous material containing needle-shaped refractile crystals suggestive of uric acid. Tophaceous gout was diagnosed. Presence of a periarticular mass with characteristics of gout should warrant investigation with biopsy and imaging. This can prevent misdiagnosis of malignancy and avoid unnecessary surgery in asymptomatic lesions.
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Affiliation(s)
- Nikhil Sahdev
- St George's University Hospitals NHS Foundation Trust, Department of Thoracic surgery, London SW17 0QT, UK
| | - Jeremy Smelt
- St George's University Hospitals NHS Foundation Trust, Department of Thoracic surgery, London SW17 0QT, UK
| | - Zoe Avila
- St George's University Hospitals NHS Foundation Trust, Department of Thoracic surgery, London SW17 0QT, UK
| | - Duncan Tennent
- St George's University Hospitals NHS Foundation Trust, Department of Thoracic surgery, London SW17 0QT, UK
| | - Ian Hunt
- St George's University Hospitals NHS Foundation Trust, Department of Thoracic surgery, London SW17 0QT, UK
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21
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Smelt J, Santhirakumaran G, Vaughan P, Hunt I, Tan C. Thoracic Surgery during Coronavirus Disease 2019 (COVID-19): The Experience of a Level 1 Trauma Center. Thorac Cardiovasc Surg 2020; 69:252-258. [PMID: 33225438 DOI: 10.1055/s-0040-1718938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus primarily affecting the respiratory system, was initially diagnosed in Wuhan, China, in late 2019. Identified as coronavirus disease 2019 (COVID-19) by the World Health Organization, the virus rapidly became a global pandemic. The effects on health care worldwide were unprecedented as countries adapted services to treat masses of critically ill patients.The aim of this study is to analyze the effect that the COVID-19 pandemic had on thoracic surgery at a major trauma center during peak prevalence. METHODS Prospective unit data were collected for all patients who underwent thoracic surgery during March 2020 until May 2020 inclusive. Retrospective data were collected from an earlier comparable time period as a comparison. RESULTS In the aforementioned time frame, 117 thoracic surgical operations were performed under the care of four thoracic surgeons. Six operations were performed on three patients who were being treated for SARS-CoV-2. One operation was performed on a patient who had recovered from SARS-CoV-2. There were no deaths due to SARS-CoV-2 in any patient undergoing thoracic surgery. CONCLUSION This study demonstrates that during the first surge of SARS-CoV-2, it was possible to adapt a thoracic oncology and trauma service without increase in mortality due to COVID-19. This was only possible due to a significant reduction in trauma referrals, cessation of benign and elective work, and the more stringent reprioritization of cancer surgery. This information is vital to learn from our experience and prepare for the predicted second surge and any similar future pandemics we might face.
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Affiliation(s)
- Jeremy Smelt
- Department of Thoracic Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gowthanan Santhirakumaran
- Department of Thoracic Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Paul Vaughan
- Department of Thoracic Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ian Hunt
- Department of Thoracic Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carol Tan
- Department of Thoracic Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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22
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Hussain A, Patel A, Hunt I. Are non-radiation-based imaging modalities effective for objectively assessing and monitoring patients with pectus deformities? Interact Cardiovasc Thorac Surg 2020; 31:536-539. [PMID: 32964931 DOI: 10.1093/icvts/ivaa134] [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: 10/27/2019] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'What is the role of non-radiation-based imaging modalities in the management of pectus deformities?'. Altogether 29 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that non-radiation-based imaging modalities provide a safe and easily implemented alternative to traditional computed tomography scan assessment for pectus deformities. This is particularly true for deformities on the more severe end of the spectrum and as an aid in providing an on-going assessment tool particularly in treatment modalities requiring a high degree of compliance (external bracing or vacuum bell therapy).
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Affiliation(s)
- Azhar Hussain
- Department of Thoracic Surgery, St Georges Hospital, London, UK
| | - Akshay Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, UK
| | - Ian Hunt
- Department of Thoracic Surgery, St Georges Hospital, London, UK
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23
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Hunt KA, Hunt I, Ali K, Dassios T, Greenough A. Prediction of extubation success using the diaphragmatic electromyograph results in ventilated neonates. J Perinat Med 2020; 48:609-614. [PMID: 32598319 DOI: 10.1515/jpm-2020-0129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/05/2020] [Indexed: 11/15/2022]
Abstract
Objectives Extubation failure is common in infants and associated with complications. Methods A prospective study was undertaken of preterm and term born infants. Diaphragm electromyogram (EMG) was measured transcutaneously for 15-60 min prior to extubation. The EMG results were related to tidal volume (Tve) to calculate the neuroventilatory efficiency (NVE). Receiver operating characteristic curves (ROC) were constructed and areas under the ROCs (AUROC) calculated. Results Seventy-two infants, median gestational age 28 (range 23-42) weeks were included; 15 (21%) failed extubation. Infants successfully extubated were more mature at birth (p=0.001), of greater corrected gestational age (CGA) at extubation (p<0.001) and heavier birth weight (p=0.005) than those who failed extubation. The amplitude and area under the curve of the diaphragm EMG were not significantly different between those who were and were not successfully extubated. Those successfully extubated required a significantly lower inspired oxygen and had higher expiratory tidal volumes (Tve) and NVE. The CGA and Tve had AUROCs of 0.83. A CGA of >29.6 weeks had the highest combined sensitivity (86%) and specificity (80%) in predicting extubation success. Conclusions Although NVE differed significantly between those who did and did not successfully extubate, CGA was the best predictor of extubation success.
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Affiliation(s)
- Katie A Hunt
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ian Hunt
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kamal Ali
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Asthma UK Centre in Allergic Mechanisms of Asthma, Kings College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas 'NHS Foundation Trust and King's College London, London, UK
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24
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Fraser S, Richards T, Harling L, Patel AJ, Hunt I. Initial reduction of flexible pectus carinatum with outpatient manipulation as an adjunct to external compressive bracing: technique and early outcomes at 12 weeks. J Pediatr Surg 2020; 55:1347-1350. [PMID: 31708203 DOI: 10.1016/j.jpedsurg.2019.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/10/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Our aim was to assess whether initial reduction with outpatient soft-tissue manipulation of flexible pectus carinatum deformity prior to external compressive bracing was associated with improved compliance and patient satisfaction compared to reported outcomes of external brace with progressive tightening. MATERIALS AND METHODS From our observational cohort of 227 patients, 177 were felt appropriate to undergo initial reduction and soft tissue manipulation prior to immediate custom fitting of an external compressive brace. These patients then followed a prescriptive schedule of 12 weeks of continuous external bracing with subsequent follow-up in clinic. RESULTS The reduction in Haller Index was maintained throughout the period of external bracing without the need for progressive tightening of the external brace. The treatment was associated with high levels of patient satisfaction and high patient concordance compared to other protocols. There were no major complications and minor complications included only skin irritation. CONCLUSIONS Out-patient initial reduction with manipulation prior to external compressive bracing is a novel technique which resulted in excellent concordance and high rates of patient satisfaction and should be considered as an adjunct to standard external bracing techniques. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Stephanie Fraser
- Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK
| | - Tom Richards
- Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK
| | - Leanne Harling
- Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK
| | - Akshay J Patel
- Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK; Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK..
| | - Ian Hunt
- Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK
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25
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Smelt J, Lovejoy CA, Thakker R, Hunt I, Martin F, Tan C. Elective Lung Resections in the Elderly: Where Do We Draw the Line? Thorac Cardiovasc Surg 2020; 69:109-112. [PMID: 31994146 DOI: 10.1055/s-0039-3402725] [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: 10/25/2022]
Abstract
INTRODUCTION The increasing longevity of the Western population means patients with a more advanced age are being diagnosed with resectable disease. With improvements in imaging and diagnostic capabilities, this trend is likely to develop further. As a unit operating on a higher proportion of older patients and with limited literature regarding the population of older than 85 years, we retrospectively compared the outcomes of patients older than 85 years in our unit treated with elective lung resection for non-small cell lung cancer (NSCLC) with those between the age of 80 and 84 years inclusive. METHODS All patients who underwent elective lung cancer resection between the years 2012 and 2015 were identified from the National Thoracic Surgical Database. RESULTS A total of 701 elective lung resections were performed during this time frame; 76 patients between the ages of 80 and 84 years and 18 patients older than 85 years. The follow-up period was 3 to 7 years. There was a significant increase in the Thoracic Surgery Scoring System (2.04; 2.96%, p = 0.0015) and a significant reduction in the transfer factor (94.7; 69.5%, p = 0.0001) between the younger and older groups. There were three (3.9%) in-hospital deaths in the 80 to 84 years age group and no in-hospital deaths in the 85 years and older age group. CONCLUSION This study demonstrates that surgery for early NSCLC can be safely performed in 85 years and older population. This is a higher risk population and parenchymal-sparing procedures should be considered.
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Affiliation(s)
- Jeremy Smelt
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | | | - Rudrik Thakker
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Ian Hunt
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Fionna Martin
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Carol Tan
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
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Smelt JLC, Madden B, Du Parcq J, Hunt I. A rare solitary and endobronchial pulmonary hyalinising granuloma requiring bilobectomy. SAGE Open Med Case Rep 2020; 8:2050313X20967175. [PMID: 35154768 PMCID: PMC8826096 DOI: 10.1177/2050313x20967175] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/28/2020] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hyalinising granuloma is a very rare disease often presenting as multiple smooth rounded nodules within the lung parenchyma and mimicking metastatic disease. Solitary pulmonary hyalinising granuloma is an even rarer subgroup, and to our knowledge, there have been no endoluminal pulmonary hyalinising granulomas reported. A 36-year-old female non-smoker with no significant past medical history presented with a persistent cough and was found to have a right lower lobe bronchial lesion causing lower lobe obstruction. After multiple failed attempts at tissue diagnosis from both percutaneous and endobronchial biopsies, and with worsening haemoptysis, the patient underwent a right thoracotomy and lower bilobectomy. The histopathology was reported as a solitary endobronchial pulmonary hyalinising granuloma. Although benign in nature, tissue diagnosis can be difficult in these lesions, especially when presenting as a solitary mass in a central location. This report demonstrates that these lesions can also be found endobronchially necessitating parenchymal resection for diagnosis and obstructive symptoms.
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Affiliation(s)
- Jeremy LC Smelt
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
| | - Brendan Madden
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
| | - John Du Parcq
- Department of Histopathology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Ian Hunt
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
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Kar A, Patel A, Tinwell B, Hunt I. P1.09-17 In the Minimally Invasive Era, What Is the Role of Intra-Operative Frozen Section Prior to Lobectomy: A Single Institution Perspective. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1046] [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: 10/25/2022]
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Roth M, Okeke-Eweni K, Fontenot B, Tusa R, Rhodes S, Oral E, Moreno-Walton L, Hunt I, Castillo C. 149 Adequacy of Health Care Advance Directives in Patients Admitted to the Intensive Care Unit. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.154] [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: 11/27/2022]
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Fraser S, Harling L, Patel A, Richards T, Hunt I. External Compressive Bracing With Initial Reduction of Pectus Carinatum: Compliance Is the Key. Ann Thorac Surg 2019; 109:413-419. [PMID: 31557482 DOI: 10.1016/j.athoracsur.2019.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To assess the impact of manipulation and a tailored program for compressive bracing on the quality of life of patients with flexible pectus carinatum. METHODS Two hundred forty-nine sequential patients attending a clinic for assessment of pectus carinatum deformities underwent outpatient manipulation and then followed a prescribed schedule of continuous external compressive bracing but without significant progressive tightening. RESULTS There was successful sustained reduction of the deformity in 244 patients with high reported rates of concordance (98%) and satisfaction (94%). Patients experienced a reduction in symptoms of anxiety and depression (P < .001) and had improved body satisfaction (P < .001). Mild skin irritation occurred in 18% of patients (n = 44), and there were 2 severe cases of skin irritation, 1 of which resulted in abandonment of bracing. CONCLUSIONS Manipulation and nontightening compressive bracing was associated with complete concordance, high levels of successful bracing, improved confidence, and reduced psychological morbidity.
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Affiliation(s)
- Stephanie Fraser
- Department of Thoracic Surgery, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Akshay Patel
- Department of Thoracic Surgery, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Tom Richards
- Department of Thoracic Surgery, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Ian Hunt
- Department of Thoracic Surgery, St George's Hospital NHS Foundation Trust, London, United Kingdom.
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Patel AJ, Hunt I. Is vacuum bell therapy effective in the correction of pectus excavatum? Interact Cardiovasc Thorac Surg 2019; 29:287–290. [PMID: 30919892 DOI: 10.1093/icvts/ivz082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/12/2018] [Revised: 01/09/2019] [Accepted: 02/24/2019] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: 'In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?' Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.
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Affiliation(s)
- Akshay J Patel
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Thoracic Surgery, Heartland's Hospital, UHB NHS Trust, Birmingham, UK
| | - Ian Hunt
- Department of Thoracic Surgery, St. George's Hospital, London, UK
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Hunt I, Patel AJ. Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review. Thorac Cardiovasc Surg 2019; 68:72-79. [PMID: 31022736 DOI: 10.1055/s-0039-1687824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There has been a growing interest in the nonoperative treatment of chest wall deformities over the last few decades; with the advent of external compressive orthotics, similar outcomes have been reported compared with surgical intervention. There have been fewer major complications reported with dynamic compression bracing on the chest wall; however, the Achilles heel of this approach still lies with treatment tolerability and compliance. A Medline literature search was undertaken to evaluate the evidence concerning the techniques, modifications, and outcomes associated with external compressive bracing in the setting of pectus carinatum. Sixteen articles were integrated after literature review and data were collected on methods of assessing pectus carinatum (degree of severity as well as type), patient selection protocol (i.e., suitability for external compressive bracing), the bracing protocol itself, duration of treatment, metrics used to assess outcome, and success, compliance, and dropout rate, and length of long-term follow-up. Compressive external bracing appears to be a safe and well tolerated nonsurgical treatment option for young patients with flexible pectus carinatum deformities. However, there is still a need for robust level I randomized data from multiple centers with a clearly standardized bracing protocol, objective measurement of outcomes, and recording of results at the end of the bracing treatment program in sufficiently powered sample sizes over a significant follow-up period.
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Affiliation(s)
- Ian Hunt
- Department of Thoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Akshay Jatin Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
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Kreamer NNK, Chopra R, Caughlan RE, Fabbro D, Fang E, Gee P, Hunt I, Li M, Leon BC, Muller L, Vash B, Woods AL, Stams T, Dean CR, Uehara T. Acylated-acyl carrier protein stabilizes the Pseudomonas aeruginosa WaaP lipopolysaccharide heptose kinase. Sci Rep 2018; 8:14124. [PMID: 30237436 PMCID: PMC6147952 DOI: 10.1038/s41598-018-32379-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022] Open
Abstract
Phosphorylation of Pseudomonas aeruginosa lipopolysaccharide (LPS) is important for maintaining outer membrane integrity and intrinsic antibiotic resistance. We solved the crystal structure of the LPS heptose kinase WaaP, which is essential for growth of P. aeruginosa. WaaP was structurally similar to eukaryotic protein kinases and, intriguingly, was complexed with acylated-acyl carrier protein (acyl-ACP). WaaP produced by in vitro transcription-translation was insoluble unless acyl-ACP was present. WaaP variants designed to perturb the acyl-ACP interaction were less stable in cells and exhibited reduced kinase function. Mass spectrometry identified myristyl-ACP as the likely physiological binding partner for WaaP in P. aeruginosa. Together, these results demonstrate that acyl-ACP is required for WaaP protein solubility and kinase function. To the best of our knowledge, this is the first report describing acyl-ACP in the role of a cofactor necessary for the production and stability of a protein partner.
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Affiliation(s)
- Naomi N K Kreamer
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Rajiv Chopra
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Cambridge, MA, USA.
| | - Ruth E Caughlan
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Doriano Fabbro
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Eric Fang
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Patricia Gee
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Ian Hunt
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Min Li
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Barbara C Leon
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Lionel Muller
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Brian Vash
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Angela L Woods
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Travis Stams
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Charles R Dean
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | - Tsuyoshi Uehara
- Infectious Diseases, Novartis Institutes for Biomedical Research, Emeryville, CA, USA.
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Affiliation(s)
- Olatunde Falode
- Cardiothoracic Surgery Centre, St Thomas' Hospital, London SE1 7EH, UK.
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34
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Abstract
Congenital chest wall or pectus deformities including pectus excavatum (funnel chest) and pectus carinatum (pigeon chest) affect a significant proportion of the general population and up to 70% of patients with Marfan syndrome. Patients often experience significant morbidity and psychological distress, which can worsen with age. Here we discuss new techniques for both operative and non-operative treatment of pectus deformity, the importance of a welltimed intervention and special considerations in patients with Marfan syndrome.
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35
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Dole WV, Hunt I. Stranger in a Strange Land: A Non-Librarian Expanding Library Collections. Journal of Library Administration 2017. [DOI: 10.1080/01930826.2017.1281668] [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: 10/19/2022]
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36
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Needleman I, Ashley P, Meehan L, Petrie A, Weiler R, McNally S, Ayer C, Hanna R, Hunt I, Kell S, Ridgewell P, Taylor R. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists. Br J Sports Med 2015; 50:41-4. [PMID: 26527674 DOI: 10.1136/bjsports-2015-094953] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The few studies that have assessed oral health in professional/elite football suggest poor oral health with minimal data on impact on performance. The aim of this research was to determine oral health in a representative sample of professional footballers in the UK and investigate possible determinants of oral health and self-reported impact on well-being, training and performance. METHODS Clinical oral health examination of senior squad players using standard methods and outcomes carried out at club training facilities. Questionnaire data were also collected. 8 teams were included, 5 Premier League, 2 Championship and 1 League One. RESULTS 6 dentists examined 187 players who represented >90% of each senior squad. Oral health was poor: 37% players had active dental caries, 53% dental erosion and 5% moderate-severe irreversible periodontal disease. 45% were bothered by their oral health, 20% reported an impact on their quality of life and 7% on training or performance. Despite attendance for dental check-ups, oral health deteriorated with age. CONCLUSIONS This is the first large, representative sample study in professional football. Oral health of professional footballers is poor, and this impacts on well-being and performance. Successful strategies to promote oral health within professional football are urgently needed, and research should investigate models based on best evidence for behaviour change and implementation science. Furthermore, this study provides strong evidence to support oral health screening within professional football.
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Affiliation(s)
- Ian Needleman
- Unit of Periodontology, International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | - Paul Ashley
- Unit of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK
| | | | - Aviva Petrie
- Unit of Biostatistics, UCL Eastman Dental Institute, London, UK
| | - Richard Weiler
- West Ham United Football Club, Sports Medicine & Sports Science Department, West Ham United FC Training Ground, Chadwell Heath, Essex, UK University College London Hospitals NHS Foundation Trust & UCLH Institute of Sport, Exercise and Health, London, UK The FA Centre for Disability Football Research, Burton-Upon-Trent, UK
| | - Steve McNally
- Football Medicine & Science Department, Manchester United Football Club, Manchester, UK
| | | | | | - Ian Hunt
- Maple Dental Care, Manchester, UK
| | - Steven Kell
- Lewes High Street Dental Practice, Lewes, UK
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Bano G, Sennik D, Kenchaiah M, Kyaw Y, Snape K, Tripathi V, Wilson P, Vlahos I, Hunt I, Hodgson S. A case of co-existing paraganglioma and thymoma. Springerplus 2015; 4:632. [PMID: 26543766 PMCID: PMC4628025 DOI: 10.1186/s40064-015-1269-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/24/2015] [Indexed: 02/06/2023]
Abstract
Background Head and neck paragangliomas are rare tumours and can arise as a part of inherited syndromes. Their association with thymic tumour is not well known. Case description This report describes a female patient who presented with right sided neck paragangliomas. The histology of the tumour was consistent with paraganlioma. Few years later her MRI scan of the chest revealed presence of an anterior mediastinal mass that corresponded to the location of the thymus. Review of her previous scans showed that the mass was present all along and had gradually increased in size. Patient developed symptoms including fatigue, dyspnoea, migratory polyarthritis, Raynaud’s phenomenon and erythema nodosum. She had sternotomy and excision of mediastinal mass. The histology was consistent with cortical thymoma (WHO type B2) and she had radiotherapy. After treatment her constitutional symptoms improved. Her paraganglioma susceptibility genes are negative. Discussion and evaluation To our knowledge this is only the second case report in the literature of coexistence of carotid body tumour and thymoma. The first case reported was bilateral carotid body tumour, thyroid gland adenoma and thymoma. This case also highlights the importance of long term surveillance, multidisciplinary management and being aware of associated pathologies in patients with isolated paraganglioma.
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Affiliation(s)
- G Bano
- Department of Endocrinology and Diabetes, Thomas Addison Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - D Sennik
- Department of Endocrinology and Diabetes, Thomas Addison Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - M Kenchaiah
- Department of Endocrinology and Diabetes, Thomas Addison Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Ye Kyaw
- Department of Endocrinology and Diabetes, Thomas Addison Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Katie Snape
- Clinical Genetics, Southwest Thames Regional Genetics Service, St George's Healthcare NHS Trust, London, UK
| | - V Tripathi
- Clinical Genetics, Southwest Thames Regional Genetics Service, St George's Healthcare NHS Trust, London, UK
| | - P Wilson
- Cellular Pathology, St George's Healthcare NHS Trust, London, UK
| | - I Vlahos
- Radiology, St George's Healthcare NHS Trust, London, UK
| | - I Hunt
- Cardiothoracic Surgery, St George's Healthcare NHS Trust, London, UK
| | - S Hodgson
- Clinical Genetics, Southwest Thames Regional Genetics Service, St George's Healthcare NHS Trust, London, UK
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Ross P, Weihofen W, Siu F, Xie A, Katakia H, Wright SK, Hunt I, Brown RK, Freire E. Isothermal chemical denaturation to determine binding affinity of small molecules to G-protein coupled receptors. Anal Biochem 2014; 473:41-5. [PMID: 25481736 DOI: 10.1016/j.ab.2014.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022]
Abstract
The determination of accurate binding affinities is critical in drug discovery and development. Several techniques are available for characterizing the binding of small molecules to soluble proteins. The situation is different for integral membrane proteins. Isothermal chemical denaturation has been shown to be a valuable biophysical method to determine, in a direct and label-free fashion, the binding of ligands to soluble proteins. In this study, the application of isothermal chemical denaturation was applied to an integral membrane protein, the A2a G-protein coupled receptor. Binding affinities for a set of 19 small molecule agonists/antagonists of the A2a receptor were determined and found to be in agreement with data from surface plasmon resonance and radioligand binding assays previously reported in the literature. Therefore, isothermal chemical denaturation expands the available toolkit of biophysical techniques to characterize and study ligand binding to integral membrane proteins, specifically G-protein coupled receptors in vitro.
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Affiliation(s)
| | - Wilhelm Weihofen
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - Fai Siu
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - Amy Xie
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - Hetal Katakia
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - S Kirk Wright
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - Ian Hunt
- Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | | | - Ernesto Freire
- AVIA Biosystems, Norton, MA 02766, USA; Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA.
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Patel A, Perry T, Hunt I, Abele J, Maquire C, Allegretto M, Bedard E. Should We Routinely Investigate Incidental Head and Neck Findings on 18-Fluorodeoxyglucose Positron Emission Tomography in Patients Being Staged for Non-small Cell Lung Cancer? A Retrospective Analysis. Thorac Cardiovasc Surg 2014; 63:604-8. [PMID: 24959935 DOI: 10.1055/s-0034-1381742] [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: 10/25/2022]
Abstract
BACKGROUND Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is routinely performed for investigating suspected lung cancers. Despite the known potential for false-positive FDG uptake in the head and neck, most suspicious lesions on FDG-PET are investigated. METHODS Between October 2002 and January 2010, FDG-PET/PET-computed tomography (CT) reports showing significant incidental uptake were retrospectively analyzed using controls to compare time to treatment for lung cancer and the rate of secondary malignancy in those with and without incidental head and neck FDG uptake. RESULTS In this study, 48/1,846 PET/PET-CT scan reports reviewed, and demonstrated nonthyroidal head and neck abnormalities. A total of 30 patients had proven non-small cell lung cancer (1.6%); 3/30 (10%) went on to have biopsy proven malignancy. Furthermore, there was a significant increase in time to treatment in those patients with incidental head and neck findings (p = 0.002). CONCLUSION These unexpected findings are mostly of no clinical significance and the patient should continue treatment without delay; however, aggressive work-up should be pursued if concerns for head and neck pathology are raised following clinical assessment.
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Affiliation(s)
- Akshay Patel
- Division of Thoracic Surgery, St George's Hospital, London, England, United Kingdom
| | - Troy Perry
- Department of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Hunt
- Division of Thoracic Surgery, St George's Hospital, London, England, United Kingdom
| | - Jonathan Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Connor Maquire
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Allegretto
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Bedard
- Department of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
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40
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Affiliation(s)
- Akshay J Patel
- Department of Thoracic Surgery, St. George's Hospital, London, UK
| | - Ian Hunt
- Department of Thoracic Surgery, St. George's Hospital, London, UK
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Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: might digital drains speed up the time to thoracic drain removal in terms of time till chest drain removal, hospital stay and overall cost? A total of 296 papers were identified as a result of the search as described below. Of these, five papers provided the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. A literature search revealed that several single-centre prospective randomized studies have shown significantly earlier removal of chest drains with digital drains ranging between 0.8 and 2.1 days sooner. However, there was heterogeneity in studies in the management protocol of chest drains in terms of the use of suction, number of drains and assessment for drain removal. Some protocols such as routinely keeping drains irrespective of the presence of air leak or drain output may have skewed results. Differences in exclusion criteria and protocols for discharging home with portable devices may have biased results. Due to heterogeneity in the management protocol of chest drains, there is conflicting evidence regarding hospital stay. The limited data on cost suggest that there may be significantly lower postoperative costs in the digital drain group. All the studies were single-centre series generally including patients with good preoperative lung function tests. Further larger studies with more robust chest drain management protocols are required especially to assess length of hospital stay, cost and whether the results are applicable to a larger patient population.
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Affiliation(s)
- Jonathan Afoke
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Carol Tan
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Ian Hunt
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Mustafa Zakkar
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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Patel AJ, Hunt I. Review of the evidence supports role for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection: Table 1:. Interact Cardiovasc Thorac Surg 2014; 19:111-6. [DOI: 10.1093/icvts/ivu082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zakkar M, Kanagasabay R, Hunt I. No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection. Interact Cardiovasc Thorac Surg 2013; 18:488-93. [PMID: 24351508 DOI: 10.1093/icvts/ivt502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5-12.5%) than in patients who underwent mechanical closure (1-5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection.
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Affiliation(s)
- Mustafa Zakkar
- Department of Cardiothoracic, St. George's Hospital, London, UK
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Nazari D, Sugand K, Yates M, Hunt I. An audit on the documentation of the interpretation of chest radiographs following thoracic surgery. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zakkar M, Tan C, Hunt I. 045 * THE ROLE OF PREOPERATIVE INTRATHECAL DIAMORPHINE INJECTION IN THORACIC SURGERY: SINGLE-UNIT EXPERIENCE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.45] [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: 11/12/2022] Open
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Zakkar M, Frazer S, Hunt I. Is there a role for gabapentin in preventing or treating pain following thoracic surgery? Interact Cardiovasc Thorac Surg 2013; 17:716-9. [PMID: 23832920 DOI: 10.1093/icvts/ivt301] [Citation(s) in RCA: 30] [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] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether gabapentin, a commonly prescribed neuropathic analgesic and anticonvulsant, is safe and beneficial in patients with post-thoracotomy pain following thoracic surgery. Seventeen papers were identified using the search described below, and five papers presented the best evidence to reach conclusions regarding the issues of interest for this review. Side effects and complications as well as evidence of benefit, typically using various pain-scoring systems, were included in the assessment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. The systematic review of two randomized controlled trials (RCTs) demonstrated that the use of a single dose gabapentin does not reduce pain scores or the need for epidural or morphine immediately in hospital following thoracic surgery. One double-blinded RCT used multiple doses of gabapentin perioperatively and showed that oral gabapentin administered preoperatively and during the first 2 days postoperatively, in conjunction with patient controlled analgesia morphine, provides effective analgesia in thoracic surgery with a consequent improvement in postoperative pulmonary function and less morphine consumption. One prospective clinical study comparing a 2-month course of gabapentin with naproxen sodium for chronic post thoracotomy pain following surgery showed significant improvement in both the visual analogue scale (VAS) score and the Leeds assessment of neuropathic symptoms and signs (LANSS) at 60 days in the gabapentin (P = 0.001). One prospective study of out-patients with chronic pain (>4 weeks since thoracotomy performed) suggested that gabapentin is effective, safe and well tolerated when used for persistent postoperative and post-traumatic pain in thoracic surgery patients. We conclude that there is no evidence to support the role of a single preoperative oral dose of gabapentin in reducing pain scores or opioid consumption following thoracic surgery. Multiple dosing regimens may be beneficial in reducing acute and chronic pain; however, more robust randomized control studies are needed.
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Affiliation(s)
- Mustafa Zakkar
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK
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Afoke J, Tan C, Hunt I, Zakkar M. Is sublobar resection equivalent to lobectomy for surgical management of peripheral carcinoid? Interact Cardiovasc Thorac Surg 2013; 16:858-63. [PMID: 23466951 DOI: 10.1093/icvts/ivt067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Is sub-lobar resection equivalent to lobectomy in terms of operative morbidity and mortality, long-term survival and disease recurrence in patients with peripheral carcinoid lung cancer? A total of 342 papers were identified using the search as described below. Of these, 10 papers presented the best evidence to answer the clinical question as they presented sufficient data to reach conclusions regarding the issues of interest for this review. Long-term survival, disease recurrence and operative morbidity were included in the assessment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. A literature search showed that there is a good prognosis after resection of lung carcinoid with the 10-year disease-free survival rate ranging between 77 and 94%, and suggested that sub-lobar resection of a typical carcinoid did not compromise the long-term survival. The proportion of peripheral tumours ranged between 22.6 and 100% and the proportion of patients with a preoperative diagnosis of carcinoid ranged between 51.9 and 86.7%, with many series not providing either or both of these data. As a result, a lobectomy or greater resection was necessary on anatomical or diagnostic grounds and led to a low number of sub-lobar resections. Owing to the high heterogeneity within and between series and small numbers of cases included, it is difficult to draw conclusions on disease recurrence and postoperative morbidity. All studies available retrospectively compared heterogeneous groups of non-matched group of patients, which can bias the outcomes reported. There is a lack of comprehensive randomized studies to compare a lobectomy or greater resection and sub-lobar resection. We conclude that there is little objective evidence to show the equivalence or superiority of lobectomy over sub-lobar resection.
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Affiliation(s)
- Jonathan Afoke
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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Zakkar M, Hunt I. Simple method of fluid resuscitation in patients requiring emergency thoracotomy through direct cardiac cannulation. Ann R Coll Surg Engl 2013. [PMID: 23317737 PMCID: PMC3964648 DOI: 10.1308/003588413x13511609957056d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Zakkar
- St George's Healthcare NHS Trust, UK.
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Zakkar M, Hunt I. Simple method of fluid resuscitation in patients requiring emergency thoracotomy through direct cardiac cannulation. Ann R Coll Surg Engl 2013; 95:75. [DOI: 10.1308/rcsann.2013.75] [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: 11/22/2022] Open
Affiliation(s)
- M Zakkar
- St George’s Healthcare NHS Trust, UK
| | - I Hunt
- St George’s Healthcare NHS Trust, UK
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