1
|
Heinzerling JH, Mileham K, Robinson M, Symanowski JT, Induru R, Corso CD, Brouse G, Prabhu RS, Haggstrom D, Moeller BJ, Bobo WE, Fasola C, Thakkar VV, Gregory J, Burri SH, Simone CB. Prospective Phase II Trial of Primary Lung Tumor Stereotactic Body Radiation Therapy (SBRT) Followed By Concurrent Mediastinal Chemoradiation and Adjuvant Immunotherapy for Locally-Advanced Non-Small Cell Lung Cancer (LA NSCLC). Int J Radiat Oncol Biol Phys 2023; 117:S27-S28. [PMID: 37784465 DOI: 10.1016/j.ijrobp.2023.06.287] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report the efficacy and toxicity outcomes of a prospective phase II trial of primary tumor SBRT followed by conventional chemoradiation to the lymph nodes and adjuvant immunotherapy in patients (pts) with unresectable LA NSCLC. MATERIALS/METHODS Eligible pts included stage II-III LA NSCLC with peripheral primary tumors ≤ 7cm or centrally based tumors that had at least 2 cm separation from involved nodal disease. Pts received SBRT to the primary tumor (50-54 Gy in 3-5 fractions) followed by standard radiation to 60 Gy in 30 fractions to the involved lymph nodes with concurrent platinum doublet chemotherapy. The trial was amended to allow pts without disease progression after chemoradiation to receive adjuvant durvalumab per the PACIFIC trial. The primary endpoint was 1 year progression free survival (PFS), evaluated as a binary variable. Frequencies and proportions were used for reporting this primary endpoint, in addition to adverse events and patterns of failure. Median PFS and OS were estimated using Kaplan Meier methods. RESULTS Safety and efficacy is reported on the first 50 pts enrolled in the trial with a median follow-up of 24 months (mos) (range, 1-54 mos). Pts were primarily stage IIIA (60%) or stage IIIB (34%), with 6% of pts stage IIB. Overall grade 3 or higher toxicity related to SBRT and/or mediastinal radiation was 8% with two pts (4%) developing grade 3 pneumonitis and one pt having a grade 5 lung infection possibly related to radiation. Overall grade 2 pneumonitis related to SBRT or mediastinal radiation was 20%. Only one pt (2%) developed grade 3 esophagitis. No late cardiac events have been observed. The one-year PFS for all pts was 62% with a median PFS of 26.3 mos and median overall survival of 40.8 mos. Of the 50 pts enrolled, 37 received at least one dose of adjuvant durvalumab. The one-year PFS for pts who received at least one dose of durvalumab was 70.3% with a median PFS not yet reached in this group (median follow-up 24 mos). Patterns of failure were mostly distant with 26% of pts experiencing distant failure, 6% regional, and 2% distant and regional. There was only one local failure (2%) after SBRT in all 50 pts. CONCLUSION SBRT to the primary tumor followed by conventional chemoradiation to the involved lymph nodes and adjuvant immunotherapy was well tolerated and showed improved 1-year PFS compared to prior conventional chemoradiation trials for locally advanced NSCLC. The results of this trial will be further evaluated in a randomized phase III study, NRG LU-008. Pts will receive either conventional chemoradiation vs. SBRT to the primary tumor followed by chemoradiation to the involved lymph nodes followed by consolidative immunotherapy to evaluate the possibility of utilization of SBRT as a new standard of care for LA NSCLC.
Collapse
Affiliation(s)
- J H Heinzerling
- Levine Cancer Institute, Atrium Health/Wake Forest School of Medicine and Southeast Radiation Oncology Group, Charlotte, NC
| | - K Mileham
- Levine Cancer Institute, Atrium Health/Wake Forest School of Medicine, Charlotte, NC
| | - M Robinson
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - R Induru
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - C D Corso
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - G Brouse
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - R S Prabhu
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - D Haggstrom
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - B J Moeller
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - W E Bobo
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - C Fasola
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - V V Thakkar
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - J Gregory
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - S H Burri
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | | |
Collapse
|
2
|
Gregory J, Kilvert H, Williams T, Cooper M, Polli A, Iadeluca L, Ou S. P08.02 Lorlatinib in First Line Treatment of Patients With ALK-Positive NSCLC: A Network Meta-Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.295] [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: 11/17/2022]
|
3
|
Sharma PR, Brech H, Pérez-Pachón L, Gregory J, Lowe T, Poyade M, Gröning F. O49 The use of augmented reality for surgical guidance: an assessment of the human error. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Microsoft HoloLens® is an augmented-reality headset which is increasingly used for surgical guidance. This headset allows the overlay of patient-specific virtual models obtained from medical images onto the patient’s body surface using automatic marker-based alignment. This can guide surgeons during certain surgical tasks, e.g. determining biopsy needle entry points. This study aims to measure the human error in the localisation of virtual models with the headset and discuss its surgical implications.
Method
59 adults were recruited between the ages of 20–59 years. A 12 cm2 digital marker was displayed on a monitor in 9 different positions, one at a time. This was repeated 3 times, resulting in 27 markers shown to each participant. Once a marker was detected by the headset’s camera, a virtual hexagon was rendered on the headset’s transparent lenses. Participants were tasked to click on the hexagon’s vertices using a mouse. The clicks’ coordinates were recorded by the system and compared to the predicted coordinates. This allowed for the calculation of the vertex localisation error.
Result
The mean vertex localisation error was found to be 5.19 mm (±3.56) with a range from 0.08 to 29.77 mm. There was a significant difference between marker positions as determined by a one-way ANOVA (P < 0.001).
Conclusion
This study suggests that the error in the localisation of virtual models depends on the position of the markers relative to the user wearing the headset. Further research is required to explore whether training can reduce the human error with this headset.
Take-home Message
The range of the human error in localising virtual models via the Microsoft HoloLens® headset is large and may be dependent on the position of the marker relative to the user of the headset. Further research is needed to investigate whether training with the headset can improve human performance.
Collapse
Affiliation(s)
- P R Sharma
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - H Brech
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - L Pérez-Pachón
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - J Gregory
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - T Lowe
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
- Head and Neck Oncology Unit, Aberdeen Royal Infirmary (NHS Grampian), Aberdeen, UK
| | - M Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, UK
| | - F Gröning
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| |
Collapse
|
4
|
Hartley A, Hardcastle SA, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Granell R, Gregory J, Williams M, Tobias JH, Gregson CL. Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1180-1190. [PMID: 32417557 DOI: 10.1016/j.joca.2020.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
Collapse
Affiliation(s)
- A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - S A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK; Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Integrated Research Into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - K E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - K Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - R Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Gregory
- Institute of Medical Science, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - M Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol UK
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
5
|
Faber BG, Bredbenner TL, Baird D, Gregory J, Saunders F, Giuraniuc CV, Aspden RM, Lane NE, Orwoll E, Tobias JH. Subregional statistical shape modelling identifies lesser trochanter size as a possible risk factor for radiographic hip osteoarthritis, a cross-sectional analysis from the Osteoporotic Fractures in Men Study. Osteoarthritis Cartilage 2020; 28:1071-1078. [PMID: 32387760 PMCID: PMC7387228 DOI: 10.1016/j.joca.2020.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/17/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Statistical shape modelling (SSM) of hip dual-energy X-ray absorptiometry (DXA) scans has identified relationships between hip shape and radiographic hip OA (rHOA). We aimed to further elucidate shape characteristics related to rHOA by focusing on subregions identified from whole-hip shape models. METHOD SSM was applied to hip DXAs obtained in the Osteoporotic Fractures in Men Study. Whole-hip shape modes (HSMs) associated with rHOA were combined to form a composite at-risk-shape. Subsequently, subregional HSMs (cam-type and lesser trochanter modes) were built, and associations with rHOA were examined by logistic regression. Subregional HSMs were further characterised, by examining associations with 3D-HSMs derived from concurrent hip CT scans. RESULTS 4,098 participants were identified with hip DXAs and radiographs. Composite shapes from whole-hip HSMs revealed that lesser trochanter size and cam-type femoral head are related to rHOA. From sub-regional models, lesser trochanter mode (LTM)1 [OR 0.74; 95%CI 0.63.0.87] and cam-type mode (CTM)3 [OR 1.27; 1.13.1.42] were associated with rHOA, associations being similar to those for whole hip HSMs. 515 MrOS participants had hip DXAs and 3D-HSMs derived from hip CT scans. LTM1 was associated with 3D-HSMs that also represented a larger lesser trochanter [3D-HSM7 (beta (β)-0.23;-0.33,-0.14) and 3D-HSM9 (β0.36; 0.27.0.45)], and CTM3 with 3D-HSMs describing cam morphology [3D-HSM3 (β-0.16;-0.25,-0.07) and 3D-HSM6 (β 0.19; 0.10.0.28)]. CONCLUSION Subregional SSM of hip DXA scans suggested larger lesser trochanter and cam morphology underlie associations between overall hip shape and rHOA. 3D hip modelling suggests our subregional SSMs represent true anatomical variations in hip shape, warranting further investigation.
Collapse
Affiliation(s)
- B G Faber
- Medical Research Council Clinical Research Fellow, Musculoskeletal Research Unit, University of Bristol, Bristol, UK.
| | - T L Bredbenner
- Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado, USA
| | - D Baird
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - F Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - C V Giuraniuc
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - N E Lane
- Center for Musculoskeletal Health, U.C. Davis School of Medicine, Sacramento, CA 95817, USA
| | - E Orwoll
- Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| |
Collapse
|
6
|
Boo SL, Botchu R, McLoughlin E, Patel A, James SL, Gregory J, Davies AM. Sarcoma multidisciplinary team meeting: past, present, and future. Clin Radiol 2020; 75:316-318. [PMID: 31973939 DOI: 10.1016/j.crad.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S L Boo
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
7
|
Hartley L, Evans S, Davies M, Kelly S, Gregory J. A Daily Diagnostic Multidisciplinary Team Meeting to Reduce Time to Definitive Diagnosis in the Context of Bone and Soft Tissue Sarcoma. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.09.017] [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: 11/28/2022] Open
|
8
|
Fujiwara T, Medellin MR, Sambri A, Tsuda Y, Balko J, Sumathi V, Gregory J, Jeys L, Abudu A. Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels. Bone Joint J 2019; 101-B:1024-1031. [DOI: 10.1302/0301-620x.101b8.bjj-2018-0963.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.
Collapse
Affiliation(s)
- T. Fujiwara
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - M. R. Medellin
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Oncology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - A. Sambri
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Istituto Ortopedico Rizzoli/University of Bologna, Bologna, Italy
| | - Y. Tsuda
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Balko
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - V. Sumathi
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Gregory
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - L. Jeys
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Abudu
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
9
|
Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101:405-410. [PMID: 31155889 DOI: 10.1308/rcsann.2019.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/11/2022] Open
Abstract
INTRODUCTION The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. MATERIALS AND METHODS A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. RESULTS Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. CONCLUSIONS This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.
Collapse
Affiliation(s)
- J R Lex
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J Gregory
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - C Allen
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J P Reid
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J D Stevenson
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| |
Collapse
|
10
|
Henney K, Hayers L, Dick K, Gregory J, Francis J, Murray N, Dixon E. P398 Cystic fibrosis education for schools and nurseries. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30690-3] [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: 11/29/2022]
|
11
|
Seddon L, Dick K, Balfour-Lynn I, Carr S, Gregory J, Henney K, Francis J. WS20-3 Newborn screening - telling parents that their baby might have cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30236-x] [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: 10/26/2022]
|
12
|
Medellin MR, Fujiwara T, Tillman RM, Jeys LM, Gregory J, Stevenson JD, Parry M, Abudu A. Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture. Bone Joint J 2018; 100-B:1626-1632. [PMID: 30499317 DOI: 10.1302/0301-620x.100b12.bjj-2018-0189.r2] [Citation(s) in RCA: 24] [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] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). PATIENTS AND METHODS A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. RESULTS The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. CONCLUSION In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.
Collapse
Affiliation(s)
| | - T Fujiwara
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - L M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J D Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - A Abudu
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
13
|
Estes-Doetsch H, Rusnak S, Gilmore D, Gregory J, Ritchey K, Nahikian-Nelms M. Dietetic Education: The Value of an Experiential Workshop Using Patient Simulation in Teaching Assessment of Malnutrition. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.116] [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: 10/28/2022]
|
14
|
Abstract
Abstract:To practice medicine in the near future, health care providers in the USA need an information infrastructure they do not yet have. We offer a contribution from social science research to discussions of current medical records practices and how health care activity systems may be transformed by the advent of electronic health records. The goal of the paper is to set forth a framework that connects over-arching questions concerning medical informatics systems development with the practical, cultural and conceptual issues involved in transitions from handwritten and other free text documentation to structured entry of medical records to build patient profiles. The research is broadly framed by an interest in how reciprocal modifications of the design and use of an electronic health record are negotiated in an iterative prototyping project. It is conducted as part of a complex multi-disciplinary research and development effort to create an electronic health record prototype for use in the integrated health care delivery environment of the Southern California Kaiser Permanente Medical Care Program.
Collapse
|
15
|
Gregory J, Barlow R, McGee U, Cole H, Edwards S, Howell G, Lewis W. Incidence and recognition of malnutrition on admission to hospital. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.051] [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: 11/16/2022]
|
16
|
Edwards S, Barlow R, Cole H, Gregory J, McGee U. Does age, gender, smoking and alcohol intake influence nutritional status on admission to an acute hospital? Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Cole H, Barlow R, Edwards S, Gregory J, McGee U, Howell G, Lewis W. Impact of nutritional status on length of hospital stay. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Aweid B, Gregory J. Early Analgesic and Anti-Emetic Prescriptions for New Surgical Admissions: A Closed Loop Audit. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.201] [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: 11/17/2022]
|
19
|
Gregory TM, Gregory J, Nicolas E, Pierrart J, Masmejean E. Shoulder Arthroplasty Imaging: What's New. Open Orthop J 2017; 11:1126-1132. [PMID: 29152007 PMCID: PMC5675998 DOI: 10.2174/1874325001711011126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/10/2017] [Accepted: 05/14/2017] [Indexed: 11/22/2022] Open
Abstract
Background Shoulder arthroplasty, in its different forms (hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty) has transformed the clinical outcomes of shoulder disorders. Improvement of general clinical outcome is the result of stronger adequacy of the treatment to the diagnosis, enhanced surgical techniques, specific implanted materials, and more accurate follow up. Imaging is an important tool in each step of these processes. Method This article is a review article declining recent imaging processes for shoulder arthroplasty. Results Shoulder imaging is important for shoulder arthroplasty pre-operative planning but also for post-operative monitoring of the prosthesis and this article has a focus on the validity of plain radiographs for detecting radiolucent line and on new Computed Tomography scan method established to eliminate the prosthesis metallic artefacts that obscure the component fixation visualisation. Conclusion Number of shoulder arthroplasties implanted have grown up rapidly for the past decade, leading to an increase in the number of complications. In parallel, new imaging system have been established to monitor these complications, especially component loosening.
Collapse
Affiliation(s)
- T M Gregory
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France.,Department of Mechanical Engineering, Imperial College, London, UK
| | - J Gregory
- Department of Radiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes Paris, France
| | - E Nicolas
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - J Pierrart
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - E Masmejean
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| |
Collapse
|
20
|
Gregory TM, Boukebous B, Gregory J, Pierrart J, Masemjean E. Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty. Open Orthop J 2017; 11:1133-1141. [PMID: 29152008 PMCID: PMC5676001 DOI: 10.2174/1874325001711011133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/03/2017] [Revised: 05/14/2017] [Accepted: 05/14/2017] [Indexed: 12/20/2022] Open
Abstract
Total shoulder arthroplasty (TSA) is an effective approach for the treatment of a variety of clinical conditions affecting the shoulder, including osteoarthritis, inflammatory arthritis and osteonecrosis, and the number of TSA implanted has grown exponentially over the past decade. This review gives an update of the major complications, mainly infections, instability and loosening, encountered after TSA, based on a corpus of recent publications and a dynamic approach: The review focuses on the causes of glenoid loosening, which account for 80% of the complication, and underlines the importance of glenoid positioning in the recovery of early shouder function and in the long term survival rate of TSA.
Collapse
Affiliation(s)
- T M Gregory
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France.,Department of Mechanical Engineering, Imperial College, London, UK
| | - B Boukebous
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| | - J Gregory
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - J Pierrart
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| | - E Masemjean
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| |
Collapse
|
21
|
Morgan-Trimmer S, Gregory J, Townson J, Channon S, Chestnutt I, Chadwick B, Murphy S, Hutchings S. OP86 Understanding intervention acceptability: changing participant views over time and the importance of context. Methods 2017. [DOI: 10.1136/jech-2017-ssmabstracts.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
22
|
Powell SK, Gregory J, Akbarian S, Brennand KJ. Application of CRISPR/Cas9 to the study of brain development and neuropsychiatric disease. Mol Cell Neurosci 2017; 82:157-166. [PMID: 28549865 DOI: 10.1016/j.mcn.2017.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022] Open
Abstract
CRISPR/Cas9 technology has transformed our ability to manipulate the genome and epigenome, from efficient genomic editing to targeted localization of effectors to specific loci. Through the manipulation of DNA- and histone-modifying enzyme activities, activation or repression of gene expression, and targeting of transcriptional regulators, the role of gene-regulatory and epigenetic pathways in basic biology and disease processes can be directly queried. Here, we discuss emerging CRISPR-based methodologies, with specific consideration of neurobiological applications of human induced pluripotent stem cell (hiPSC)-based models.
Collapse
Affiliation(s)
- S K Powell
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - J Gregory
- Instructional Technology Group, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - S Akbarian
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - K J Brennand
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| |
Collapse
|
23
|
Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
Collapse
Affiliation(s)
- L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK; School of Health and Life Sciences, Aston University, Birmingham, UK.
| | - G Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
24
|
Sampath Kumar V, Tyrrell PNM, Singh J, Gregory J, Cribb GL, Cool P. Surveillance of intramedullary cartilage tumours in long bones. Bone Joint J 2017; 98-B:1542-1547. [PMID: 27803232 DOI: 10.1302/0301-620x.98b11.37864] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. PATIENTS AND METHODS A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients). RESULTS Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025). CONCLUSION Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542-7.
Collapse
Affiliation(s)
- V Sampath Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P N M Tyrrell
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Gregory
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - G L Cribb
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| |
Collapse
|
25
|
Morris O, Gregory J, Kadirvel M, Henderson F, Blykers A, McMahon A, Taylor M, Allsop D, Allan S, Grigg J, Boutin H, Prenant C. Development & automation of a novel [(18)F]F prosthetic group, 2-[(18)F]-fluoro-3-pyridinecarboxaldehyde, and its application to an amino(oxy)-functionalised Aβ peptide. Appl Radiat Isot 2016; 116:120-7. [PMID: 27518217 PMCID: PMC5034901 DOI: 10.1016/j.apradiso.2016.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
Abstract
2-[(18)F]-Fluoro-3-pyridinecarboxaldehyde ([(18)F]FPCA) is a novel, water-soluble prosthetic group. It's radiochemistry has been developed and fully-automated for application in chemoselective radiolabelling of amino(oxy)-derivatised RI-OR2-TAT peptide, (Aoa-k)-RI-OR2-TAT, using a GE TRACERlab FX-FN. RI-OR2-TAT is a brain-penetrant, retro-inverso peptide that binds to amyloid species associated with Alzheimer's Disease. Radiolabelled (Aoa-k)-RI-OR2-TAT was reproducibly synthesised and the product of the reaction with FPCA has been fully characterised. In-vivo biodistribution of [(18)F]RI-OR2-TAT has been measured in Wistar rats.
Collapse
Affiliation(s)
- Olivia Morris
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK.
| | - J Gregory
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - M Kadirvel
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Fiona Henderson
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - A Blykers
- In-Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Belgium
| | - Adam McMahon
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Mark Taylor
- Division of Biomedical and Life Sciences, The University of Lancaster, UK
| | - David Allsop
- Division of Biomedical and Life Sciences, The University of Lancaster, UK
| | | | - J Grigg
- GE Healthcare, Life Sciences, Imaging R&D, The Grove Centre, Amersham, Bucks, UK
| | - Herve Boutin
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Christian Prenant
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| |
Collapse
|
26
|
Nistor V, Cannell J, Gregory J, Yeghiazarian L. Stimuli-responsive cylindrical hydrogels mimic intestinal peristalsis to propel a solid object. Soft Matter 2016; 12:3582-3588. [PMID: 26971454 DOI: 10.1039/c5sm02553b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The emerging field of soft robotics relies on soft, stimuli-responsive materials to enable load transport, manipulation, and mobility in complex unconstrained environments. These materials often need to replicate biological functionality such as muscle contractions and flexibility. Here we demonstrate a soft actuator prototype based on thermosensitive PNIPAAM hydrogels that can transport and manipulate objects. A hollow cylindrical hydrogel was selectively heated and cooled with Peltier devices to yield a traveling wave of shrinking and swelling akin to intestinal peristalsis. A 4 mm diameter bead was placed inside the cylinder and propelled 19.5 mm, equal to distance traveled by the peristaltic wave. We derived conditions that enable peristaltic transport as a function of transporter-cargo design parameters. We conclude that hydrogel-based peristaltic manipulators covering 2 orders of magnitude in stiffness (1-10(2) kPa) could transport cargo spanning 4 orders of magnitude in size (μm-m).
Collapse
Affiliation(s)
- V Nistor
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - J Cannell
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - J Gregory
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - L Yeghiazarian
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| |
Collapse
|
27
|
Gregory J, Larkin A, Nicholas M, Winder J, Borromeo M, MacGregor C. ESTABLISHING A RHYTHM: THE DEVELOPMENT OF AN INTER-PROFESSIONAL COMMUNICATION PRACTICE MODEL IN THE CARDIAC SERVICES INTENSIVE CARE [CSICU]. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
28
|
Trubiano JA, Lee JYH, Valcanis M, Gregory J, Sutton BA, Holmes NE. Non-O1, non-O139 Vibrio cholerae bacteraemia in an Australian population. Intern Med J 2015; 44:508-11. [PMID: 24816311 DOI: 10.1111/imj.12409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022]
Abstract
This retrospective case series identifies the largest cohort of non-O1, non-O139 Vibrio cholerae bacteraemia in an Australian population from 2000 to 2013. We examine the risk factors, epidemiology, clinical presentations and mortality of non-O1, non-O139 V. cholerae bacteraemia in Victoria and compare them with published cases in the literature. This case series highlights the pathogenic potential of non-O1, non-O139 V. cholerae and identifies possible associations with host (underlying chronic liver disease and malignancy) and environmental factors (contaminated water supply and raw seafood). Clinicians should be aware of the morbidity and mortality associated with invasive non-O1, non-O139 V. cholerae infections, particularly in immunocompromised patients.
Collapse
Affiliation(s)
- J A Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia; Communicable Disease Prevention and Control Section, Health Protection Branch, Victorian Government Department of Health, Melbourne, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
29
|
Whitehouse S, Stephenson J, Sinclair V, Gregory J, Tambe A, Verma R, Siddique I, Saeed M. A validation of the Oswestry Spinal Risk Index. Eur Spine J 2014; 25:247-251. [PMID: 25391625 DOI: 10.1007/s00586-014-3665-4] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.
Collapse
Affiliation(s)
- S Whitehouse
- ST7 Orthopaedics, North West Deanery, Manchester, UK.
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - V Sinclair
- ST7 Orthopaedics, North West Deanery, Manchester, UK
| | - J Gregory
- University of Manchester, Manchester, UK
| | - A Tambe
- Salford Royal Foundation Trust, Salford, UK
| | - R Verma
- Salford Royal Foundation Trust, Salford, UK
| | | | | |
Collapse
|
30
|
Gregory J, Vernon C, Onwudike F, Ainsworth G, Patel E, Barnes S, Ross E, Feilding E. 3 * THE BOLTON PAIN ASSESSMENT TOOL: DEVISING AND IMPLEMENTING A PAIN ASSESSMENT TOOL FOR PATIENTS UNABLE TO COMMUNICATE. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Garcia LAD, Brito ELR, Serpa P, Gregory J, Natalini C, Mattos RC, Jobim MIM. Horse Seminal Plasma proteins (HSP-1 and HSP-2) concentration: a possible marker for poor fertility? PFERDEHEILKUNDE 2014. [DOI: 10.21836/pem20140506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Sandor K, Bas D, Petterson J, Gregory J, Christianson C, Codeluppi S, Holmdahl R, Nandakumar K, Svensson C. Collagen antibody-induced arthritis (CAIA) evokes transient inflammation but persistent allodynia. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Feusner JH, Gregory J, Moser BK, Hars V, Willman CL, Powell BL, Larson RA. Dose-intensified daunorubicin induction and consolidation plus combined modality maintenance therapy for children with newly diagnosed acute promyelocytic leukemia (APL): North American Intergroup Study C9710. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
|
35
|
|
36
|
Abstract
AIMS The importance of getting transition right for young people with diabetes is increasingly recognized and a strong professional consensus has emerged on best practice in this domain. Research evidence to inform the design of transitional healthcare services is weak, however, and prevailing views about 'the problem of transition' are based on a number of assumptions about adolescence, adulthood and chronic disease management which have been accepted uncritically. METHODS Drawing on youth studies and the sociology of chronic disease management, in this paper we describe how 'the problem of transition' has been defined in the professional and UK policy literature and examine the assumptions that underpin it. RESULTS We argue that the overwhelming emphasis is on how best to support young people in fitting in with the healthcare system. This has produced an orientation which is more concerned with supporting young people in the process of becoming adults rather than giving attention to their contemporaneous experiences and needs. Two years after the introduction of the UK National Service Framework for diabetes, the challenge of transitional services remains. CONCLUSIONS We suggest that the time has come to consider alternative formulations of the 'problem'. Rather than asking how best to manage transition, we might ask how best to meet the needs of young people with diabetes at this stage of the life course. This requires an understanding of their experiences, the social networks in which they are embedded and consideration of how self-management might be supported by the healthcare system.
Collapse
Affiliation(s)
- D Allen
- Nursing and Midwifery Studies, Cardiff University, Cardiff, UK.
| | | |
Collapse
|
37
|
Rees GA, Richards CJ, Gregory J. Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches. J Hum Nutr Diet 2008; 21:420-7. [DOI: 10.1111/j.1365-277x.2008.00885.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
38
|
Chung H, Ku B, Gregory J. Development of an advanced water treatment system for wastewater reuse. Environ Technol 2008; 29:931-939. [PMID: 18844120 DOI: 10.1080/09593330802318894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of this research was to develop an optimal reuse system applying various types of advanced oxidation processes such as titanium dioxide (TiO2), ozone (O3) and electro-coagulation/oxidation methods. This system is suitable for improving the treatment efficiency of difficult wastewaters, and for the efficient reuse of wastewater. The connecting systems were divided into various types to investigate the stability and treatment efficiency according to the kinds of waste load. Different treatment sequences were examined taking into consideration the characteristics and economical efficiency. In the case of electro-coagulation/oxidation + ozone system, the mean treatment efficiency in terms of BOD5, CODCr and SS removal was 98.7%. The effluent concentration was 50.2 mg l(-1), 38.3 mg l(-1), 30.4 mg l(-1), respectively. In considering the economical efficiency and commercial use, around an eighth of the treatment expenses and around a fifth of the maintenance expenses could be saved compared with existing water treatment systems. The initial construction expenses could be reduced by a third to a fifth. Therefore, if a proper implementation of this research is carried out in relation to site conditions and the purpose of the water reuse, the water reuse rate will be higher and water resources can be protected.
Collapse
Affiliation(s)
- H Chung
- Department of Civil Engineering, Keimyung University, 1000 Sindang Dong, Dalseo Gu, Daegu, 704-701, South Korea
| | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Central pontine myelinolysis (CPM) usually presents in chronic alcoholics and in patients in whom hyponatraemia has been corrected rapidly. However, CPM may occur in other clinical circumstances, including patients with severe hypoglycaemia. We describe the occurrence of CPM and quadriplegia in a patient who experienced fluoroquinolone-associated severe hypoglycaemia. CASE REPORT A 63-year-old man with Type 2 diabetes mellitus was admitted to hospital for resection of a large liposarcoma. Renal-dose levofloxacin was utilized as part of an antimicrobial regimen to treat post-operative peritonitis. On days 6-8 of levofloxacin therapy, the patient experienced recurrent hypoglycaemia despite total parenteral nutrition, 10% dextrose containing fluids and cessation of insulin therapy 3 days prior to the first hypoglycaemic episode. Hypoglycaemia resolved within 24 h of stopping levofloxacin. After a final and severe hypoglycaemic event, the patient developed quadriplegia and tonic left deviation of gaze. Magnetic resonance imaging revealed a high-intensity lesion in the central pons consistent with CPM. CONCLUSIONS Fluoroquinolones should be considered as a potential cause of hypoglycaemia. Severe hypoglycaemia has the potential to cause white matter lesions in the pons. Putative mechanisms include failure of membrane ion channels, oligodendrocyte apoptosis and oxidative stress of glucose reperfusion. Fluoroquinolone-associated hypoglycaemia and hypoglycaemia-induced quadriplegia are both rare and we believe this is the first case report linking the two events.
Collapse
Affiliation(s)
- S Vallurupalli
- Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, IL, USA.
| | | | | | | |
Collapse
|
40
|
|
41
|
Gregory J, Gibson B, Robinson PG. The relevance of oral health for attenders and non-attenders: a qualitative study. Br Dent J 2007; 202:E18; discussion 406-7. [PMID: 17308534 DOI: 10.1038/bdj.2007.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2006] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low expectations of health mean that oral health becomes a low priority for some people, an appreciation of which would help dentists when a non-attender does come to the surgery. OBJECTIVE To provide an insight into why oral health is not important to some people and how this attitude might hinder access to dental care. METHOD In this qualitative study, purposive sampling was used to recruit two groups of participants with sociably visible missing, decayed or broken teeth but apparently differing responses to that status. The data analysis used social systems theory as operationalised by grounded theory techniques. RESULTS The core category that emerged from the data was that people constructed their own 'margins of the relevance' of oral health. For some people oral health was highly relevant whilst for others it was not very relevant. The degree of relevance of oral health was organised along seven dimensions: the perceived 'normal' state of oral health, the perceived causes of oral health and disease, the degree of trust held in dentistry, perceptions of oral 'health' as a commodity, perceptions of the accessibility of oral health care, perceptions of 'natural' oral health and judgements of character. CONCLUSIONS If certain aspects of oral health are not relevant, little that is said about those aspects will be meaningful to people. The key is to either emphasize or gently challenge those ideas and beliefs that allow or hinder the margins of relevance.
Collapse
Affiliation(s)
- J Gregory
- Unit of Oral Health Services Research and Dental Public Health, Guy's, King's and St Thomas' Dental Institute, King's College London, Denmark Hill, London, UK
| | | | | |
Collapse
|
42
|
Stafford RJ, Schluter P, Kirk M, Wilson A, Unicomb L, Ashbolt R, Gregory J. A multi-centre prospective case-control study of campylobacter infection in persons aged 5 years and older in Australia. Epidemiol Infect 2006; 135:978-88. [PMID: 17134530 PMCID: PMC2870644 DOI: 10.1017/s0950268806007576] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There are an estimated 277,000 cases of campylobacteriosis in Australia each year, most of which are thought to be sporadically acquired. To explore causes for these infections, we conducted a multi-centre case-control study of patients and community controls across five Australian States during 2001-2002. A total of 881 campylobacter cases and 833 controls aged 5 years were recruited into the study. Crude logistic analyses were conducted within various food and non-food exposure groups. A final most parsimonious multivariable logistic regression model was developed and adjusted odds ratios (aOR), 95% confidence intervals (95% CI) were derived together with adjusted population attributable risks (PAR). Consumption of undercooked chicken (aOR 4.7, 95% CI 2.6-8.4) and offal (aOR 2.0, 95% CI 1.0-4.0), ownership of domestic chickens aged<6 months (aOR 12.4, 95% CI 2.6-59.3) and domestic dogs aged<6 months (aOR 2.1, 95% CI 1.1-4.2) were found to be independent risk factors for illness in the final model. The PAR proportions indicate that eating chicken meat, either cooked or undercooked may account for approximately 30% of campylobacter cases that occur each year in Australia. These results justify the continued need for education of consumers and foodhandlers about the risks associated with the handling of raw chicken and the potential for cross-contamination.
Collapse
Affiliation(s)
- R J Stafford
- OzFoodNet, Communicable Diseases Unit, Queensland Health, Brisbane, Australia.
| | | | | | | | | | | | | |
Collapse
|
43
|
Unicomb LE, Simmons G, Merritt T, Gregory J, Nicol C, Jelfs P, Kirk M, Tan A, Thomson R, Adamopoulos J, Little CL, Currie A, Dalton CB. Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini. Epidemiol Infect 2006; 133:1065-72. [PMID: 16274503 PMCID: PMC2870340 DOI: 10.1017/s0950268805004085] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2004] [Indexed: 11/06/2022] Open
Abstract
In November 2002, the first of three outbreaks of Salmonella Montevideo infection in Australia and New Zealand was identified in New South Wales, Australia. Affected persons were interviewed, and epidemiologically linked retail outlets inspected. Imported tahini was rapidly identified as the source of infection. The contaminated tahini was recalled and international alerts posted. A second outbreak was identified in Australia in June-July 2003 and another in New Zealand in August 2003. In a total of 68 S. Montevideo infections, 66 cases were contacted. Fifty-four (82%) reported consumption of sesame seed-based foods. Laboratory analyses demonstrated closely related PFGE patterns in the S. Montevideo isolates from human cases and sesame-based foods imported from two countries. On the basis of our investigations sesame-based products were sampled in other jurisdictions and three products in Canada and one in the United Kingdom were positive for Salmonella spp., demonstrating the value of international alerts when food products have a wide distribution and a long shelf life. A review of the controls for Salmonella spp. during the production of sesame-based products is recommended.
Collapse
Affiliation(s)
- L E Unicomb
- OzFoodNet, Hunter Population Health, Wallsend, New South Wales (NSW), Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The effect of shear on the formation and break-up of flocs generated using cationic, anionic and non-ionic polymers, and dual combinations of these, has been investigated using conventional jar test procedure and by continuous optical monitoring. The breakage of flocs was followed at a high stirring speed, corresponding to average shear rate (G) of approximately 520 s(-1). Most of the breakage occurred within a few seconds of increasing the shear rate. After each breakage, the stirring rate was reduced to the original value of 50 rpm (G approximately 23 s(-1)) to allow the flocs to regrow. For cationic-anionic polymers case, the regrowth of flocs was fully reversible and the breakage factors were smallest indicating highest floc strength. In contrast, flocs formed using non-ionic polymer together with anionic or cationic did not produce as strong flocs. It is found that the sequence of polymer addition is not very significant for floc formation and reformation when the cationic-anionic dual system is used.
Collapse
Affiliation(s)
- M A Yukselen
- Department of Environmental Engineering, Marmara University, Goztepe, Istanbul, Turkey.
| | | | | |
Collapse
|
45
|
Rawlings MM, Fitzpatrick CSB, Gregory J, Wetherill A. The effect of polymeric flocculants on floc strength and filter performance. Water Sci Technol 2006; 53:77-85. [PMID: 16752767 DOI: 10.2166/wst.2006.210] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Polymeric flocculants are widely used throughout the water industry as flocculant aids, they are known to increase floc density and aid settlement in the clarification stage of the water treatment process. In this research, polymeric flocculants were used to improve floc strength prior to filtration on a dissolved air flotation (DAF) plant in an attempt to prevent filter breakthrough. A modified jar test procedure using a PDA (photometric dispersion analyser) optical flocculation monitor was developed in order to evaluate the system floc strength. Filtration trials were carried out on a pilot filter rig situated on a surface water treatment works in Yorkshire. The filter feed originated from the main plant filter channel. Filter performance was assessed by continuous online monitoring of effluent particle counts, turbidity and headloss over the period of the filter run. Results indicated that low doses of polymeric flocculants had a beneficial effect on filtered water quality, as measured by particle counts, turbidity, UV254 absorption and dissolved organic carbon (DOC). Polymeric flocculants also had the effect of extending filter run length. The modified jar test results indicated that the flocculants used improved the floc strength and enhanced reflocculation of the micro flocs present after the flotation process.
Collapse
Affiliation(s)
- M M Rawlings
- Department of Civil and Environmental Engineering, University College London, UK.
| | | | | | | |
Collapse
|
46
|
Jarvis P, Jefferson B, Gregory J, Parsons SA. A review of floc strength and breakage. Water Res 2005; 39:3121-37. [PMID: 16000210 DOI: 10.1016/j.watres.2005.05.022] [Citation(s) in RCA: 312] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 05/06/2005] [Accepted: 05/18/2005] [Indexed: 05/03/2023]
Abstract
The main focus of the paper is to review current understanding of floc structure and strength. This has been done by reviewing current theoretical understanding of floc growth and breakage and an analysis of different techniques used for measuring floc strength. An overview has also been made of the general trends seen in floc strength analysis. The rate of floc formation is a balance between breakage and aggregation with flocs eventually reaching a steady-state size for a given shear rate. The steady-state floc size for a particular shear rate can, therefore, be a good indicator of floc strength. This has resulted in the development of a range of techniques to measure floc size at different applied shear levels using a combination of one or more of the following tools: light scattering and transmission; microscopy; photography; video and image analysis software. Floc strength may be simply quantified using the initial floc size for a given shear rate and the floc strength factor. More complex techniques have used theoretical modelling to determine whether flocs break by large-scale fragmentation or smaller-scale surface erosion effects, although this interpretation is open to debate. Impeller-based mixing, ultrasound and vibrating columns have all been used to provide a uniform, accurate and controllable dissipation of energy onto a floc suspension to determine floc strength. Other more recent techniques have used sensitive micromanipulators to measure the force required to break or compress individual flocs, although these techniques have been limited to the measurement of only a few hundred flocs. General trends emerge showing that smaller flocs tend to have greater strength than larger flocs, whilst the use of polymer seems to give increased strength to only some types of floc. Finally, a comparison of the strength of different types of floc (activated sludge flocs, organic matter flocs, sweep flocs and charge neutralised flocs) has been made highlighting differences in relative floc strength.
Collapse
Affiliation(s)
- P Jarvis
- School of Water Sciences, Cranfield University, Cranfield, Bedfordshire MK40 0AL, UK
| | | | | | | |
Collapse
|
47
|
Jeppesen PB, Sanguinetti EL, Buchman A, Howard L, Scolapio JS, Ziegler TR, Gregory J, Tappenden KA, Holst J, Mortensen PB. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut 2005; 54:1224-31. [PMID: 16099790 PMCID: PMC1774653 DOI: 10.1136/gut.2004.061440] [Citation(s) in RCA: 326] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Glucagon-like peptide 2 (GLP-2) may improve intestinal absorption in short bowel syndrome (SBS) patients with an end jejunostomy. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant GLP-2 analogue, prolongs the intestinotrophic properties of GLP-2 in animal models. The safety and effect of teduglutide were investigated in SBS patients with and without a colon in continuity. METHODS Teduglutide was given subcutaneously for 21 days once or twice daily to 16 SBS patients in the per protocol investigational group, 10 with end jejunostomy (doses of 0.03 (n = 2), 0.10 (n = 5), or 0.15 (n = 3) mg/kg/day), one with <50% colon in continuity (dose 0.03 mg/kg/day), and five with > or = 50% colon in continuity (dose 0.10 mg/kg/day). Nutrient balance studies, D-xylose tests, and intestinal mucosa biopsies were performed at baseline, on the last three days of treatment, and after three weeks of follow up. Pre-study fasting native GLP-2 levels were determined for the five patients with > or = 50% colon in continuity. RESULTS Pooled across groups and compared with baseline, teduglutide increased absolute (+743 (477) g/day; p<0.001) and relative (+22 (16)%; p<0.001) wet weight absorption, urine weight (+555 (485) g/day; p<0.001), and urine sodium excretion (+53 (40) mmol/day; p<0.001). Teduglutide decreased faecal wet weight (-711 (734) g/day; p = 0.001) and faecal energy excretion (-808 (1453) kJ/day (-193 (347) kcal/day); p = 0.040). In SBS patients with end jejunostomy, teduglutide significantly increased villus height (+38 (45)%; p = 0.030), crypt depth (+22 (18)%; p = 0.010), and mitotic index (+115 (108)%; p = 0.010). Crypt depth and mitotic index did not change in colonic biopsies from SBS patients with colon in continuity. The most common side effects were enlargement of the stoma nipple and mild lower leg oedema. The improvements in intestinal absorption and decreases in faecal excretion noted after treatment had reversed after the drug free follow up period. A controlled study with a more robust design is ongoing in order to determine the optimal dosage of teduglutide for SBS patients to achieve the maximal effect and utility of this drug in clinical practice. CONCLUSION Teduglutide, at three dose levels for 21 days, was safe and well tolerated, intestinotrophic, and significantly increased intestinal wet weight absorption in SBS patients with an end jejunostomy or a colon in continuity.
Collapse
Affiliation(s)
- P B Jeppesen
- Department of Medicine CA-2121, Section of Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Z Mah
- Alberta Cancer Board, Calgary, AB T2S 3C1
| | - J Gregory
- Alberta Cancer Board, Calgary, AB T2S 3C1
| | - C Pim
- Alberta Cancer Board, Calgary, AB T2S 3C1
| |
Collapse
|
49
|
Gregory J, Riffaud L, Catier A, Cuggia M, Charlin J. 136 Étude prospective des hémorragies intraoculaires au cours des hémorragies sous-arachnoïdiennes spontanées chez 100 patients consécutifs. Syndrome de Terson. J Fr Ophtalmol 2005. [DOI: 10.1016/s0181-5512(05)74532-0] [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: 11/16/2022]
|
50
|
Koss K, Harrison RF, Gregory J, Darnton SJ, Anderson MR, Jankowski JAZ. The metabolic marker tumour pyruvate kinase type M2 (tumour M2-PK) shows increased expression along the metaplasia-dysplasia-adenocarcinoma sequence in Barrett's oesophagus. J Clin Pathol 2004; 57:1156-9. [PMID: 15509675 PMCID: PMC1770481 DOI: 10.1136/jcp.2004.018150] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Proliferating and tumour cells express the glycolytic isoenzyme, pyruvate kinase type M2 (M2-PK). In tumours cells, M2-PK usually exists in dimeric form (tumour M2-PK), causing the accumulation of glycolytic phosphometabolites, which allows cells to invade areas with low oxygen and glucose concentrations. AIMS To investigate the expression of tumour M2-PK during the metaplasia-dysplasia-adenocarcinoma sequence of Barrett's oesophagus, and to assess the prognostic usefulness of tumour M2-PK in oesophageal cancer. MATERIALS/METHODS One hundred and ninety cases selected from the histopathology archives as follows: 17 reflux oesophagitis, 37 Barrett's oesophagus, 21 high grade dysplasia, 112 adenocarcinomas, and three control tumours. Sections were stained immunohistochemically with antibody to tumour M2-PK. RESULTS Tumour M2-PK was expressed in all cases, and increased cytoplasmic expression was seen with progression along the metaplasia-dysplasia-adenocarcinoma sequence. All cases of adenocarcinoma showed 100% staining so that tumour M2-PK was not a useful prognostic marker. CONCLUSIONS Tumour M2-PK is not a specific marker of Barrett's adenocarcinoma, but may be important as a marker of transformed and highly proliferating clones during progression along the metaplasia-dysplasia-adenocarcinoma sequence.
Collapse
Affiliation(s)
- K Koss
- Department of Gastroenterology, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
| | | | | | | | | | | |
Collapse
|