1
|
Smith L, Cornish J, Meggy A, Torkington J. DD-01 THE INVITE STUDY: INCISIONAL HERNIA PREVENTION: RISK-BENEFIT FROM A PATIENT'S PERSPECTIVE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.005] [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
Incisional Hernia (IH) is a common complication of abdominal surgery. IH is associated with significant morbidity to patients, and costs to the NHS. With no singular intervention demonstrated to bring the rate of IH below 12%, focus is now on pre-operative risk-prediction. High-risk patients may benefit from prophylactic mesh placement during their index operation, however with controversy surrounding the use of mesh, there is no understanding of whether this intervention is acceptable to patients.
Methods
This is a retrospective, single centre mixed-methods cohort study. Patients with and without IH who have undergone colorectal surgery will be approached, along with a smaller cohort of patients about to undergo surgery. Participants will be asked to complete a questionnaire and a sub-set of participants will be invited to semi-structured interviews. The primary objective is to assess the acceptability of prophylactic mesh to patients. Secondary outcomes include understanding patient's views on risk-predictive modelling, and factors that may influence or alter the acceptability of mesh.
Analysis
Questionnaires have been developed using a 5-point Likert scale to allow quantitative analysis. Qualitative analysis of interviews will be conducted using Clarke and Braun's framework of thematic analysis. Data will be presented using the Journal Article Reporting Standards (JARS) for mixed-methods research.
Outcomes
Ethical approval has been granted, and the trial is currently in set-up. Results from this study will be used to inform both in the design and recruitement of patients to future interventional trials using prophylactic mesh in the UK.
Collapse
Affiliation(s)
- L Smith
- Colorectal Surgery, University Hospital of Wales , Caerdydd , United Kingdom
| | - J Cornish
- Colorectal Surgery, University Hospital of Wales , Caerdydd , United Kingdom
| | - A Meggy
- Clinical Research Facility, University Hospital of Wales , Caerdydd , United Kingdom
| | - J Torkington
- Colorectal Surgery, University Hospital of Wales , Cardiff , United Kingdom
| |
Collapse
|
2
|
Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
Collapse
|
3
|
Silva L, Mohammed SA, Strong P, Watts T, Torkington J, Cornish J. O040 Patient reported outcomes and experiences following emergency laparotomy: a mixed methods patient survey. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.040] [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: 11/07/2022]
Abstract
Abstract
Introduction
Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be. This study aims to establish the impact of EmLap on PROMs and PREMs.
Methods
All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis.
Results
Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were >80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p<0.001), or incisional hernia (OR 4.228, p<0.001). Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work. Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%) and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010).
Conclusion
This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic care.
Collapse
Affiliation(s)
- L Silva
- Cardiff & Vale University Health Board
| | | | - P Strong
- Cardiff & Vale University Health Board
| | - T Watts
- Cardiff & Vale University Health Board
| | | | - J Cornish
- Cardiff & Vale University Health Board
| |
Collapse
|
4
|
Bolam S, Konar S, Park Y, Ferguson D, Dalbeth N, Coleman B, Monk A, Cornish J, Munro J, Musson D. Patient Body Mass Index Has No Direct Effect on The Characteristics of Primary Tenocytes Derived from Torn Rotator Cuffs. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.03.2022.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
5
|
Carpenter-Heath L, Butler K, Cornish J, Da Silva R, Muirhead B. Virtual or face to face modified Constraint Induced Movement Therapy (mCIMT) or CIMT – real world service transformation considerations. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.064] [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]
|
6
|
Mohamed SA, Silva L, Strong P, Dietrich A, Cornish J. SP3.1.14 NELA; what happens after discharge? Br J Surg 2021. [DOI: 10.1093/bjs/znab361.065] [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
Aims
NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge.
Methods
This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up.
Results
944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%).
1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76).
Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002).
Conclusion
This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.
Collapse
|
7
|
Parker J, Cornish J, Cripps H, Dober L, Torkington J. The Moondance Bowel Cancer Project schools initiative. Ann R Coll Surg Engl 2021; 103:656-660. [PMID: 34432523 PMCID: PMC10911451 DOI: 10.1308/rcsann.2020.7151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The 5-year survival rate for bowel cancer in Wales is poor and lags behind the rest of the UK. The aim of the pilot phase of the Moondance Schools Initiative was to develop, deliver and assess a bowel cancer learning module for secondary school students in South Wales. Ultimately, we aim to introduce this programme into the National Curriculum across Wales. METHODS Two programmes regarding bowel cancer and screening were designed and delivered to a cohort of secondary school pupils in South Wales. This involved interactive teaching with patients and clinicians, practical sessions and live-streamed videos of bowel cancer surgery. Feedback regarding the events and bowel screening was collected from students and their families. RESULTS The programmes were delivered to 185 secondary school students and feedback was extremely positive. The students delivered a live event at the end of the programme to demonstrate their learning to their families and invited guests. Feedback from family members revealed that 100% of respondents were more likely to take a bowel screening test as a result of attending the event. CONCLUSION This project established that a pilot to create young bowel screening ambassadors is feasible and was positively received by students, their families and the local community. Future work will disseminate the programme further and correlate changes in bowel screening participation in the local area as a result of these events.
Collapse
Affiliation(s)
| | - J Cornish
- Cardiff and Vale University Health Board, UK
| | | | | | | | | |
Collapse
|
8
|
Li CH, Parker J, Reeve N, Cornish J. P26: EVALUATING AND DEVELOPING A TEACHING TOOL ON FAECAL INCONTINENCE IN THE UNDERGRADUATE MEDICAL CURRICULUM. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.111] [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
To evaluate the medical school undergraduate curriculum on faecal incontinence (FI) and develop an educational tool to improve the teaching on the subject.
Method
Qualitative analysis of literature research and data collected from medical students via emails, questionnaires and focused group discussions.
Result
FI has not been implanted into the undergraduate curriculum 12,13 and there are variations in teaching on the topic in different medical schools. n= 111 medical students at Cardiff University responded to the survey. FI was reported to be overlooked compared to other types of bowel dysfunction. 38 students reported to have teaching on bowel incontinence, whereas 64 and 74 students had teaching on diarrhoea and constipation respectively. 77% of medical students would like more teaching on bowel incontinence. 9 students participated in a focused group discussion. An interactive e-learning module from Xerte was created based on the students' suggestions and were trialed by a separate cohort of students (n=20). All 20 students showed significant improvement of students' confidence in faecal incontinence (p <= 2.132e∧-6) after completing the e-learning module.
Conclusion
We recommend introducing the educational resource into the undergraduate curriculum of Cardiff University medical school, especially targeting the clinical year, a clear guidance for FI should be published by the relevant postgraduate healthcare faculties and consider assessing at which stage of the postgraduate training should FI be taught.
Take-home message
Baseline knowledge of FI is poor. Lack of content in medical school curriculum and E learning modules potentially useful adjuncts.
Collapse
Affiliation(s)
- CH Li
- University of Cardiff, Medical school
| | - J Parker
- General Surgery, University Hospital of Wales, Cardiff
| | - N Reeve
- General Surgery, University Hospital of Wales, Cardiff
| | - J Cornish
- General Surgery, University Hospital of Wales, Cardiff
| |
Collapse
|
9
|
Abstract
INTRODUCTION The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
Collapse
Affiliation(s)
| | - L Hurt
- Morriston Hospital, Swansea, UK
| | | | - N Reeves
- University Hospital of Wales, Cardiff, UK
| | | | | | - J Cornish
- University Hospital of Wales, Cardiff, UK
| |
Collapse
|
10
|
Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, Wall P, Spinelli A, Torkington J. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107:1406-1413. [PMID: 32363596 PMCID: PMC7267397 DOI: 10.1002/bjs.11679] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [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: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022]
Abstract
Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
Collapse
Affiliation(s)
- N G Mowbray
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Ansell
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Horwood
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - P Rizkallah
- School of Medicine, Cardiff University, Cardiff, UK
| | - A Parker
- School of Medicine, Cardiff University, Cardiff, UK
| | - P Wall
- Isca Healthcare Research, Caerleon, UK
| | - A Spinelli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Rozzano, Italy
| | - J Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
11
|
Brogan P, Burns JC, Cornish J, Diwakar V, Eleftheriou D, Gordon JB, Gray HH, Johnson TW, Levin M, Malik I, MacCarthy P, McCormack R, Miller O, Tulloh RMR. Lifetime cardiovascular management of patients with previous Kawasaki disease. Heart 2019; 106:411-420. [PMID: 31843876 PMCID: PMC7057818 DOI: 10.1136/heartjnl-2019-315925] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 09/04/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.
Collapse
Affiliation(s)
- Paul Brogan
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - Jane C Burns
- Pediatrics, University of California, San Diego, California, USA.,Pediatrics, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Jacqueline Cornish
- National Clinical Director Children, Young People and Transition to Adulthood, Medical Directorate, NHS England, London, UK
| | | | - Despina Eleftheriou
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - John B Gordon
- Cardiology, Sharp Memorial Hospital and San Diego Cardiac Center, San Diego, California, USA
| | | | | | | | - Iqbal Malik
- Imperial College London, International Centre for Circulatory Health, London, UK
| | | | | | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Robert M R Tulloh
- Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Bristol, UK .,University of Bristol, Bristol Heart Institute, Bristol, UK
| | | |
Collapse
|
12
|
Hargreaves DS, Lemer C, Ewing C, Cornish J, Baker T, Toma K, Saxena S, McCulloch B, McFarlane L, Welch J, Sparrow E, Kossarova L, Lumsden DE, Cheung CRLH. Measuring and improving the quality of NHS care for children and young people. Arch Dis Child 2019; 104:618-621. [PMID: 29720493 PMCID: PMC6589454 DOI: 10.1136/archdischild-2017-314564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 11/28/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Dougal S Hargreaves
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK,Nuffield Trust, London, UK
| | - Claire Lemer
- General Paediatrics, Evelina London Children’s Hospital, London, UK,NHS England, London, UK
| | - Carol Ewing
- Department of Paediatrics, Royal Manchester Children’s Hospital, Manchester, UK,Royal College of Paediatrics and Child Health, London, UK
| | | | | | | | | | | | | | - Jack Welch
- RCPCH & Us Children, Young People and Families Network, London, UK
| | - Emma Sparrow
- Royal College of Paediatrics and Child Health, London, UK
| | | | | | | |
Collapse
|
13
|
Affiliation(s)
- Huon Gray
- National Clinical Director for Heart Disease, NHS England, UK
| | - Jacqueline Cornish
- National Clinical Director, Children, Young People and Transition to Adulthood, NHS England, UK
| |
Collapse
|
14
|
Musson D, Tay M, Chhana A, Pool B, Coleman B, Naot D, Cornish J. Lactoferrin and parathyroid hormone are not harmful to primary tenocytes in vitro, but PDGF may be. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2017.03] [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: 11/05/2022]
Affiliation(s)
- D.S. Musson
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - M.L. Tay
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - A. Chhana
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - B. Pool
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - B. Coleman
- Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | - D. Naot
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - J. Cornish
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
15
|
Kalev-Zylinska ML, Hearn JI, Rong J, Zhu M, Munro J, Cornish J, Dalbeth N, Poulsen RC. Altered N-methyl D-aspartate receptor subunit expression causes changes to the circadian clock and cell phenotype in osteoarthritic chondrocytes. Osteoarthritis Cartilage 2018; 26:1518-1530. [PMID: 30031924 DOI: 10.1016/j.joca.2018.06.015] [Citation(s) in RCA: 12] [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: 02/26/2018] [Revised: 06/08/2018] [Accepted: 06/30/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED The chondrocyte circadian clock is altered in osteoarthritis. This change is implicated in the disease-associated changes in chondrocyte phenotype and cartilage loss. Why the clock is changed is unknown. N-methyl-D-aspartate receptors (NMDAR) are critical for regulating the hypothalamic clock. Chondrocytes also express NMDAR and the type of NMDAR subunits expressed changes in osteoarthritis. OBJECTIVE To determine if NMDAR regulate the chondrocyte clock and phenotype. DESIGN Chondrocytes isolated from macroscopically-normal (MN) and osteoarthritic human cartilage were treated with NMDAR antagonists or transfected with GRIN2A or GRIN2B-targetting siRNA. H5 chondrocytes were transfected with GluN2B-expression plasmids. Clock genes and chondrocyte phenotypic markers were measured by RT-qPCR. RESULTS PER2 amplitude was higher and BMAL1 amplitude lower in osteoarthritic compared to MN chondrocytes. In osteoarthritic chondrocytes, NMDAR inhibition restored PER2 and BMAL1 expression to levels similar to MN chondrocytes, and resulted in reduced MMP13 and COL10A1. Paradoxically, NMDAR inhibition in MN chondrocytes resulted in increased PER2, decreased BMAL1 and increased MMP13 and COL10A1. Osteoarthritic, but not MN chondrocytes expressed GluN2B NMDAR subunits. GluN2B knockdown in osteoarthritic chondrocytes restored expression of circadian clock components and phenotypic markers to levels similar to MN chondrocytes. Ectopic expression of GluN2B resulted in reduced BMAL1, increased PER2 and altered SOX9, RUNX2 and MMP13 expression. Knockdown of PER2 mitigated the effects of GluN2B on SOX9 and MMP13. CONCLUSIONS NMDAR regulate the chondrocyte clock and phenotype suggesting NMDAR may also regulate clocks in other peripheral tissues. GluN2B expression in osteoarthritis may contribute to pathology by altering the chondrocyte clock.
Collapse
Affiliation(s)
- M L Kalev-Zylinska
- Department of Molecular Medicine and Pathology, School of Medical Sciences, Auckland, New Zealand.
| | - J I Hearn
- Department of Molecular Medicine and Pathology, School of Medical Sciences, Auckland, New Zealand.
| | - J Rong
- Department of Medicine, School of Medicine, Auckland, New Zealand.
| | - M Zhu
- Department of Medicine, School of Medicine, Auckland, New Zealand; Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - J Munro
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - J Cornish
- Department of Medicine, School of Medicine, Auckland, New Zealand.
| | - N Dalbeth
- Department of Medicine, School of Medicine, Auckland, New Zealand.
| | - R C Poulsen
- Department of Medicine, School of Medicine, Auckland, New Zealand.
| |
Collapse
|
16
|
Robinson D, Vance-Daniels J, Powell-Chandler A, Lewis M, Cornish J. Management of Faecal Incontinence – What are the Options for Wales? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.172] [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]
|
17
|
Lin STC, Musson DS, Amirapu S, Cornish J, Bhattacharyya D. Development of organic solvent-free micro-/nano-porous polymer scaffolds for musculoskeletal regeneration. J Biomed Mater Res A 2017; 105:1393-1404. [DOI: 10.1002/jbm.a.36023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/09/2017] [Accepted: 01/27/2017] [Indexed: 12/25/2022]
Affiliation(s)
- S. T. C. Lin
- Centre for Advanced Composite Materials, Department of Mechanical Engineering; The University of Auckland; Auckland New Zealand
- Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - D. S. Musson
- Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - S. Amirapu
- Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - J. Cornish
- Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - D. Bhattacharyya
- Centre for Advanced Composite Materials, Department of Mechanical Engineering; The University of Auckland; Auckland New Zealand
| |
Collapse
|
18
|
Lucchini G, Labopin M, Beohou E, Dalissier A, Dalle JH, Cornish J, Zecca M, Samarasinghe S, Gibson B, Locatelli F, Bertrand Y, Abdel-Rahman F, Socie G, Sundin M, Lankester A, Sedlacek P, Hamladji RM, Heilmann C, Afanasyev B, Hough R, Peters C, Bader P, Veys P. Impact of Conditioning Regimen on Outcomes for Children with Acute Myeloid Leukemia Undergoing Transplantation in First Complete Remission. An Analysis on Behalf of the Pediatric Disease Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2016; 23:467-474. [PMID: 27916512 DOI: 10.1016/j.bbmt.2016.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 01/26/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents the cornerstone of treatment in pediatric high-risk and relapsed acute myeloid leukemia (AML). The aim of the present study was to compare outcomes of pediatric patients with AML undergoing HSCT using 3 different conditioning regimens: total body irradiation (TBI) and cyclophosphamide (Cy); busulfan (Bu) and Cy; or Bu, Cy, and melphalan (Mel). In this retrospective study, registry data for patients > 2 and <18 years age undergoing matched allogeneic HSCT for AML in first complete remission (CR1) in 204 European Group for Blood and Marrow Transplantation centers between 2000 and 2010 were analyzed. Data were available for 631 patients; 458 patients received stem cells from a matched sibling donor and 173 from a matched unrelated donor. For 440 patients, bone marrow was used as stem cell source, and 191 patients received peripheral blood stem cells. One hundred nine patients received TBICy, 389 received BuCy, and 133 received BuCyMel as their preparatory regimen. Median follow-up was 55 months. Patients receiving BuCyMel showed a lower incidence of relapse at 5 years (14.7% versus 31.5% in BuCy versus 30% in TBICy, P < .01) and higher overall survival (OS) (76.6% versus 64% versus 64.5%, P = .04) and leukemia-free survival (LFS) (74.5% versus 58% versus 61.9%, P < .01), with a comparable nonrelapse mortality (NRM) (10.8% versus 10.5% versus 8.1%, P = .79). Acute graft-versus-host disease (GVHD) grades III and IV but not chronic GVHD, was higher in patients receiving BuCyMel. Older age at HSCT had an adverse impact on NRM and the use of peripheral blood as stem cell source was associated with increased chronic GVHD and NRM as well as lower LFS and OS. Among pediatric patients receiving HSCT for AML in CR1, the use of BuCyMel conditioning proved superior to TBICy and BuCy in reducing relapse and improving LFS.
Collapse
Affiliation(s)
- Giovanna Lucchini
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom.
| | - Myriam Labopin
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | - Eric Beohou
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | - Arnauld Dalissier
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | | | - Jacqueline Cornish
- Paediatric Haematology/Oncology Department, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marco Zecca
- Pediatric Hematology-Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sujith Samarasinghe
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom
| | - Brenda Gibson
- Haematology Department, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Franco Locatelli
- Pediatric Hematology-Oncology Department, IRCCS Bambino Gesu' Children Hospital, Rome, Italy
| | - Yves Bertrand
- Pediatric Hematology and Oncology Department, Institut d'Hématologie et d'Oncologie Pédiatriqu, Lyon, France
| | - Fawzi Abdel-Rahman
- Bone Marrow and Stem Cell Transplantation Department, King Hussein Cancer Centre, Amman, Jordan
| | - Gerald Socie
- Hematology/Transplantation Department, Hôpital St. Louis, Paris, France
| | - Mikael Sundin
- Hematology/Immunology/SCT Department, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Arjan Lankester
- Pediatrics Department, Division of Immuno-Hematology and Stem Cell Transplantation Leiden University Hospital, The Netherlands
| | - Peter Sedlacek
- Paediatric Haematology & Oncology Department, University Hospital Motol, Prague, Czech Republic
| | | | - Carsten Heilmann
- Paediatrics and Adolescent Medicine Department, Rigshospitalet, Copenhagen, Denmark
| | - Boris Afanasyev
- Hematology and Transplantology Department, Saint Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children's Institute, St. Petersburg, Russia
| | - Rachel Hough
- Stem Cell Transplantation Department, University College Hospital, London, United Kingdom
| | - Cristina Peters
- Stem Cell Transplantation Department, St. Anna Kinderspital, Vienna, Austria
| | - Peter Bader
- Stem Cell Transplantation and Immunology Department, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Paul Veys
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom
| |
Collapse
|
19
|
Cornish J, Harries RL, Bosanquet D, Rees B, Ansell J, Frewer N, Dhruva Rao PK, Parry C, Ellis-Owen R, Phillips SM, Morris C, Horwood J, Davies ML, Davies MM, Hargest R, Davies Z, Hilton J, Harris D, Ben-Sassi A, Rajagopal R, Hanratty D, Islam S, Watkins A, Bashir N, Jones S, Russell IR, Torkington J. Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial. Trials 2016; 17:454. [PMID: 27634489 PMCID: PMC5025615 DOI: 10.1186/s13063-016-1573-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions. Trial registration Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J Cornish
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R L Harries
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - D Bosanquet
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - B Rees
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Ansell
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - N Frewer
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - P K Dhruva Rao
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Parry
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Ellis-Owen
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - S M Phillips
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Horwood
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M L Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M M Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Hargest
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Z Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Hilton
- Princess of Wales Hospital, Bridgend, UK
| | | | | | | | - D Hanratty
- Royal Glamorgan Hospital, Llantrisant, UK
| | - S Islam
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - A Watkins
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - N Bashir
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - S Jones
- Involving People, Health and Care Research Wales, Cardiff, UK
| | - I R Russell
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - J Torkington
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | | |
Collapse
|
20
|
Veys P, Danby R, Vora A, Slatter M, Wynn R, Lawson S, Steward C, Gibson B, Potter M, de la Fuente J, Shenton G, Cornish J, Gennery A, Snowden JA, Bonney D, Velangi M, Ruggeri A, Gluckman E, Hough R, Rocha V. UK experience of unrelated cord blood transplantation in paediatric patients. Br J Haematol 2016; 172:482-6. [PMID: 26728432 DOI: 10.1111/bjh.13914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Veys
- Great Ormond Street Hospital for Children, London, UK.
| | - Robert Danby
- Oxford University Hospitals NHS Trust, Oxford, UK.,NHS Blood and Transplant Oxford Centre, Oxford, UK.,Eurocord, Hôpital Saint Louis APHP, Paris, France
| | - Ajay Vora
- Sheffield Children's Hospital, Sheffield, UK
| | - Mary Slatter
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Robert Wynn
- Royal Manchester Children's Hospital, Manchester, UK
| | | | | | | | | | | | | | | | - Andrew Gennery
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | - John A Snowden
- Sheffield Children's Hospital, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Denise Bonney
- Royal Manchester Children's Hospital, Manchester, UK
| | | | | | | | | | - Vanderson Rocha
- Oxford University Hospitals NHS Trust, Oxford, UK.,NHS Blood and Transplant Oxford Centre, Oxford, UK.,Eurocord, Hôpital Saint Louis APHP, Paris, France
| | | |
Collapse
|
21
|
Harries R, Stimpson A, Cornish J. Embracing smartphone apps and social media at #NRCM2014. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey J, Frewer K, Frewer N, Russell D, Russell I, Torkington J. Systematic review and meta regression of factors affecting midline incisional hernia rates: An analysis of 14,618 patients. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.307] [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]
|
23
|
Dalbeth N, Pool B, Franklin C, House M, Cornish J, Naot D. SAT0528 Role of Micrornas in Regulation of the Acute Inflammatory Response to Monosodium Urate Crystals. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3400] [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]
|
24
|
Lin STC, Bhattacharyya D, Fakirov S, Cornish J. Novel Organic Solvent Free Micro-/Nano-fibrillar, Nanoporous Scaffolds for Tissue Engineering. INT J POLYM MATER PO 2014. [DOI: 10.1080/00914037.2013.854210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
25
|
Sreenivasan D, Watson M, Callon K, Dray M, Das R, Grey A, Cornish J, Fernandez J. Integrating micro CT indices, CT imaging and computational modelling to assess the mechanical performance of fluoride treated bone. Med Eng Phys 2013; 35:1793-800. [DOI: 10.1016/j.medengphy.2013.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
|
26
|
Cornish J, Musson DS. EVALUATION OF SCAFFOLDS IN VITRO FOR USE IN TENDON REGENERATION. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092459.43] [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]
|
27
|
Dignan FL, Amrolia P, Clark A, Cornish J, Jackson G, Mahendra P, Scarisbrick JJ, Taylor PC, Shaw BE, Potter MN. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol 2012; 158:46-61. [DOI: 10.1111/j.1365-2141.2012.09128.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Persis Amrolia
- Department of Bone Marrow Transplantation; Great Ormond Street Hospital; London; UK
| | - Andrew Clark
- Bone Marrow Transplant Unit; Beatson Oncology Centre; Gartnavel Hospital; Glasgow; UK
| | - Jacqueline Cornish
- Department of Haematology; Bristol Royal Hospital for Children; Bristol; UK
| | - Graham Jackson
- Department of Haematology; Freeman Road Hospital; Newcastle; UK
| | - Prem Mahendra
- Department of Haematology; University Hospital Birmingham; Birmingham; UK
| | | | - Peter C. Taylor
- Department of Haematology; Rotherham General Hospital; Rotherham; UK
| | | | - Michael N. Potter
- Section of Haemato-oncology; The Royal Marsden NHS Foundation Trust; London; UK
| | | |
Collapse
|
28
|
Dignan FL, Scarisbrick JJ, Cornish J, Clark A, Amrolia P, Jackson G, Mahendra P, Taylor PC, Shah P, Lightman S, Fortune F, Kibbler C, Andreyev J, Albanese A, Hadzic N, Potter MN, Shaw BE. Organ-specific management and supportive care in chronic graft-versus-host disease. Br J Haematol 2012; 158:62-78. [DOI: 10.1111/j.1365-2141.2012.09131.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | | | - Andrew Clark
- Bone Marrow Transplant Unit; Beatson Oncology Centre; Gartnavel Hospital; Glasgow
| | - Persis Amrolia
- Department of Bone Marrow Transplantation; Great Ormond Street Hospital; London
| | - Graham Jackson
- Department of Haematology; Freeman Road Hospital; Newcastle
| | - Prem Mahendra
- Department of Haematology; University Hospital Birmingham; Birmingham
| | - Peter C. Taylor
- Department of Haematology; Rotherham General Hospital; Rotherham
| | - Pallav Shah
- Department of Respiratory Medicine; Royal Brompton Hospital; London
| | - Sue Lightman
- University College London/Institute of Opthalmology; Moorfields Eye Hospital; London
| | - Farida Fortune
- Department of Oral Medicine; Barts and the London NHS Trust; London
| | | | - Jervoise Andreyev
- Department of Medicine; The Royal Marsden NHS Foundation Trust; London
| | | | - Nedim Hadzic
- Paediatric Liver Service & Institute of Liver Studies; King's College Hospital; London
| | - Michael N. Potter
- Section of Haemato-oncology; The Royal Marsden NHS Foundation Trust; London
| | | | | |
Collapse
|
29
|
Dignan FL, Clark A, Amrolia P, Cornish J, Jackson G, Mahendra P, Scarisbrick JJ, Taylor PC, Hadzic N, Shaw BE, Potter MN. Diagnosis and management of acute graft-versus-host disease. Br J Haematol 2012; 158:30-45. [DOI: 10.1111/j.1365-2141.2012.09129.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Andrew Clark
- Bone Marrow Transplant Unit; Beatson Oncology Centre; Gartnavel Hospital; Glasgow; UK
| | - Persis Amrolia
- Department of Bone Marrow Transplantation; Great Ormond Street Hospital; London; UK
| | - Jacqueline Cornish
- Department of Haematology; Bristol Royal Hospital for Children; Bristol; UK
| | - Graham Jackson
- Department of Haematology; Freeman Road Hospital; Newcastle; UK
| | - Prem Mahendra
- Department of Haematology; University Hospital Birmingham; Birmingham; UK
| | | | - Peter C. Taylor
- Department of Haematology; Rotherham General Hospital; Rotherham; UK
| | - Nedim Hadzic
- Paediatric Liver Service and Institute of Liver Studies; King's College Hospital; London; UK
| | | | - Michael N. Potter
- Section of Haemato-oncology; The Royal Marsden NHS Foundation Trust; London; UK
| | | |
Collapse
|
30
|
Palmano K, Ramos R, Watson M, Callon K, Cornish J. Survival and bone-active properties of bovine lactoferrin supplemented into stirred yoghurt. Int Dairy J 2011. [DOI: 10.1016/j.idairyj.2011.02.006] [Citation(s) in RCA: 10] [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: 11/15/2022]
|
31
|
Shaw BE, Mayor NP, Russell NH, Apperley JF, Clark RE, Cornish J, Darbyshire P, Ethell ME, Goldman JM, Little AM, Mackinnon S, Marks DI, Pagliuca A, Thomson K, Marsh SGE, Madrigal JA. Diverging effects of HLA–DPB1 matching status on outcome following unrelated donor transplantation depending on disease stage and the degree of matching for other HLA alleles. Leukemia 2009; 24:58-65. [DOI: 10.1038/leu.2009.239] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
32
|
Sibson K, Steward C, Moppett J, Cornish J, Goulden N. Dismal long-term prognosis for children with refractory acute myeloid leukaemia treated with gemtuzumab ozogamicin and stem cell transplantation: where now? Br J Haematol 2009; 146:342-4. [PMID: 19545292 DOI: 10.1111/j.1365-2141.2009.07750.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Naot D, Cornish J. The role of peptides and receptors of the calcitonin family in the regulation of bone metabolism. Bone 2008; 43:813-8. [PMID: 18687416 DOI: 10.1016/j.bone.2008.07.003] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/28/2022]
Abstract
The 'calcitonin family' is a group of peptide hormones that share structural similarities with calcitonin, and includes calcitonin gene-related peptide (CGRP), amylin, adrenomedullin and adrenomedullin 2 (intermedin). These hormones are produced by different tissues, with calcitonin being produced in thyroid C cells, alphaCGRP predominantly in neural tissue, amylin in beta-islet cells of the pancreas and adrenomedullin in many tissues and cell types. Bone appears to be a common target for all the peptides of the calcitonin family, although the specific bone effects of the peptides vary. Administration of calcitonin produces rapid lowering of serum calcium levels, mainly through inhibition of bone resorption by osteoclasts. In vitro and in a number of animal experimental models, amylin and CGRP are also effective in inhibiting osteoclast activity and bone resorption. Amylin, adrenomedullin and CGRP can also affect cells of the osteoblast lineage, inducing osteoblast proliferation and promoting bone formation. Receptors for the peptides of the calcitonin family are formed by heterodimerization of the calcitonin receptor (CTR) or calcitonin receptor-like receptor (CLR) with receptor activity modifying proteins (RAMPs). Although the different combinations of these proteins create receptors with distinct ligand specificities, there is a degree of cross-reactivity and the receptors are able to bind other ligands from the family, usually with lower affinity. Analysis of the expression of the receptors for the calcitonin family in 16 samples of human osteoblasts showed high levels of CLR and RAMP1, low levels of RAMP2 and no expression of RAMP3 or CTR. Recent studies of the bone phenotype of knockout animals lacking the calcitonin, alphaCGRP or amylin gene indicated that in this experimental system the main physiological role of amylin in bone is the inhibition of bone resorption, that of CGRP is the activation of bone formation, while calcitonin, unexpectedly appears to be inhibiting bone formation without affecting bone resorption. Further investigations will be required to determine the mechanisms of action of calcitonin peptides in bone and their significance to human bone physiology.
Collapse
Affiliation(s)
- D Naot
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | | |
Collapse
|
34
|
Dalbeth N, Smith T, Gray S, Doyle A, Antill P, Lobo M, Robinson E, King A, Cornish J, Shalley G, Gao A, McQueen FM. Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease. Ann Rheum Dis 2008; 68:279-82. [DOI: 10.1136/ard.2008.096024] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:Magnetic resonance imaging (MRI) bone oedema is an important predictor of bone erosion in rheumatoid arthritis (RA). This study aimed to determine the cellular components of MRI bone oedema, and clarify the relationship between bone erosion and MRI bone oedema.Methods:Twenty-eight bones from 11 patients with RA undergoing orthopaedic surgery were analysed by quantitative and semi-quantitative immunohistochemistry. Pre-operative contrast-enhanced MRI scans were analysed for bone oedema.Results:The density of osteoclasts was higher in those samples with MRI bone oedema than those without MRI bone oedema (p = 0.01). Other cells identified within bone marrow included macrophages and plasma cells, and these were more numerous in samples with MRI bone oedema (p = 0.02 and 0.05 respectively). B cells were present in lower numbers, but B cell aggregates were identified in some samples with MRI bone oedema. There was a trend to increased RANKL expression in samples with MRI bone oedema (p = 0.09). Expression of RANKL correlated with the number of osteoclasts (r = 0.592, p = 0.004).Conclusions:The increased number of osteoclasts and RANKL expression in samples with MRI bone oedema supports the hypothesis that bone erosion in RA occurs through activation of local bone resorption mechanisms within subchondral bone as well as through synovial invasion into bone.
Collapse
|
35
|
Schrauder A, von Stackelberg A, Schrappe M, Cornish J, Peters C. Allogeneic hematopoietic SCT in children with ALL: current concepts of ongoing prospective SCT trials. Bone Marrow Transplant 2008; 41 Suppl 2:S71-4. [PMID: 18545248 DOI: 10.1038/bmt.2008.58] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The definition of indications for allogeneic SCT in children with high-risk (HR) ALL in the first remission or after the first or subsequent relapse depends on biological features, response to treatment and survival after chemotherapy alone. As the results of frontline and relapse protocols are improving over time, there is a strong need for prospective SCT trials, ensuring a well-standardized procedure regarding all relevant components that are potentially responsible for heterogeneity in post-SCT outcome. Therefore, in 2003, the ALL-BFM and the ALL-REZ BFM Study Group initiated a prospective, international, multicenter trial (ALL-SCT-BFM 2003). This trial will now be extended to a larger consortium, trial ALL-SCT-BFM-international (ALL-SCT-BFMi). Strict rules define HLA-typing, donor selection, conditioning regimen, GvHD prophylaxis and therapy as well as standards of supportive care to reduce treatment-related mortality and establish an early GVL effect. Moreover, comprehensive and closely reviewed documentation and serious adverse event reporting shall ensure high study quality. Case-by-case discussions of any fatal or critical course during annual meetings will improve the culture of failure management and lead to modifications of guidelines of supportive care. Finally, the results of these prospective trials will determine the current potential of the different SCT procedures in HR or relapsed childhood ALL.
Collapse
Affiliation(s)
- A Schrauder
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Tan EK, Vaizey C, Cornish J, Darzi A, Tekkis PP. Surgical strategies for faecal incontinence--a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stoma. Colorectal Dis 2008; 10:577-86. [PMID: 18005188 DOI: 10.1111/j.1463-1318.2007.01418.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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: 12/15/2022]
Abstract
BACKGROUND Artificial bowel sphincter (ABS) and dynamic graciloplasty (DG) are surgical treatments for faecal incontinence (FI). FI may affect quality of life (QOL) so severely that patients are often willing to consider a permanent end stoma (ES). It is unclear which is the more cost-effective strategy. METHOD Probability estimates for patients with FI were obtained from published data (ABS, n = 319; DG, n = 301), supplemented by expert opinion. The primary outcome was quality-adjusted life years (QALYs) gained from each strategy. Factors considered were the risk of failure of the primary and redo operation and the consequent risk of permanent stoma. Results were assessed as incremental cost-effectiveness ratio (ICER). RESULTS Over the 5-year time horizon, ES gave a QALY gain of 3.45 for 16,280 pounds sterling, giving an ICER of 4719 pounds sterling/QALY. ABS produced a gain of 4.38 QALYs for 23,569 pounds sterling, giving an ICER of 5387 pounds sterling/QALY. DG produced a gain of 4.00 QALYs for 25,035 pounds sterling, giving an ICER of 6257 pounds sterling/QALY. With the willingness-to-pay threshold set at 30,000 pounds sterling/QALY, ES was the most cost-effective intervention. The ABS was most cost-effective after 10 years. CONCLUSION All three procedures were found to be cost-effective. The ES was most cost-effective over 5 years, while the ABS was most cost-effective in excess of 10. DG maybe considered as an alternative in specialist centres.
Collapse
Affiliation(s)
- E K Tan
- Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK
| | | | | | | | | |
Collapse
|
37
|
Bui K, Cornish J. Innovative Therapies for Neonatal Respiratory Failure: High-Frequency Ventilation and Extracorporeal Membrane Oxygenation. Semin Respir Crit Care Med 2008. [DOI: 10.1055/s-2007-1006198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Abstract
BACKGROUND Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. AIM To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. DESIGN The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. PATIENTS AND SETTING A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. RESULTS For women with IBD, there was a 1.87-fold increase in incidence of prematurity (<37 weeks gestation; 95% CI 1.52 to 2.31; p<0.001) compared with controls. The incidence of low birth weight (<2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p<0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p<0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p<0.001). CONCLUSION The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.
Collapse
Affiliation(s)
- J Cornish
- Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College, 10th Floor QEQM Wing, Praed Street, London W2 1NY, UK
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) are well-documented potent regulators of osteoclast development. However, their effects in mature bone cells and in organ cultures have not been well studied. It is uncertain whether their activities in different experimental models are comparable. MATERIALS AND METHODS RANKL and OPG were evaluated for their activities in mouse calvarial organ cultures, mouse bone marrow cultures, isolated rat mature osteoclast assays and rat primary osteoblast cultures. Results In murine calvarial organ culture, both muRANKL (> or = 10 ng mL(-1)) and rRANKL (> or = 100 ng mL(-1)) significantly stimulated (45)Ca release, while OPG (> or = 50 ng mL(-1)) was an inhibitor of bone resorption. Meanwhile, [(3)H]-thymidine incorporation in this assay was also modulated (indicating proliferation increases in the osteoblast lineage of cells) although these peptides had no direct effect on [(3)H]-thymidine incorporation in isolated osteoblast assays. In mouse bone marrow cultures, muRANKL (> or = 1 ng mL(-1)) and rRANKL (> or = 5 ng mL(-1)) significantly stimulated osteoclastogenesis. The number of nuclei per osteoclast was also significantly increased. OPG strongly inhibited this index, with over 90% suppression at 1 ng mL(-1). Both muRANKL (10 ng mL(-1)) and rRANKL (100 ng mL(-1)) stimulated, while OPG (10 ng mL(-1)) inhibited osteoclast activity in isolated mature osteoclast assays. CONCLUSION The current study demonstrated that bone resorption modulated by RANKL and OPG, in murine calvarial organ culture, leads to changes in osteoblast proliferation, suggesting a feedback mechanism from osteoclasts to osteoblasts. In addition, it was found that RANKL and OPG have more potent effects on osteoclastogenesis than on the activity of mature osteoclasts.
Collapse
Affiliation(s)
- J M Lin
- University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | |
Collapse
|
40
|
Miano M, Labopin M, Hartmann O, Angelucci E, Cornish J, Gluckman E, Locatelli F, Fischer A, Egeler RM, Or R, Peters C, Ortega J, Veys P, Bordigoni P, Iori AP, Niethammer D, Rocha V, Dini G. Haematopoietic stem cell transplantation trends in children over the last three decades: a survey by the paediatric diseases working party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2007; 39:89-99. [PMID: 17213848 DOI: 10.1038/sj.bmt.1705550] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [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: 11/09/2022]
Abstract
This paper describes the trends in haematopoietic stem cell transplantation (HSCT) activity for children in Europe over the last three decades. We analysed 31,713 consecutive paediatric HSCTs reported by the European Group for Blood and Marrow Transplantation (EBMT) centres between 1970 and 2002. Data were taken from the EBMT registry and were compared according to period and centre category (paediatric or combined). Since 1996, there has been a significant increase in the number of HSCTs performed exclusively by paediatric centres, as well as in the number of alternative donor HSCTs, and in the use of peripheral blood stem cells (P<0.0001). The number of allogeneic HSCTs (allo-HSCTs) for acute lymphoblastic leukaemia, acute myeloblastic leukaemia and chronic myeloid leukaemia remained stable, whereas it increased for myelodysplastic syndromes and lymphomas, and decreased significantly for non-malignant diseases (P<0.0001). Multivariate analysis showed that younger age, human leukocyte antigen genoidentical donors, HSCT performed after 1996 and transplant centres performing more than 10 allo-HSCT/year were all associated with decreased transplant-related mortality (TRM) (P<0.0001). The number of autologus HSCTs (auto-HSCTs) for acute leukaemia decreased significantly, whereas it increased for solid tumours (P<0.0001). Multivariate analysis showed that both auto-HSCT performed before 1996 and paediatric solid tumours (P<0.0001) had higher TRM. Indications for paediatric HSCT have changed considerably during the last seven years. These changes provide tools for decision making in health-care planning and counselling.
Collapse
Affiliation(s)
- M Miano
- Department of Paediatric Haematology and Oncology, IRCSS Giannina Gaslini, Genova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Alvimopan is a selective, competitive mu-opioid receptor antagonist with limited oral bioavailability which may be used to reduce length of post-operative ileus. AIM The study compared alvimopan with placebo following bowel resection or total abdominal hysterectomy. METHODS A meta-analysis of randomized-controlled trials published between 2001 and 2006 of alvimopan vs. placebo was performed. The primary efficacy end-points were composite measures of passage of flatus, stool, and tolerance of solid food (GI-3) and passage of stool and tolerance of solid food (GI-2). The incidence of treatment emergent adverse events was assessed. RESULTS Five trials matched the selection criteria, reporting on 2195 patients. A total of 1521 (69.3%) had alvimopan and 674 (30.7%) placebo. GI-3 significantly improved (hazard ratio 1.30; 95% confidence intervals 1.16, 1.45, P < 0.001), as did GI-2 (hazard ratio 1.61; 95% confidence intervals 1.26, 2.05, P < 0.001) on alvimopan 12 mg. Time to discharge (hazard ratio 1.26; 95% confidence intervals 1.13, 1.40, P < 0.001), time to bowel motion (hazard ratio 1.74; 95% confidence intervals 1.29, 2.35, P < 0.001), and time to solid food (hazard ratio 1.14; 95% confidence intervals 1.01, 1.30, P < 0.04) also improved significantly. No difference was noted in the incidence of treatment emergent adverse events. CONCLUSIONS Alvimopan showed significant advantages over placebo in restoring gastro-intestinal function, and reduced time to discharge following major abdominal surgery, with acceptable side effects.
Collapse
Affiliation(s)
- E K Tan
- Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College, London, UK
| | | | | | | |
Collapse
|
42
|
Cornish J, Callon KE, Bava U, Watson M, Xu X, Lin JM, Chan VA, Grey AB, Naot D, Buchanan CM, Cooper GJS, Reid IR. Preptin, another peptide product of the pancreatic beta-cell, is osteogenic in vitro and in vivo. Am J Physiol Endocrinol Metab 2007; 292:E117-22. [PMID: 16912056 DOI: 10.1152/ajpendo.00642.2005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several hormones that regulate nutritional status also impact on bone metabolism. Preptin is a recently isolated 34-amino acid peptide hormone that is cosecreted with insulin and amylin from the pancreatic beta-cells. Preptin corresponds to Asp(69)-Leu(102) of pro-IGF-II. Increased circulating levels of a pro-IGF-II peptide complexed with IGF-binding protein-2 have been implicated in the high bone mass phenotype observed in patients with chronic hepatitis C infection. We have assessed preptin's activities on bone. Preptin dose-dependently stimulated the proliferation (cell number and DNA synthesis) of primary fetal rat osteoblasts and osteoblast-like cell lines at periphysiological concentrations (>10(-11) M). In addition, thymidine incorporation was stimulated in murine neonatal calvarial organ culture, likely reflecting the proliferation of cells from the osteoblast lineage. Preptin did not affect bone resorption in this model. Preptin induced phosphorylation of p42/p44 MAP kinases in osteoblastic cells in a dose-dependent manner (10(-8)-10(-10) M), and its proliferative effects on primary osteoblasts were blocked by MAP kinase kinase inhibitors. Preptin also reduced osteoblast apoptosis induced by serum deprivation, reducing the number of apoptotic cells by >20%. In vivo administration of preptin increased bone area and mineralizing surface in adult mice. These data demonstrate that preptin, which is cosecreted from the pancreatic beta-cell with amylin and insulin, is anabolic to bone and may contribute to the preservation of bone mass observed in hyperinsulinemic states such as obesity.
Collapse
Affiliation(s)
- J Cornish
- Dept. of Medicine, Univ. of Auckland, Private Bag 92019, Auckland, NZ, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hows JM, Passweg JR, Tichelli A, Locasciulli A, Szydlo R, Bacigalupo A, Jacobson N, Ljungman P, Cornish J, Nunn A, Bradley B, Socié G. Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors. Bone Marrow Transplant 2006; 38:799-805. [PMID: 17075568 DOI: 10.1038/sj.bmt.1705531] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 77+/-5% for the MSD and 67+/-11% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.
Collapse
Affiliation(s)
- J M Hows
- Department of Biomedical Sciences, Faculty of Applied Sciences, University of the West of England, Bristol, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Cornish J, Palmano K, Callon KE, Watson M, Lin JM, Valenti P, Naot D, Grey AB, Reid IR. Lactoferrin and bone; structure–activity relationshipsThis paper is one of a selection of papers published in this Special Issue, entitled 7th International Conference on Lactoferrin: Structure, Function, and Applications, and has undergone the Journal's usual peer review process. Biochem Cell Biol 2006; 84:297-302. [PMID: 16936800 DOI: 10.1139/o06-057] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [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: 11/22/2022] Open
Abstract
The maintenance of the mechanical integrity of the skeleton depends on bone remodeling, the well-coordinated balance between bone formation by osteoblasts and bone resorption by osteoclasts. The coupled action of osteoblasts and osteoclasts is regulated by the action of many local and circulating hormones and factors as well as central regulation by a neurological mechanism. We have previously shown that lactoferrin can promote bone growth. At physiological concentrations, lactoferrin potently stimulates the proliferation and differentiation of primary osteoblasts and acts as a survival factor. Lactoferrin also affects osteoclasts, potently inhibiting their formation. In vivo, local injection of lactoferrin results in substantial increases in bone formation and bone area. In a critical bone-defect model in vivo, lactoferrin was also seen to promote bone growth. The mitogenic effect of lactoferrin in osteoblast-like cells is mediated mainly through low-density lipoprotein-receptor protein-1 (LRP1), a member of the low-density lipoprotein-receptor-related proteins that are primarily known as endocytic receptors; however, LRP1 is not necessary for the anti-apoptotic actions of lactoferrin. Lactoferrin also induces the activation of p42/44 mitogen-activated protein kinase (MAPK) signalling and the PI3-kinase-dependent phosphorylation of Akt in osteoblasts. In this study, we examined other properties of lactoferrin and the way they affect osteogenic activity. The degree of glycosylation, iron-binding, and the structure–activity relationships indicate that lactoferrin maintains osteogenic activity in deglycosylated, holo, and apo forms, and in with various small fragments of the molecule. These data suggest that lactoferrin signals through more than 1 membrane-bound receptor to produce its anabolic skeletal effects, and that it signals through diverse pathways. We conclude that lactoferrin might have a physiological role in bone growth and healing and a potential therapeutic role as an anabolic factor in osteoporosis.
Collapse
Affiliation(s)
- J Cornish
- Department of Medicine, University of Auckland, Private Bag 92019 Auckland, New Zealand.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Duarte RF, Pamphilon D, Cornish J, Shaw BE, Samson D, Craddock C, Marks D, Mufti GJ, Powles RL, Apperley JF, Madrigal JA, Goldman JM. Topical issues in unrelated donor haematopoietic stem cell transplants: a report from a workshop convened by the Anthony Nolan Trust in London - 2005. Bone Marrow Transplant 2006; 37:901-8. [PMID: 16670700 DOI: 10.1038/sj.bmt.1705365] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over more than three decades, The Anthony Nolan Trust (ANT) has provided an unrelated donor (UD) for over 4000 children and adults lacking a suitable family member donor, and has remained at the forefront of developments in haematopoietic stem cell transplantation (HSCT) and bone marrow register management. These three decades have seen major changes in clinical practice of UD-HSCT, including new indications, increased use of alternative haematopoietic cell sources, significant improvement of the outcome as a result of better support care, less-toxic conditioning regimens, and better donor selection, and expansion to older patients with higher comorbidities. In order to foster our goal of improving UD-HSCT availability and outcome in a progressively more complex clinical scenario, a new initiative from ANT was launched in 2005 to convene an experts workshop to address the topical issues in this field. Four consecutive panels addressed factors influencing donor selection and transplant outcome, the use of cord blood, regulatory and accreditation issues, and future developments in this field. This report summarizes the discussions held in this workshop, which will likely develop into a periodic event where transplant clinicians, scientists and registry members will meet to share their experience and vision in the field of UD-HSCT.
Collapse
Affiliation(s)
- R F Duarte
- The Anthony Nolan Trust, Royal Free Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Miano M, Cancedda R, Hartmann O, Cornish J, Locatelli F, Egeler RM, Slavin S, Veys P, Ortega J, Peters C, Wynn RF, Iori AP, Fagioli F, Ljungmann P, Niethammer D, Bordigoni P, Dini G. Survey on haematopoietic stem cell transplantation for children in Europe. Bone Marrow Transplant 2005; 35 Suppl 1:S3-8. [PMID: 15812526 DOI: 10.1038/sj.bmt.1704834] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A recent report, prepared in March 2003, regarding the paediatric transplantation activity registered between 1970 and 2002 in the European Bone Marrow Transplantation (EBMT) database showed a decrease in the number of registrations in 2001 and in 2002. In order to validate this observation, the Paediatric Diseases Working Party (PDsWP) secretariat distributed a questionnaire to 395 institutions participating in the EBMT Registry. Each institution was requested to check the number of transplants they reported and to confirm or to correct the figures. As of 15 March 2004, replies had been received from 135 centres reporting a median of 48 transplants per centre over the study period, total 17 891 (58% of the total number). Among them, 55 confirmed their original figures, while 80 corrected the numbers. The overall number of autologous and allogeneic SCTs performed and not reported were 461 and 692, respectively. Most of the teams that corrected their figures stated that their data managers could provide missing data to the EBMT; 260 other teams, each reporting a median of 15 transplants during the study period, total 12 866 (42% of the total number) chose not to reply. A report prepared in March 2004, following the PDsWP survey, showed an increasing number of transplants performed on patients below 18 years of age between 1973 and 2002 and reported to the EBMT Registry (328 autologous and 628 allogeneic) as compared to the 2003 report. This first PDsWP survey, reaching more than 50% of activity in the field, illustrates that the decrease in activity we observed in the 2003 report does not correspond to a decrease in the number of transplants that were actually performed. It demonstrates the compliance of most major paediatric institutions and confirms the important role of cooperation between National Registries and EBMT Registries.
Collapse
Affiliation(s)
- M Miano
- Department of Paediatric Haematology and Oncology, IRCCS G Gaslini, Genova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Afify Z, Hunt L, Green A, Guttridge M, Cornish J, Oakhill A. Factors affecting the outcome of stem cell transplantation from unrelated donors for childhood acute lymphoblastic leukemia in third remission. Bone Marrow Transplant 2005; 35:1041-7. [PMID: 15806120 DOI: 10.1038/sj.bmt.1704958] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Between July 1990 and March 2002, 35 consecutive children with ALL in third complete remission (CR3) underwent stem cell transplantation (SCT) from unrelated donors (UD). All patients received CAMPATH-1M 5-20 mg daily for 5 days. Grafts were T-cell depleted in 30 patients, 29 by CAMPATH antibodies and one by CD34 selection. Median follow-up was 3.8 years (0.3-9.3). Event-free survival (EFS) at 3 years was 35% (SE 8%); relapse rate and transplant-related mortality (TRM) at 3 years was 42 and 23%. Short first complete remission (CR1) <2.5 years was associated with lower EFS (P=0.001), higher TRM (P=0.019) and higher relapse rate (P=0.023). Short second complete remission (CR2) <2.5 years was associated with lower EFS (P=0.003) and higher TRM (0.009). Higher relapse rate and lower EFS were associated with isolated first extramedullary relapse (P=0.019, 0.012). There was no significant difference in outcome between mismatched unrelated donor stem cell transplantation (MMUD-SCT) and matched unrelated donor stem cell transplantation (UD-SCT). We conclude that UD-SCT is an effective treatment of ALL in CR3. The outcome remains limited by TRM and a high relapse rate. Short duration of CR1 and of CR2 and extramedullary site at first relapse are particularly adverse. MMUD should also be considered in high-risk patients, since the outcome of MMUD appears similar to MUD.
Collapse
Affiliation(s)
- Z Afify
- Department of Pediatrics, Hematology Oncology Division, University of Utah, Primary Children's Medical Center, 100 N. Medical Drive Ste. 1400, Salt Lake City, UT 84113, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Cornish J. Unrelated donor transplant for acute leukaemia in children—the UK experience. ACTA ACUST UNITED AC 2005; 53:167-70. [DOI: 10.1016/j.patbio.2004.03.007] [Citation(s) in RCA: 4] [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] [Received: 11/19/2003] [Accepted: 03/05/2004] [Indexed: 11/16/2022]
|
49
|
Abstract
We have demonstrated bovine or human lactoferrin to be an anabolic factor in skeletal tissue. In vitro, lactoferrin stimulates the proliferation of bone forming cells, osteoblasts, and cartilage cells at physiological concentrations (above 0.1 microg/ml). The magnitude of this effect exceeds that observed in response to other skeletal growth factors such as IGF-1 and TGFbeta. DNA synthesis is also stimulated in a bone organ culture system likely reflecting the proliferation of cells of the osteoblast lineage. Lactoferrin is also a potent osteoblast survival factor. In TUNEL and DNA fragmentation assays, lactoferrin decreased apoptosis, induced by serum withdrawal, by up to 70%. In addition, lactoferrin has powerful effects on bone resorbing cells, osteoclasts, decreasing osteoclast development at concentrations > 1 microg/ml in a murine bone marrow culture system. However, lactoferrin did not alter bone resorption in calvarial organ culture, suggesting that it does not influence mature osteoclast function. In vivo, local injection of lactoferrin in adult mice resulted in increased calvarial bone growth, with significant increases in bone area and dynamic histomorphometric indices of bone formation after only 5 injections. Taken together, these data demonstrate that the naturally-occurring glycoprotein lactoferrin is anabolic to bone in vivo, an effect which is consequent upon its potent proliferative and anti-apoptotic actions in osteoblasts, and its ability to inhibit osteoclastogenesis. Lactoferrin may therefore have a physiological role in bone growth, and a potential therapeutic role in osteoporosis.
Collapse
Affiliation(s)
- J Cornish
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| |
Collapse
|
50
|
Grey A, Xu X, Hill B, Watson M, Callon K, Reid IR, Cornish J. Osteoblastic cells express phospholipid receptors and phosphatases and proliferate in response to sphingosine-1-phosphate. Calcif Tissue Int 2004; 74:542-50. [PMID: 15354862 DOI: 10.1007/s00223-003-0155-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sphingosine-1-phosphate (S1P) is a naturally occurring polar phospholipid that exerts growth-factor--like effects in a number of cell types, potentially by endocrine, paracrine, and intracrine mechanisms. The biological actions of S1P are mediated in part by its specific binding to at least four members of the edg/lp family of G protein-coupled receptors (edg 1, 3, 6, and 8), and further regulated by the actions of specific cell membrane-bound lipid phosphate phosphatases (LPPs). Recent evidence has suggested that S1P may act as an osteoblast growth factor. In the current study, we demonstrate expression in osteoblastic cells of the S1P receptors edg 1, edg 5 and edg 8; the lipid phosphate phosphatases LPP-1, LPP-2, and LPP-3, and the S1P phosphatase mSPP1. S1P exerts dose-dependent mitogenic effects in cultures of primary rat osteoblastic cells and SaOS-2 cells. S1P also activates p42/44 mitogen-activated protein (MAP) kinases in osteoblastic cells, and the proliferative effects of S1P in these cultures are partially abrogated by PD-98059 and U-0126, specific inhibitors of p42/44 MAP kinase signaling. S1P-induced p42/44 MAP kinase activation in osteoblastic cells is dependent on functional Gi proteins and intracellular calcium fluxes, but not on protein kinase A, phospha-tidylinositol-3 kinase, or protein Kinase C. These data demonstrate (1) the expression by osteoblastic cells of several cell membrane-bound components of phospholipid signaling and (2) that S1P is a potent osteoblast mitogen, the proliferative action of which is mediated by a signaling pathway that involves Gi proteins, intracellular calcium, and p42/44 MAP kinases.
Collapse
Affiliation(s)
- A Grey
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | | | | | | | | | | | | |
Collapse
|