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Lussiez A, Dally CK, Boateng EA, Bosompem K, Peprah E, Hayward L, Janes L, Byrnes M, Vitous A, Duby A, Varlamos C, Ma L, Darkwa D, Aitpillah F, Gyasi-Sarpong KC, Opoku BK, Raghavendran K, Kwakye G. Barriers to colorectal cancer screening in Ghana: a qualitative study of patients and physicians. Cancer Causes Control 2022; 33:951-958. [PMID: 35415797 PMCID: PMC9005024 DOI: 10.1007/s10552-022-01578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The incidence of colorectal cancer (CRC) in Ghana has increased eightfold since the 1960s. In 2011, national guidelines were set forth recommending all patients aged 50-70 years old undergo annual CRC screening with fecal occult blood testing (FOBT), but adherence to these guidelines is poor and screening rates remain low for unclear reasons. METHODS We performed semi-structured interviews with 28 Ghanaians including physicians (n = 14) and patients (n = 14) from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, to better understand the factors driving screening adherence and perceived barriers identified in an earlier quantitative study. RESULTS Participants reported sociocultural factors such as reliance on alternative medicine or religion, lack of education, and financial burden as community-level barriers to CRC screening. At the system level, screening was limited by insufficient access to FOBT as well as a perceived lack of national prioritization. This was described as inadequate efforts from the Ministry of Health regarding national education as well as lack of incorporation of CRC screening into the National Health Insurance Scheme. CONCLUSION Several community- and system-level barriers exist to widespread screening of CRC in Ghana. A multi-level approach will be required to improve rates of CRC screening and ultimately reduce the burden of CRC in Ghana.
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Affiliation(s)
- A Lussiez
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA. .,University of Michigan, Taubman Center, Floor 2 Reception C, 1500 E Medical Center Dr SPC 5331, Ann Arbor, MI, 48109-5331, USA.
| | - C K Dally
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana.,Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - E A Boateng
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana
| | - K Bosompem
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana
| | - E Peprah
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana
| | - L Hayward
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - L Janes
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - M Byrnes
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - A Vitous
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - A Duby
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - C Varlamos
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - L Ma
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - D Darkwa
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana
| | - F Aitpillah
- Department of Surgery, Komfo Anokye Teaching Hospital (KATH), Okomfo Anokye Road, Kumasi, Ghana
| | - K C Gyasi-Sarpong
- Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - B K Opoku
- Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.,Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - K Raghavendran
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA.,Michigan Center for Global Surgery, University of Michigan, Ann Arbor, MI, USA
| | - G Kwakye
- Department of Surgery, University of Michigan, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA.,Michigan Center for Global Surgery, University of Michigan, Ann Arbor, MI, USA
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Challa A, Hayward L, Maxwell R, Burns K, Wijesekera V, Chan W. Emerging Treatment Options for the Systemic Right Ventricle: A Single Centre Experience of Sacubitril/Valsartan in Transposition of Great Arteries. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.067] [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: 10/20/2022]
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Hayward L, Guo D, Wagner K, King O, Emerson C. FSHD / OPMD / MYOTONIC DYSTROPHY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.231] [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]
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Jones R, Casbard A, Carucci M, Smith J, Ingarfield K, Gee J, Hudson Z, Alchami F, Hayward L, Hickish T, Hwang D, McAdam K, Spensley S, Waters S, Wheatley D, Beresford M. LBA20 Vandetanib plus fulvestrant versus placebo plus fulvestrant after relapse or progression on an aromatase inhibitor in metastatic ER positive breast cancer (FURVA): A randomised, double-blind, placebo-controlled, phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2248] [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: 10/23/2022] Open
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Hayward L, Moses R, Hughes L, Forster E, Saul N. Tracheostomy weaning in community and the importance of the Multi-Disciplinary Team (MDT) to optimise outcomes - a case report. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.041] [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]
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Horne A, McMenemy M, Holly E, Rigglesford N, Linksted P, Murdoch L, Oikonomidou O, Michie C, Hayward L, Lilley C, Hall P. Real-world treatment sequencing patterns in secondary breast cancer (SBC): Pathway visualisation using national datasets. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.073] [Citation(s) in RCA: 1] [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: 11/12/2022] Open
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Nixon J, Cowie F, White J, Chong P, Lo S, Bodie D, Hayward L, Ferguson M, Campbell L. EP-1602 Role of clinical networks in sarcomas: The Scottish Sarcoma Network(SSN)Experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32022-5] [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]
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Abstract
The use of vaginal mesh in prolapse surgery has created enormous controversy and unprecedented media interest; it has become the most emotive topic in urogynecology today. The US Food and Drug Administration 510(k) system allowed the proliferation of mesh products which were rapidly adopted by surgeons internationally. The importance of a firm understanding of the biomechanical properties of tissue and implants, surgical skill, patient selection, communication skills, informed consent, and high-quality research are all important lessons we can learn from the mesh story. These lessons need to be applied to all novel treatments in the field of urogynecology and beyond.
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Affiliation(s)
- D Karmakar
- a Department of Urogynaecology , Mercy Hospital, Heidelberg , Melbourne , Australia
| | - L Hayward
- b Immediate Past President of the International Urogynecological Association, Department of Women's Health , Middlemore Hospital , Auckland , New Zealand
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Hayward S, Hayward L. Opaque hemithorax (whiteout): a literature review exploring its causes, potential use of thoracic ultrasound and the role of physiotherapy. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hayward S, Hayward L, Tait C, Gidden J, Seddon D, Williams N. Thoracic ultrasound to differentially diagnose causes of opaque hemithorax (whiteout) when patients are referred for “chest” physiotherapy. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.066] [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]
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Hayward L, Hayward S. Thoracic ultrasound can differentiate between the causes of an opaque hemithorax (whiteout) during an on-call physiotherapy assessment: a case report. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.128] [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]
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12
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Cao S, Parelkar S, Ko H, Thompson P, Hayward L. CMT AND NEUROGENIC DISEASE. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.394] [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]
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Ali HR, Dariush A, Thomas J, Provenzano E, Dunn J, Hiller L, Vallier AL, Abraham J, Piper T, Bartlett JMS, Cameron DA, Hayward L, Brenton JD, Pharoah PDP, Irwin MJ, Walton NA, Earl HM, Caldas C. Lymphocyte density determined by computational pathology validated as a predictor of response to neoadjuvant chemotherapy in breast cancer: secondary analysis of the ARTemis trial. Ann Oncol 2017; 28:1832-1835. [PMID: 28525534 PMCID: PMC5834010 DOI: 10.1093/annonc/mdx266] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We have previously shown lymphocyte density, measured using computational pathology, is associated with pathological complete response (pCR) in breast cancer. The clinical validity of this finding in independent studies, among patients receiving different chemotherapy, is unknown. PATIENTS AND METHODS The ARTemis trial randomly assigned 800 women with early stage breast cancer between May 2009 and January 2013 to three cycles of docetaxel, followed by three cycles of fluorouracil, epirubicin and cyclophosphamide once every 21 days with or without four cycles of bevacizumab. The primary endpoint was pCR (absence of invasive cancer in the breast and lymph nodes). We quantified lymphocyte density within haematoxylin and eosin (H&E) whole slide images using our previously described computational pathology approach: for every detected lymphocyte the average distance to the nearest 50 lymphocytes was calculated and the density derived from this statistic. We analyzed both pre-treatment biopsies and post-treatment surgical samples of the tumour bed. RESULTS Of the 781 patients originally included in the primary endpoint analysis of the trial, 609 (78%) were included for baseline lymphocyte density analyses and a subset of 383 (49% of 781) for analyses of change in lymphocyte density. The main reason for loss of patients was the availability of digitized whole slide images. Pre-treatment lymphocyte density modelled as a continuous variable was associated with pCR on univariate analysis (odds ratio [OR], 2.92; 95% CI, 1.78-4.85; P < 0.001) and after adjustment for clinical covariates (OR, 2.13; 95% CI, 1.24-3.67; P = 0.006). Increased pre- to post-treatment lymphocyte density showed an independent inverse association with pCR (adjusted OR, 0.1; 95% CI, 0.033-0.31; P < 0.001). CONCLUSIONS Lymphocyte density in pre-treatment biopsies was validated as an independent predictor of pCR in breast cancer. Computational pathology is emerging as a viable and objective means of identifying predictive biomarkers for cancer patients. CLINICALTRIALS.GOV NCT01093235.
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Affiliation(s)
- H. R. Ali
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute
- Department of Pathology
| | - A. Dariush
- Institute of Astronomy, University of Cambridge, Cambridge
| | - J. Thomas
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
| | - E. Provenzano
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - J. Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L. Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - A.-L. Vallier
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - J. Abraham
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - T. Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
| | - J. M. S. Bartlett
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
- Ontario Institute for Cancer Research, Toronto, Canada
| | - D. A. Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
| | - L. Hayward
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
| | - J. D. Brenton
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - P. D. P. Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - M. J. Irwin
- Institute of Astronomy, University of Cambridge, Cambridge
| | - N. A. Walton
- Institute of Astronomy, University of Cambridge, Cambridge
| | - H. M. Earl
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - C. Caldas
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute
- Department of Oncology, University of Cambridge, Addenbrooke’s Hospital, Cambridge
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
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Brown ERS, Bartlett J, Chalulu K, Gadama L, Gorman D, Hayward L, Jere Y, Mpinganjira M, Noah P, Raphael M, Taylor F, Masamba L. Development of multi-disciplinary breast cancer care in Southern Malawi. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28111860 DOI: 10.1111/ecc.12658] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
The Edinburgh Malawi Breast Cancer Project, a collaborative partnership project between the Queen Elizabeth Central Hospital (QECH) Oncology Unit, Blantyre, Malawi and the Edinburgh Cancer Centre, UK, was established in 2015. The principal objective of the project is to help to develop high quality multi-disciplinary breast cancer care in Malawi. A needs assessment identified three priority areas for further improvement of breast cancer services: multi-disciplinary working, development of oestrogen receptor (ER) testing and management of clinical data. A 3-year project plan was implemented which has been conducted through a series of reciprocal training visits. Key achievements to date have been: (1) Development of a new specialist breast care nursing role; (2) Development of multi-disciplinary meetings; (3) Completion of a programme of oncology nursing education; (4) Development of a clinical database that enables prospective collection of data of all new patients with breast cancer; (5) Training of local staff in molecular and conventional approaches to ER testing. The Edinburgh Malawi Breast Cancer Project is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will include the development of a breast cancer diagnostic clinic and a breast cancer registry.
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Affiliation(s)
- E R S Brown
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - J Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Chalulu
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - L Gadama
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - D Gorman
- Department of Public Health, NHS Lothian, Edinburgh, UK
| | - L Hayward
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Y Jere
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - P Noah
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - M Raphael
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - F Taylor
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - L Masamba
- Queen Elizabeth Central Hospital, Blantyre, Malawi
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Layfield DM, See H, Stahnke M, Hayward L, Cutress RI, Oeppen RS. Radiopathological features predictive of involved margins in ductal carcinoma in situ. Ann R Coll Surg Engl 2017; 99:137-144. [PMID: 27659365 PMCID: PMC5392827 DOI: 10.1308/rcsann.2016.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/31/2016] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography but may be uncalcified. Consequently, a quarter of patients undergoing excision of a presumed pure DCIS require further surgery to re-excise margins. Patients at highest risk of margin involvement may benefit from additional preoperative assessment. METHODS A retrospective review was carried out of patients treated for screen detected, biopsy proven DCIS in a single centre over a ten-year period (1999-2009). Logistic regression analysis identified factors predictive of need for further surgery to clear margins. RESULTS Overall, 248 patients underwent surgery for DCIS (low/intermediate grade: 82, high grade: 155) and 49 (19.8%) required further surgery. High grade disease was associated with greater mammographic extent (mean: 32mm [range: 5-120mm] vs 25mm [range: 2-100mm]), p=0.009) and higher incidence of mastectomy (38% vs 24%, p=0.034). Factors predictive of involvement of surgical margins necessitating further surgery included negative oestrogen receptor status (OR: 5.2, 95% CI: 2.1-12.8, p<0.001) and mammographic extent (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2-2.1, p=0.004). Once size exceeded 30mm, more than 50% of patients required secondary breast surgery for margins. CONCLUSIONS Reoperation rates for DCIS increase with preoperative size on mammography and negative oestrogen receptor status on core biopsy. Patients with these risk features should be counselled accordingly and consideration should be given to the role of additional preoperative imaging.
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Affiliation(s)
| | - H See
- University of Southampton , UK
| | - M Stahnke
- University Hospital Southampton NHS Foundation Trust , UK
| | | | - R I Cutress
- University of Southampton , UK
- University Hospital Southampton NHS Foundation Trust , UK
- Contributed equally
| | - R S Oeppen
- University Hospital Southampton NHS Foundation Trust , UK
- Contributed equally
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See H, Layfield D, Stahnke M, Hayward L, Squire K, Summerhayes C, Rew D, Royle G, Rubin C, Oeppen R, Cutress R. Clinicopathological features predictive of unexpected invasive disease and multiple operations in pure ductal carcinoma in situ. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.201] [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: 10/26/2022] Open
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Hayward L, Oeppen RS, Grima AV, Royle GT, Rubin CM, Cutress RI. The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ. Ann R Coll Surg Engl 2011; 93:385-90. [PMID: 21943463 PMCID: PMC3365457 DOI: 10.1308/003588411x579829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The extent of calcified ductal carcinoma in situ (DCIS) detected by screening mammography is a determinant for treatment with breast conserving surgery (BCS). However, DCIS may be uncalcified and almost a quarter of patients with DCIS treated initially by BCS either require a second operation or are found to have unexpected invasive disease following surgery. Identification of these cases might guide selective implementation of additional diagnostic procedures. METHODS A retrospective review of patients with a preoperative diagnosis of pure high-grade DCIS at the Southampton and Salisbury Breast Screening Unit over a ten-year period was carried out. Mammograms were reviewed independently by a consultant radiologist and additional factors including the Breast Imaging Reporting and Data System (BI-RADS(®)) breast density score, DCIS extent and disease location within the breast recorded. RESULTS Unexpected invasive disease was found in 35 of 144 patients (24%). Within our unit the re-excision rate for all screen-detected DCIS is currently 23% but for patients included in this study with high-grade DCIS the re-excision rate was 39% (34/87). The extent of DCIS (p=0.008) and lack of expression of the oestrogen receptor (ER) predicted the requirement for re-excision in both univariate (p=0.004) and multivariate analysis (p=0.005). CONCLUSIONS High-grade DCIS may be focally uncalcified, leading to underestimation of disease extent, which might be related to ER status. Invasive foci associated with high-grade DCIS are often mammographically occult. Exploration of additional biomarkers and targeted use of further diagnostic techniques may improve the preoperative staging of DCIS.
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MESH Headings
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Calcinosis/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Incidental Findings
- Mammography/standards
- Mastectomy/methods
- Middle Aged
- Preoperative Care
- Reoperation
- Retrospective Studies
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Affiliation(s)
- L Hayward
- Southampton Breast unit, Princess Anne Hospital, Southampton, UK
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18
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Plummer ER, Lorigan P, Hayward L, Jassem J, Demidov L, Moiseyenko V, Soriano V, Chmielowska E, Prados R, Szyldergemajn S. Plitidepsin (APL) alone or with dacarbazine (DTIC) as first-line treatment for advanced unresectable melanoma (AUM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8537] [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: 11/20/2022] Open
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Plummer R, Hayward L, Lorigan P, Soriano V, Moiseyenko V, Szyldergemajn S, Prados R, Smyth J, Calvert H. Plitidepsin alone or with dacarbazine (DTIC) as first-line treatment for advanced unresectable melanoma (AUM). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9059 Background: AUM remains incurable in most patients (pts). DTIC alone had a 8–15% response rate (RR), while plitidepsin (Aplidin [APL]) showed a 6% RR and a 14% stable disease (SD) in a Phase (Ph) II study in 35 relapsed/refractory pts after DTIC failure. Furthermore, APL + DTIC has additive activity in preclinical models. Methods: This multicenter Ph Ib study aim to determine the safe recommended dose (RD) of APL on days 1, 8 & 15 + DTIC only day 1 q4wk. RD was defined as the highest dose with >5 days G4 neutropenia or G4 thrombocytopenia (TC) and/or febrile neutropenia (FN); any drug-related ≥ G3 toxicity (except nausea/vomiting or hypersensitivity reaction) in cycle 1. Results: Of 28pts with AUM, 23 were evaluable for DLT; 57% were males, median (med) age was 48 y (20–77), med ECOG 0 (0–2) and med LDH was 226 IU/l (126–983). Most pts (96%) had metastasis with a median of 2 sites involved (1–5). Dose levels of APL + DICT (mg/m2), were: DL1 (1.8 + 800), 7 pts; DL2 (2.4 + 800), 8 pts; DL 2b (2.4 + 1000), 5 pts; DL3 (3.0 + 800), 8 pts. Pts received 4 (2–6), 2 (2–5), 2 (1–2), 2 (1–8) median cycles respectively. The number of DLTs were 1/6, 1/7, 2/4, 2/6, respectively. DLTs were G3 ALT in 4 pts and FN + TC in 1 pt. The MTD was at DL 2B and the RD was at DL 2. There were 3 partial responses (PR, 14%) and 4 SD > 3 months (19%); all PR at DL2/3. Five pts were not evaluable, 2 pts had G3 hypersensitivity reactions related to Cremophor oil (APL formulation) and 1 pt had a idiosyncratic reaction to DTIC with prolonged pancytopenia. One pt had a wrong diagnosis and 1 pt had early progressive disease (PD). Conclusions: APL + DTIC can be safely combined at ≥ 70% of their respective single- agent RD in AUM. Main DLTs were asymptomatic, transient and reversible ALT elevations. Ph Ib showed 14 % PR and 19% clinically meaningful SD. A randomised Ph II study of DTIC + APL vs APL alone is ongoing. [Table: see text]
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Affiliation(s)
- R. Plummer
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - L. Hayward
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - P. Lorigan
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - V. Soriano
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - V. Moiseyenko
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - S. Szyldergemajn
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - R. Prados
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - J. Smyth
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
| | - H. Calvert
- Newcastle General Hospital, Northern Center for Cancer Treatment, Newcastle upon Tyne, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Instituto Valenciano de Oncología, Valencia, Spain; Petrov Research Institute of Oncology, St. Petersburg, Russia; PharmaMar, Madrid, Spain; Western General Hospital, Edinburgh, United Kingdom
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Fourtouna A, Murray E, Hayward L, Pohler L, Hupp T. Characterization of peptide aptamers to the Anterior Gradient 2: a novel inhibitor of the tumour suppressor protein p53. Breast Cancer Res 2006. [PMCID: PMC3300257 DOI: 10.1186/bcr1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Campisi P, Hayward L, Papsin B. Mitek QuickAnchor fixation of cochlear implants using a minimal access technique. Int J Pediatr Otorhinolaryngol 2005; 69:1655-8. [PMID: 15964080 DOI: 10.1016/j.ijporl.2005.03.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 03/29/2005] [Indexed: 11/26/2022]
Abstract
RATIONALE In children with thick cortical bone, surgical exposure for cochlear implant fixation is difficult when using a minimal access technique. We report our experience in these children using the Mitek QuickAnchor system. METHODS A retrospective review of all children undergoing cochlear implantation over a 12-month period was performed to identify those children in which a Mitek QuickAnchor was used. Measurements of cortical bone thickness at the receiver-stimulator well site were obtained from pre-operative CT scans of temporal bones of all children. The application of the Mitek QuickAnchor system was also reviewed. RESULTS Cochlear implant fixation using the Mitek QuickAnchor system was performed in 14 children (mean age 12 years) during the study period. The mean cortical bone thickness was 5.6mm in patients receiving the Mitek QuickAnchor system and 3.2mm in patients undergoing conventional fixation. The difference in cortical thickness was highly statistically significant. Successful secure fixation was obtained in all cases. CONCLUSIONS The Mitek QuickAnchor system provides an effective method of cochlear implant fixation when using a minimal access technique in children with thick cortical bone.
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Affiliation(s)
- P Campisi
- The Cochlear Implant Program and Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, The University of Toronto, 555 University Avenue, 6th Floor, Elm Wing, Toronto, Ontario, Canada M5G 1X8.
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Campisi P, James A, Hayward L, Blaser S, Papsin B. Cochlear implant positioning in children: a survey of patient satisfaction. Int J Pediatr Otorhinolaryngol 2004; 68:1289-93. [PMID: 15364500 DOI: 10.1016/j.ijporl.2004.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 04/23/2004] [Accepted: 04/27/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The past decade has been witness to significant diminution in incision size and placement for pediatric cochlear implantation at our institution. Furthermore, the orientation of the long axis of the implant relative to the skull base plane has generally evolved from a retro-verted to ante-verted direction to accommodate the ear level receiver stimulator and the new minimal access technique. OBJECTIVE To characterize the cosmetic, functional and clinical implications of this evolution in cochlear implant positioning by means of a patient satisfaction survey. METHODS A survey of patient satisfaction was administered to 100 cochlear implant recipients or their parents. The survey elicits the patient's level of satisfaction with respect to implant position and functional limitations. In addition, the angle formed by the long axis of the implant and the skull base plane (implant angle) was determined from lateral skull radiographs to detect the temporal evolution in implant positioning. RESULTS Analysis of the radiographs revealed an implant angle of 65.4-125 degrees in patients implanted prior to 1997, an implant angle of 56.3-87.5 degrees in patients implanted from 1997 to 2001, and an implant angle of 35.1-78.1 degrees after 2002. In spite of this evolution in positioning, the patient satisfaction survey did not reveal any change in incidence of cosmetic, functional or clinical problems. DISCUSSION The significant changes in incision and implant positioning represent a technical evolution in pediatric cochlear implant surgery. The fact that patients have been consistently satisfied over time suggests that the cosmetic, functional and clinical implications are minimal.
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Affiliation(s)
- P Campisi
- The Cochlear Implant Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 6th Floor, Elm Wing, Ontario, Canada M5G 1X8.
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Burden AC, Burden ML, Hayward L. Minimising the impact of visual impairment. Many visual aids to help people with diabetes are no longer available. BMJ 1999; 319:707. [PMID: 10576821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Andreu AL, Bruno C, Shanske S, Shtilbans A, Hirano M, Krishna S, Hayward L, Systrom DS, Brown RH, DiMauro S. Missense mutation in the mtDNA cytochrome b gene in a patient with myopathy. Neurology 1998; 51:1444-7. [PMID: 9818877 DOI: 10.1212/wnl.51.5.1444] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A patient with progressive exercise intolerance, proximal weakness, and complex III deficiency in skeletal muscle had a missense mutation in the cytochrome b gene of mitochondrial DNA (G15762A). The mutation, which leads to the substitution of a highly conserved amino acid (G339E), was heteroplasmic (85%) in the patient's muscle and was not present in 100 individuals of different ethnic backgrounds. These data strongly suggest that this molecular defect is the primary cause of the myopathy.
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Affiliation(s)
- A L Andreu
- H. Houston Merritt Center for Muscular Dystrophy and Related Diseases, Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY 10032, USA
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Abstract
The effect of prolonged aortic depressor nerve (ADN) stimulation on carotid sinus baroreflex regulation of arterial pressure (AP) and renal sympathetic nerve activity (RSNA) was examined in anesthetized rabbits. Ramp increases in carotid sinus pressure (CSP) were repeated before and after 5 min of bilateral ADN stimulation. One minute after ADN stimulation the curve relating AP to CSP had shifted up and to the right, characterized by significant increases (P < 0.05) in the maximum (91 +/- 2 to 101 +/- 3 mmHg; mean +/- SE), midpoint (118 +/- 7 to 125 +/- 8 mmHg CSP), and minimum (45 +/- 3 to 53 +/- 4 mmHg) of the AP reflex curve. There was a parallel shift downward of the curve relating RSNA to CSP, characterized by significant decreases in the maximum [100 +/- 0 to 66 +/- 8% of maximum control RSNA value (%max)], the range (90 +/- 2 to 59 +/- 8%max), and the gain (-1.0 +/- 0.2 to -0.5 +/- 0.1%max/mmHg) of the RSNA reflex curve. Values returned to control within 10 min of cessation of ADN stimulation. These results suggest that central neurons processing baroreflex information from one set of mechanoreceptors can be reset by convergent signals arising from another baroreceptor site.
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Affiliation(s)
- L Hayward
- Cardiovascular Center, University of Iowa College of Medicine, Iowa City 52242
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Abstract
STUDY OBJECTIVE The aim was to investigate the relationship between alcohol consumption prior to suicide and the act of suicide. DESIGN This was a retrospective total ascertainment survey of a three year cohort of suicides in Western Australia. SETTING Coroner's records of suicide in Western Australia between 1986 and 1988 inclusive. PARTICIPANTS The study involved 515 consecutive suicides: 414 males and 101 females. MAIN RESULTS Information on blood alcohol levels at time of death, presence of other drugs at time of death, drug and alcohol abuse history, psychiatric history, life events prior to death and method of suicide were collected. It was found that 35.8% of cases had a positive blood alcohol reading. Those who had been drinking alcohol prior to suicide were younger, more likely to be male, more likely to have chosen carbon monoxide as the method of suicide, more likely to have experienced a break up of a relationship and less likely to have sought professional help than those who had not been drinking. CONCLUSIONS Data from the present study do not provide evidence for a causal relationship between alcohol consumption and suicide. Differences between those who had consumed alcohol and those who had not are suggestive of a contributory role of alcohol to a decision to commit suicide in a subset of suicide cases.
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Affiliation(s)
- L Hayward
- Epidemiology Branch, Health Department of Western Australia, Perth
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Hayward L, Mant A, Eyland A, Hewitt H, Purcell C, Turner J, Goode E, Le Count A, Pond D, Saunders N. Sleep disordered breathing and cognitive function in a retirement village population. Age Ageing 1992; 21:121-8. [PMID: 1575090 DOI: 10.1093/ageing/21.2.121] [Citation(s) in RCA: 17] [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: 12/27/2022] Open
Abstract
Sleep disordered breathing (SDB) may be associated with cognitive dysfunction in non-demented elderly people. A random sample of 96 retirement village residents were given both neuropsychological assessment and overnight sleep monitoring with a portable microprocessor based system (Vitalog PMS-8). Respiratory disturbance index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour of sleep. RDI was not associated with 'memory', 'verbal', and 'motor' factors identified from the analysis of cognitive tests, but was associated with the 'cerebral efficiency' factor (R2 = 0.21, p less than 0.0001). Seventy-three subjects had repeat neuropsychological tests, median time to follow-up being 17 months. Baseline RDI did not predict changes in scores on the two factors identified from the second analysis. We conclude that mild to moderate disturbance of breathing during sleep is not associated with cognitive dysfunction in non-demented subjects.
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Affiliation(s)
- L Hayward
- Neurosciences Unit, Selby Centre, Perth, Australia
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Hayward L, Wesselmann U, Rymer WZ. Effects of muscle fatigue on mechanically sensitive afferents of slow conduction velocity in the cat triceps surae. J Neurophysiol 1991; 65:360-70. [PMID: 2016646 DOI: 10.1152/jn.1991.65.2.360] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
1. Group III and IV muscle afferents have been shown to be sensitive to both mechanical stimuli and metabolic and thermal changes in muscle. To establish the potential role of slowly conducting muscle afferents in regulating motor output during fatigue, we recorded from mechanically sensitive group III and nonspindle group II afferents originating in the triceps surae in barbiturate-anesthetized cats. We evaluated the response of these afferents to tetanic muscle contraction, stretch, and surface pressure, before, during, and after fatigue. 2. Our results show that muscle fatigue both increases spontaneous discharge in these mechanically sensitive afferents and sensitizes their response to muscle stretch, surface pressure, and, in a few instances, muscle contraction. These fatigue-induced changes typically occurred after 5-10 min of submaximal fatiguing stimulation. 3. During recovery from muscle fatigue, several contraction-sensitive free nerve endings, which had become sensitized to contractions during fatigue, remained sensitized after 20-30 min of rest. 4. The results of this study provide support for the hypothesis that fatigue-induced excitation of slowly conducting afferents is significant in mediating fatigue-induced inhibition of motoneuron output. However, our finding that the discharge of many slowly conducting mechanoreceptor afferents declines during the initial phase of fatigue argues against a primary role for these afferents in mediating the initial decline in motoneuron rate that is so prominent in fatiguing maximum voluntary muscular contraction.
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Affiliation(s)
- L Hayward
- Department of Physiology, Northwestern University Medical School, Chicago, Illinois 60611
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Cleland CL, Hayward L, Rymer WZ. Neural Mechanisms Underlying the Clasp-Knife Reflex in the Cat: II. Stretch-Sensitive Muscular-Free Nerve Endings. J Neurophysiol 1990. [DOI: 10.1152/jn.1990.64.6.1-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
C. L. Cleland, L. Hayward, and W. Z. Rymer, page 1319, the title of the article should read:,Neural Mechanisms Underlying the Clasp-Knife Reflex in the Cat. II. Stretch-Sensitive Muscular Free Nerve Endings.-The running head should read:,properties of muscular free nerve endings.-
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Cleland CL, Hayward L, Rymer WZ. Neural mechanisms underlying the clasp-knife reflex in the cat. II. Stretch-sensitive muscular-free nerve endings. J Neurophysiol 1990; 64:1319-30. [PMID: 2258749 DOI: 10.1152/jn.1990.64.4.1319] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
1. The goal of this study was to determine the contribution of muscular free nerve endings to the clasp-knife reflex by comparing their response properties and reflex actions to the clasp-knife reflex. 2. The responses of single muscle afferents were examined in anesthetized cats using stretch and isometric contraction of ankle extensor muscles identical to those that evoked clasp-knife inhibition in decerebrated and dorsal spinal-hemisectioned cats. 3. Fifty-three stretch-sensitive mechanoreceptor afferents were identified as free nerve ending afferents based on their conduction velocities, location within the muscle, uniformity of response, and dissimilarity to other muscle proprioceptors. The afferent conduction velocities were in both the group III (56%) and group II (44%) range, including five fast-conducting group II afferents (greater than 55 m/s). 4. The stretch response of stretch-sensitive, free nerve endings (SSFNEs) showed several characteristic features: 1) afferents were excited only by large stretches that produced significant passive force; 2) afferent activity began after a brief delay and exhibited segmentation of discharge during ramp stretch, a maximum at the end of ramp stretch, and rapid and complete decay during static stretch, and 3) afferent response adapted to repeated stretches. These properties match those of clasp-knife inhibition described in the companion paper, except that the SSFNE segmentation and maximum were more pronounced and their decay during maintained stretch was more rapid. 5. Isometric contraction produced by electrical stimulation of the muscle nerve, which induced force-evoked inhibition in decerebrated and dorsal hemisectioned cats, also consistently excited SSFNEs. Stretch evoked greater excitation than contraction, indicating that both length and force contribute to SSFNE activity. 6. Stimulation of free nerve endings by squeezing the achilles tendon in cats exhibiting the clasp-knife reflex evoked powerful, homonymous inhibition and a flexion-withdrawal pattern of reflex action--that is, inhibition of extensor and excitation of flexor muscles throughout the hindlimb, which parallels the spatial divergence of the clasp-knife reflex. 7. Intrathecal application of capsaicin, which preferentially blocks the reflex actions of small afferent fibers, blocked clasp-knife inhibition in decerebrated, dorsal hemisectioned cats. 8. The similarities between the reflex actions and response properties of SSFNEs and the properties of the clasp-knife reflex suggest that SSFNEs mediate clasp-knife inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C L Cleland
- Neuroscience Program, Northwestern University, Chicago, Illinois
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Abstract
High 'expressed emotion' (EE) has been held to be predictive of a poor course in patients with schizophrenia, a finding that has emphasized the predictive validity of the EE measure. We review appropriate research examining properties of the EE measure to suggest that, in particular, little is known about the construct validity of the EE measure. We report a longitudinal study examining three measures of parental style (EE; Parental Bonding Instrument or PBI; and interviewer ratings). By comparing EE scale scores with ratings derived by an interviewer we find support for the accuracy of the process generating EE scale scores, and by factor analytic techniques we examine the factorial (construct) validity of the EE scales. A principal components analysis suggested two other dimensions of relevance in parents involved with a schizophrenic member (vigilance, and acceptance of illness in their child) which may be of value in predictive studies. We examined the capacity of interviewer-generated scores (as a simple clinical rating) and factor scores (as central constructs) to predict the course, and were unable to discriminate 'relapsers' and 'non-relapsers' with either predictor.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Abstract
Fifty-seven schizophrenic patients were initially assessed after admission to hospital, at which time their parents completed a Camberwell Family Interview, generating "expressed emotion" (EE) scores. Relapse over the next nine months was not predicted by household EE status or by individual EE scales. Multivariate analyses suggested that a poor course after hospitalization was best predicted by a poor course before admission and by living in a one-parent household. High household EE status was a predictor only in one multivariate analysis after course of illness and one-parent household status had been entered, suggesting an interaction effect. We query the causal proposition linking high EE and relapse and suggest instead that a poor illness course may elicit high EE in relatives, particularly in one-parent households, and, thus, may make the principal contribution to the proposed link.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Abstract
After admission, 57 schizophrenic patients completed two versions of the Parental Bonding Instrument (PBI) to assess perceived recent and earlier parenting attributes. The parents were also assessed using the Camberwell Family Interview to generate Expressed Emotion (EE) scores. The schizophrenic patients, compared to matched non-clinical controls, reported a significantly greater chance (50% vs 26%) of exposure to "affectionless control" from their father. Nine months later, the subjects were re-interviewed and their relapse status determined. The PBI measure assessing parenting over the first 16 years had greater utility than the recent parenting version of the PBI. When re-calibrated, only the father's scores on the early parenting PBI scale discriminated "relapsers" and "non-relapsers". A multivariate analysis suggested that pre-established illness criteria and other family factors were the clearest predictors, and that PBI-defined constructs (as for EE measures) failed to add significantly to the discriminant function. The extent to which EE and PBI scales might measure similar constructs was examined, with only weak links being suggested.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick
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Abstract
We compared the magnitude of reflex inhibition induced in the soleus muscle by contraction or stretch of the medial gastrocnemius (MG), before, during, and after electrically induced fatigue of the MG. Our findings are that MG fatigue is accompanied by a substantial increase in soleus inhibition, which then recovers with MG rest. This increased inhibition may explain, at least in part, the decline in motoneuron discharge rate that has been described in fatiguing human muscle.
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Affiliation(s)
- L Hayward
- Department of Physiology, Northwestern University, Chicago, IL 60611
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Abstract
Low parental care and parental overprotection have been incriminated as risk factors to depression in adult life. The relevance of these parental characteristics to broad depressive 'types' with their varying imputed aetiologies was assessed by having 26 patients with endogenous depression (ED) and 40 with neurotic depression (ND) complete the Parental Bonding Instrument (PBI) self-report measure. In comparison to their controls, the EDs did not differ on the parental care and overprotection scales. The NDs, by contrast, were more likely than their controls to report their parents as uncaring and overprotective. A PBI care scale score of less than 10 was particularly discriminating, being reported by 3.8% of the EDs and 37.5% of the NDs. While findings support the binary view of depression in terms of broad imputed aetiological factors, several response biases which might influence the findings are considered.
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Affiliation(s)
- G Parker
- Mood Disorders Unit, Prince Henry Hospital, Sydney, N.S.W., Australia
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Abstract
We asked 28 registered nurses with varying degrees of experience in working with neurological and neurosurgical patients to fake results on 10 neuropsychological tests in such a way as to be congruent with a history of trauma to the left fronto-temporal cortex. We compared these data to those obtained from 21 patients who had been referred with verified cerebral injury and who had a diagnosis of left fronto-temporal dysfunction. The overall hit rate of classification for the two groups was 85.7% and 89.8%, depending on the way in which test scores were combined. Results showed that a knowledgeable group of informed fakers had great difficulty reproducing the test performance of individuals with left fronto-temporal impairment.
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Davidson RN, Hayward L, Pounsford JC, Saunders KB. Lung function and within-breath changes in resistance in patients who have had a laryngectomy. Q J Med 1986; 60:753-62. [PMID: 3774958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe the construction of a simple device which may be used to connect a patient with a tracheostomy to standard lung function testing equipment. We compared the lung function of nine patients after laryngectomy with nine patients matched for similar degrees of airflow obstruction, and found that peak flow rate (as per cent predicted) was significantly lower than predicted FEV1 in the patients with tracheostomy. This suggests that the larynx may normally affect production of peak flow. We then compared the change in resistance over the normal tidal volume in the two groups, finding no significant difference, and obtained similar results from paired studies in two patients before and after laryngectomy. We conclude that, while the laryngeal aperture varies during tidal breathing, it plays no major part in the overall resistance changes which occur during a normal breath.
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Abstract
Forty-four patients at risk for Huntington's disease and seventeen diagnosed as having the disease were studied longitudinally over a nine-year period to assess the evolution of cognitive impairment. Results showed that there were measurable changes in sensory-perceptual functions well in advance of the emergence of the movement disorder. Discrimination between patients with Huntington's disease and those at risk for the disease based on tests of sensory-perceptual functioning resulted in a correct classification rate of 95.1%. Subjects who had changed from being at risk to having the disease nearly all had discriminant scores from their first test sequence lying in either the disease range or the pre-symptomatic disease range. The present organic model of Huntington's disease is discussed in light of these findings and implications of the mathematical model underlying prediction are discussed.
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Abstract
An extensive literature survey is summarised. Experimentation consisted of irradiation of paraffin wax and human subjects with microwave of frequency 2 450 MHz Results, conclusions and recommendations are briefly stated. A full reference list is given.
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Abstract
Conditioning involved adding one flavor (e.g., vanilla) to an artificial diet of high caloric density and a second flavor (e.g., anise) to a similar low-calorie diet. When the rats were tested with identical foods to which the flavors were added, they showed a strong preference for the high-calorie flavor. The parameters of conditioning were varied in four experiments, which showed that the conditioning of taste preferences is rapid and powerful and has generality over a range of conditioned stimulus parameters. The last experiment indicated that the unconditioned stimulus for this conditioning is probably some oral cue, such as the taste of starch, which is correlated with caloric benefit, rather than caloric benefit per se.
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Hayward L. Surgical suture needles. Nurs Mirror Midwives J 1969; 129:20-1. [PMID: 5196480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Hayward L. Hypodermic needles. Nurs Mirror Midwives J 1968; 127:19-21. [PMID: 5187727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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