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Moreno AC, Watson EE, Humbert-Vidan L, Peterson DE, van Dijk LV, Urbano TG, Van den Bosch L, Hope AJ, Katz MS, Hoebers FJ, Aponte Wesson RA, Bates JE, Bossi P, Dayo AF, Doré M, Fregnani ER, Galloway TJ, Gelblum DY, Hanna IA, Henson CE, Kiat-amnuay S, Korfage A, Lee NY, Lewis CM, Lynggaard CD, Mäkitie AA, Magalhaes M, Mowery YM, Muñoz-Montplet C, Myers JN, Orlandi E, Patel J, Rigert JM, Saunders D, Schoenfeld JD, Selek U, Somay E, Takiar V, Thariat J, Verduijn GM, Villa A, West N, Witjes MJ, Won A, Wong ME, Yao CM, Young SW, Al-eryani K, Barbon CE, Buurman DJ, Dieleman FJ, Hofstede TM, Khan AA, Otun AO, Robinson JC, Hum L, Johansen J, Lalla R, Lin A, Patel V, Shaw RJ, Chambers MS, Ma D, Singh M, Yarom N, Mohamed ASR, Hutcheson KA, Lai SY, Fuller CD. International Expert-Based Consensus Definition, Staging Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study. medRxiv 2024:2024.04.07.24305400. [PMID: 38645105 PMCID: PMC11030490 DOI: 10.1101/2024.04.07.24305400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Purpose Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 diagnostic/staging systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ. Methods The ORAL Consortium comprised 69 international experts, including representatives from medical, surgical, radiation oncology, and oral/dental disciplines. Using a web-based modified Delphi technique, panelists classified descriptive cases using existing staging systems, reviewed systems for feature extraction and specification, and iteratively classified cases based on clinical/imaging feature combinations. Results The Consortium ORNJ definition was developed in alignment with SNOMED-CT terminology and recent ISOO-MASCC-ASCO guideline recommendations. Case review using existing ORNJ staging systems showed high rates of inability to classify (up to 76%). Ten consensus statements and nine minimum data elements (MDEs) were outlined for prospective collection and classification of precursor/ORNJ stages. Conclusion This study provides an international, consensus-based definition and MDE foundation for standardized ORNJ reporting in cancer survivors treated with RT. Head and neck surgeons, radiation, surgical, medical oncologists, and dental specialists should adopt MDEs to enable scalable health information exchange and analytics. Work is underway to develop both a human- and machine-readable knowledge representation for ORNJ (i.e., ontology) and multidisciplinary resources for dissemination to improve ORNJ reporting in academic and community practice settings.
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McVeigh TP, Monahan KJ, Christopher J, West N, Scott M, Murray J, Hanson H. Extent of investigation and management of cases of 'unexplained' mismatch repair deficiency (u-dMMR): a UK Cancer Genetics Group consensus. J Med Genet 2024:jmg-2024-109886. [PMID: 38531626 DOI: 10.1136/jmg-2024-109886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Mismatch repair deficiency (dMMR) is a characteristic feature of cancers linked to Lynch syndrome. However, in most cases, it results from sporadic somatic events rather than hereditary factors. The term 'Lynch-like syndrome' (LLS) has been used to guide colorectal cancer surveillance for relatives of individuals with a dMMR tumour when somatic and germline genomic testing is uninformative. As the assessment of mismatch repair through immunohistochemistry and/or microsatellite instability is increasingly applied across various tumour types for treatment planning, dMMR is increasingly detected in tumours where suspicion of hereditary aetiology is low. Our objective was to establish current practices and develop national guidance for investigating, and managing relatives of, patients with cancers demonstrating unexplained dMMR. METHODS This was achieved through a virtual consensus meeting involving key stakeholders from the UK, through premeeting surveys, structured discussions and in-meeting polling to formulate best practice guidance. RESULTS We identified variability in the availability of diagnostic technologies across specialist centres. It was agreed that equitable access to baseline testing is required, acknowledging the need for a pragmatic approach to investigating dMMR cancers not traditionally associated with Lynch syndrome. Factors such as family history, age, tumour type, protein loss pattern and extent of the investigation were deemed crucial in guiding family management. The term 'unexplained dMMR' was recommended over LLS. CONCLUSION Decisions regarding investigations and future cancer risk management in patients and relatives should be nuanced, considering factors like clinical suspicion of hereditary predisposition to allocate limited resources efficiently and avoid unnecessary investigations in low-suspicion families.
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Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden Hospital NHS Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Kevin J Monahan
- St Mark's Academic Institute Polyposis Registry, Harrow, UK
- Imperial College London, London, UK
| | - Joseph Christopher
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Nick West
- University of Leeds, Leeds, UK
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Malcolm Scott
- Familial Cancer Clinic, Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennie Murray
- Southeast Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - Helen Hanson
- Peninsula Regional Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
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Kovarik PDE, Fadulelmola A, Hashmi A, Kelly C, West N, Patil R, Iqbal MS. Metastatic spinal cord compression: the Spinal Instability Neoplastic Score and early surgical intervention. BMJ Support Palliat Care 2024:spcare-2023-004537. [PMID: 38458653 DOI: 10.1136/spcare-2023-004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To evaluate the value of Spinal Instability Neoplastic Score (SINS) in patients with spine metastasis who subsequently developed or did not develop metastatic spinal cord compression (MSCC). METHODS In this single institutional retrospective descriptive observational study, of 589 patients with MSCC who were referred for radiotherapy, 34 patients (with 41 compression sites) met the inclusion criteria: availability of diagnostic MRI spine pre-development of MSCC (MRI-1) and at the time of MSCC development (MRI-2) (CordGroup).For comparison, NoCordGroup consisted of 152 patients (160 sites) treated with radiotherapy to spinal metastases. SINS was compared between the two groups. RESULTS In CordGroup, the median interval between MRI-1 and MRI-2 was 11 weeks. The median SINS was 8 (range: 4-14) and 9 (range: 7-14) on MRI-1 and MRI-2, respectively. In NoCordGroup, the median SINS was 6 (range: 4-10). CONCLUSIONS Our study showed a trend in difference in SINS value between the two groups. This difference should be a subject of future prospective research in this patient population with poor survival.
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Affiliation(s)
| | - Ahmed Fadulelmola
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ahmed Hashmi
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Charles Kelly
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Nick West
- Radiotherapy Physics, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Rahul Patil
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
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Kovarik PDE, Patil R, Jackson M, Kelly C, West N, Iqbal MS. In Response to the Correspondence to the Editor Regarding 'Extra-mandibular Osteoradionecrosis After the Treatment of Head and Neck Cancer'. Clin Oncol (R Coll Radiol) 2024; 36:e74-e75. [PMID: 37951767 DOI: 10.1016/j.clon.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- P D E Kovarik
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic; Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK
| | - R Patil
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Kelly
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N West
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Iqbal
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University, Newcastle upon Tyne, UK.
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Gray R, Seymour M, Magill L, Handley K, Quirke P, West N, Morton D. Reply to S. Chakrabarti et al, R. Cohen et al, and D.C. Guven. J Clin Oncol 2023; 41:4823-4824. [PMID: 37463406 DOI: 10.1200/jco.23.00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Richard Gray
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Matt Seymour
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Laura Magill
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Kelly Handley
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Philip Quirke
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Nick West
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
| | - Dion Morton
- Richard Gray, MSc, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Matt Seymour, MD, St James's University Hospital, Leeds, United Kingdom; Laura Magill, PhD and Kelly Handley, PhD, University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom; Philip Quirke, MD and Nick West, MD, Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom; and Dion Morton, MD, University Hospital Birmingham, Birmingham, United Kingdom
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Shen Z, Brand D, Zhang Y, Simard M, Lopes A, Miles E, Gilbert A, West N, Blake A, Royle G, Appelt A, Maughan TS, Sebag-Montefiore D, Collins-Fekete CA, Hawkins MA. Modeling Acute Chemoradiotherapy (CRT) Diarrhea Severity Using Automatically Contoured Small Bowel. Int J Radiat Oncol Biol Phys 2023; 117:e338. [PMID: 37785184 DOI: 10.1016/j.ijrobp.2023.06.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Acute severe diarrhea is a common toxicity in rectal cancer patients receiving CRT. A better understanding of the radiation tolerance of the small bowel is needed especially for novel radiation drug combinations. We investigate the dose impact by providing auto-contoured small bowel, using data from the ARISTOTLE phase III trial ISRCTN: 09351447. MATERIALS/METHODS A subset of participants (n = 93/564) with locally advanced rectal cancer in the ARISTOTLE trial testing the addition of concurrent irinotecan (n = 48) to neoadjuvant capecitabine (n = 45) CRT (45/25 Gy/fx), in an MRI defined high risk of loco-regional failure. CRT was delivered with conformal techniques. Diarrhea was measured using CTCAE v4.0 weekly. We applied an AI-based auto-contouring model to segment the small bowel on planning CT. The small-bowel DVH parameters were combined with the treatment arm, age, sex and MRI-defined tumor stage in a linear regression (LR) model to predict acute diarrhea severity. Explainable Shapley values (conditional marginalized expectation of a machine learning model per feature) were used to quantify the independent and normalized impact of radiation dose vs Irinotecan on the likelihood of severe diarrhea. RESULTS The auto-contouring model accuracy was consistent with clinical practice (mean dice coefficient = 0.739) and clinically acceptable when reviewed by clinicians. The treatment arm, MRI-defined T stage and small-bowel mean dose were found to be independently correlated to the diarrhea severity (p<0.001). V30Gy showed the strongest correlation to diarrhea severity in all the DVH parameters. The LR using the three variables yielded mean AUC scores of 0.898 (95% CI: [0.831,0.958]) on predicting Grade 2 and higher diarrhea, and 0.774 (95% CI: [0.678,0.869]) on predicting Grade 3 diarrhea based on 10-fold cross-validation. Shapley values showed that V30Gy>30.56 cm3 increases the likelihood of more severe diarrhea against the average (grade = 1.03) in the cohort. The impact of irradiation will be larger than the usage of Irinotecan within the patients with V30Gy >160.93 cm3. CONCLUSION We accurately modelled acute diarrhea (AUC = 0.90) for rectal cancer patients receiving CRT using AI-contoured small-bowel structures. The treatment arm and small-bowel dose were independently correlated to the diarrhea severity. The explainable model allowed us to quantify the impact of radiation dose, usage of irinotecan, and its combination, with a threshold of V30Gy = 160.93 cm3 yielding an equivalent impact. We will be extending the analysis to the whole trial cohort to improve the statistical power.
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Affiliation(s)
- Z Shen
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - D Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Y Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - M Simard
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - A Lopes
- University College London, London, United Kingdom
| | - E Miles
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - A Gilbert
- University of Leeds, Leeds, United Kingdom
| | - N West
- University of Leeds, Leeds, United Kingdom
| | - A Blake
- MRC Oxford institute for Radiation Biology, Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - G Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - A Appelt
- St. James's University Hospital, Leeds, United Kingdom
| | - T S Maughan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | | | - C A Collins-Fekete
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - M A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Fahlman A, Mcknight JC, Blawas AM, West N, Torrente AG, Aoki K. Cardiorespiratory coupling in the bottlenose dolphin ( Tursiops truncatus). Front Physiol 2023; 14:1234432. [PMID: 37811493 PMCID: PMC10558176 DOI: 10.3389/fphys.2023.1234432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: The bottlenose dolphin (Tursiops truncatus) is an intermittent breather, where the breath begins with an exhalation followed by inhalation and an extended inter-breath interval ranging from 10 to 40 s. Breathing has been shown to alter both the instantaneous heart rate (if H) and stroke volume (iSV) in the bottlenose dolphin, with a transitory ventilatory tachycardia following the breath, and an exponential decrease to a stable if H around 40 beats • min-1 during the inter-breath period. As the total breath duration in the dolphin is around 1 s, it is not possible to assess the contribution of exhalation and inhalation to these changes in cardiac function during normal breathing. Methods: In the current study, we evaluated the if H response by separating expiration and inspiration of a breath, which allowed us to distinguish their respective contribution to the changes in if H. We studied 3 individual male bottlenose dolphins trained to hold their breath between the different respiratory phases (expiration and inhalation). Results: Our data show that inspiration causes an increase in if H, while expiration appears to result in a decrease in if H. Discussion: These data provide improved understanding of the cardiorespiratory coupling in dolphins, and show how both exhalation and inhalation alters if H.
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Affiliation(s)
- A. Fahlman
- Fundación Oceanografic de la Comunidad Valenciana, Gran Vía Marques del Turia 19, Valencia, Spain
- Kolmården Wildlife Park, Kolmården, Sweden
- Global Diving Research SL, Valencia, Spain
| | | | - A. M. Blawas
- Duke University Marine Laboratory, Nicholas School of the Environment Duke University, Beaufort, NC, United States
| | - N. West
- Dolphin Quest, Kahala Resort, Waikoloa, HI, United States
| | - A. G. Torrente
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - K. Aoki
- Department of Marine Bioscience, Atmosphere and OceanResearch Institute, The University of Tokyo, Chiba, Japan
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Kovarik PDE, Patil R, Cvek J, Kelly C, Jackson M, Mackenzie L, West N, Willis N, Kovarik JP, Banks R, Kennedy M, Adams J, Iqbal MS. Extra-mandibular Osteoradionecrosis after the Treatment of Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e498-e505. [PMID: 37433701 DOI: 10.1016/j.clon.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
AIMS Osteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database. MATERIALS AND METHODS In total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%). RESULTS Maxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3-42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22-66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months. All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20-68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2-65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream. CONCLUSION Extra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen.
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Affiliation(s)
- P D E Kovarik
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic; Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK
| | - R Patil
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Cvek
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic
| | - C Kelly
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Mackenzie
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N West
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N Willis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J P Kovarik
- Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Olomouc, Czech Republic
| | - R Banks
- Department of Oral and Maxillofacial Surgery, Royal Sunderland Hospital, Sunderland, UK
| | - M Kennedy
- Department of Oral and Maxillofacial Surgery, Freeman Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Adams
- Department of Oral and Maxillofacial Surgery, Freeman Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Iqbal
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Ali ZA, Karimi Galougahi K, Thomas SV, Abu-Much A, Chau K, Dakroub A, Shlofmitz ES, Jeremias A, West N, Matsumura M, Mintz GS, Maehara A, Shlofmitz RA. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention: Practical Application. Interv Cardiol Clin 2023; 12:215-224. [PMID: 36922062 DOI: 10.1016/j.iccl.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Optical coherence tomography (OCT) provides high-resolution imaging of coronary arteries and can be used to optimize percutaneous coronary intervention (PCI). Intracoronary OCT, however, has had limited adoption in clinical practice. Novelty and relative complexity of OCT interpretation compared with the more established intravascular ultrasound, lack of a standardized algorithm for PCI guidance, paucity of data from randomized trials, and lack of rebate for intravascular imaging have contributed to the modest practical adoption of OCT. We provide a practical step-by-step guide on how to use OCT in PCI, including device set-up, simplified image interpretation, and an algorithmic approach for PCI. optimization.
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Affiliation(s)
- Ziad A Ali
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA.
| | - Keyvan Karimi Galougahi
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Arsalan Abu-Much
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Karen Chau
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Evan S Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Nick West
- Abbott Vascular, 3200 Lakeside Drive #5314, Santa Clara, CA 95054, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
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10
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Morton D, Seymour M, Magill L, Handley K, Glasbey J, Glimelius B, Palmer A, Seligmann J, Laurberg S, Murakami K, West N, Quirke P, Gray R. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol 2023; 41:1541-1552. [PMID: 36657089 PMCID: PMC10022855 DOI: 10.1200/jco.22.00046] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/15/2022] [Accepted: 10/20/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) has potential advantages over standard postoperative chemotherapy for locally advanced colon cancer but requires formal evaluation. METHODS Patients with radiologically staged T3-4, N0-2, M0 colon cancer were randomly allocated (2:1) to 6 weeks oxaliplatin-fluoropyrimidine preoperatively plus 18 postoperatively (NAC group) or 24 weeks postoperatively (control group). Patients with RAS-wildtype tumors could also be randomly assigned 1:1 to receive panitumumab or not during NAC. The primary end point was residual disease or recurrence within 2 years. Secondary outcomes included surgical morbidity, histopathologic stage, regression grade, completeness of resection, and cause-specific mortality. Log-rank analyses were by intention-to-treat. RESULTS Of 699 patients allocated to NAC, 674 (96%) started and 606 (87%) completed NAC. In total, 686 of 699 (98.1%) NAC patients and 351 of 354 (99.2%) control patients underwent surgery. Thirty patients (4.3%) allocated to NAC developed obstructive symptoms requiring expedited surgery, but there were fewer serious postoperative complications with NAC than with control. NAC produced marked T and N downstaging and histologic tumor regression (all P < .001). Resection was more often histopathologically complete: 94% (648/686) versus 89% (311/351), P < .001. Fewer NAC than control patients had residual or recurrent disease within 2 years (16.9% [118/699] v 21.5% [76/354]; rate ratio, 0.72 [95% CI, 0.54 to 0.98]; P = .037). Tumor regression correlated strongly with freedom from recurrence. Panitumumab did not enhance the benefit from NAC. Little benefit from NAC was seen in mismatch repair-deficient tumors. CONCLUSION Six weeks of preoperative oxaliplatin-fluoropyrimidine chemotherapy for operable colon cancer can be delivered safely, without increasing perioperative morbidity. This chemotherapy regimen, when given preoperatively, produces marked histopathologic down-staging, fewer incomplete resections, and better 2-year disease control. Histologic regression after NAC is a strong predictor of lower postoperative recurrence risk so has potential use as a guide for postoperative therapy. Six weeks of NAC should be considered as a treatment option for locally advanced colon cancer.
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Affiliation(s)
- Dion Morton
- University Hospital Birmingham, Birmingham, United Kingdom
| | | | - Laura Magill
- University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | - Kelly Handley
- University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | - James Glasbey
- University Hospital Birmingham, Birmingham, United Kingdom
| | | | - Andy Palmer
- University of Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | | | | | - Keigo Murakami
- Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Nick West
- Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Philip Quirke
- Division of Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Richard Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Raja A, Osborn EA, Bergmark BA, Croce KD, Poulin MF, Tamez H, West N, Buccola J, Meinen J, Secemsky EA. OCT utilization: Summary statistics from the LightLab clinical initiative. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S36-S43. [PMID: 36661366 DOI: 10.1002/ccd.30397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The study describes the evolution of optical coherence tomography (OCT) adoption and performance during percutaneous coronary intervention (PCI) following implementation of a standardized LightLab (LL) workflow. BACKGROUND The purpose of the LL Clinical Initiative was to evaluate the impact of a standardized workflow on physician efficiency, decision making, and image quality. METHODS The LL Clinical Initiative is a multicenter, prospective, observational clinical program. Data were collected from 48 physicians at 17 U.S. centers from 01/21/19 to 06/08/21. The study included 401 OCT-guided PCIs during the baseline phase and 1898 during the LL workflow phases. The baseline phase consisted of physicians utilizing OCT at their discretion. After completing the baseline phase, the workflow progressed through multiple phases culminating in the expansion phase, which focused on addressing greater procedural complexity. The LL workflow utilized OCT to assess plaque Morphology, lesion Length, and vessel Diameter before PCI, and optimized results by treating Medial edge dissection, stent mal-Apposition, and stent under-eXpansion (MLD MAX). High-level summary statistics were generated to elucidate trends. RESULTS After program implementation, there was a rise in the number of PCIs where the LL workflow was utilized compared to the baseline phase (68% during the expansion phase vs. 41% at baseline; p for trend <0.0001). Adoption of the LL workflow was associated with progressively greater procedural and lesion complexity when OCT was performed pre- and post-PCI (87% vs. 52%, p < 0.0001; 55% vs. 37%, p < 0.0001, respectively). In addition, the quality of OCT imaging obtained improved after LL workflow introduction, with over 95% of pre- and post-PCI pullback quality considered usable during the expansion phase. Finally, there was a reduction in time spent on OCT interpretation, both pre-PCI (4.6 min vs. 7.5 min, p < 0.0001) and post-PCI (2.9 min vs. 5.3 min, p < 0.0001). CONCLUSIONS After completion of the standardized OCT-guided workflow, there was greater uptake of OCT imaging, incorporation in more complex procedures, procedural efficiency, and image quality.
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Affiliation(s)
- Aishwarya Raja
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,NYP-Columbia, Columbia University, New York City, New York, USA
| | - Eric A Osborn
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brian A Bergmark
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin D Croce
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie-France Poulin
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hector Tamez
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nick West
- Abbott Vascular, Santa Clara, California, USA
| | | | | | - Eric A Secemsky
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Bowling A, Merlo C, Cox G, Dorminey M, West N, Patel S, Cutting G, Sharma N. 598 Alternate start site M265 allows 5′ nonsense variants to escape nonsense-mediated messenger ribonucleic acid decay so that readthrough and modulators can restore cystic fibrosis transmembrane conductance regulator function. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01288-7] [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: 11/07/2022]
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13
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Hassanieh S, Domingo E, Blake A, Fisher D, Redmond K, Richman S, Walker S, Quirke P, Wilson R, Kennedy R, Tomlinson I, Kaplan R, L. brown, Dunne P, Seymour M, Morton D, Adams R, West N, Maughan T. 337P Prediction of poor response to oxaliplatin by an RNA signature derived and validated in colorectal cancer clinical trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Jain R, Peng G, Taylor-Cousar J, Lee M, Keller A, West N, Kazmerski T, Goralski J, Aitken M, Roe A, Hadjiliadis D, Uluer A, Foil K, Flume P, Mody S, Bray L. WS04.04 Impact of planned versus unplanned pregnancy in people with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00174-6] [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: 11/25/2022]
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15
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Kovarik J, Kelly C, West N, Drinnan M, Dobrowsky W, Iqbal MS. Shrinkage of the non-malignant prostate gland volume after receiving incidental radiotherapy for rectal cancer. Rep Pract Oncol Radiother 2022; 27:577-582. [PMID: 36186705 PMCID: PMC9518781 DOI: 10.5603/rpor.a2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to assess the impact of coincidental radiotherapy on the volume of the non-malignant prostate gland in rectal cancer patients treated with neo-adjuvant radiotherapy. Materials and methods In this retrospective analysis, thirty male patients with rectal cancer who had neoadjuvant radiotherapy met the inclusion criteria. These patients had pre-treatment magnetic resonance imaging (MRI) and at least one post-treatment MRI of the pelvis and the whole of their prostate volume received the full prescribed radiotherapy dose; 45 Gy in 25 fractions (n = 22), 45 Gy in 20 fractions (n = 4) and 25 Gy in 5 fractions (n = 4). Results The median age of this patient cohort was 66 years (range: 30–87). With a median interval between pre-treatment MRI and first MRI post-treatment of 2 months (range: 1–11), the mean prostate volume reduced from 36.1 cm3 [standard deviation (SD) 14.2] pre-radiotherapy to 31.3 cm3 (SD 13.0) post radiotherapy and this difference was significant (p = 0.0004). Conclusion Radiotherapy may cause shrinkage in volume of normal (non-malignant) prostate. Further research is required in this field, since these results may be of some comfort to men contemplating the consequences of radiotherapy on their quality of life. The authors suggest recording flow-rate and international prostate symptom score (IPSS) during rectal radiotherapy as a next step.
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West N, Kelly C, Kovarik J, Iqbal MS. Stereotactic radiotherapy for reirradiation of head and neck cancer: Dosimetric details matter. Head Neck 2021; 44:287-288. [PMID: 34766399 DOI: 10.1002/hed.26925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nick West
- Department of Radiotherapy Physics, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charles Kelly
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Josef Kovarik
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Honorary Clinical Senior Lecturer, Newcastle University, Newcastle upon Tyne, UK
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Rauch J, Johnson M, Maksoud A, Spoon D, Zidar F, Korngold E, Buccola J, Cabrera HG, Rapoza R, West N, Osborn E. TCT-276 A Standardized Optical Coherence Tomography Workflow Improves Procedural Efficiency and Safety During Percutaneous Coronary Intervention: Insights From the LightLab Initiative. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1129] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sanders D, Khan U, Heltshe S, Skalland M, West N, VanDevanter D, Goss C, Flume P. 153: Site of intravenous antimicrobial treatment of pulmonary exacerbations in the STOP2 study: Home versus hospital. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Byrne C, Hajime K, Wang J, Rapoza R, Jones-McMeans J, Hermiller J, Sudhir K, Ediebah D, West N. TCT-405 A Novel Machine Learning Algorithm Enhances Prediction of Target Lesion Failure: An Analysis of 4,983 Patients From the XIENCE V USA Database. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Montemayor K, Psoter K, Lechtzin N, Riekert K, Carson S, Toporek A, Merlo C, Dezube R, West N. 35: Female sex is associated with increased pulmonary exacerbations in people with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Jain R, Keller A, Lee M, West N, Kazmerski T, Aitken M, Roe A, Hadjiliadis D, Uluer A, Mody S, Flume P, Bray L, Taylor-Cousar J. 169: Effect of pregnancy on lung function: Impact of CFTR modulators. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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22
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VanDevanter D, Heltshe S, Skalland M, West N, Sanders D, Goss C, Flume P. 157: C-reactive protein (CRP) as a biomarker of exacerbation presentation and treatment response. J Cyst Fibros 2021. [PMCID: PMC8518450 DOI: 10.1016/s1569-1993(21)01582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Aetesam-Ur-Rahman M, Zhao T, Paques K, Oliveira J, Khialani B, Kyranis S, Braganza D, Clarke S, Bennett M, West N, Hoole S. Whole cycle non-hyperaemic pressure ratios have better stability than diastolic ratios after percutaneous coronary intervention due to changes in diastolic coronary haemodynamics. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Post percutaneous intervention (PCI) fractional flow reserve (FFR) value of ≥0.90 is an accepted marker of procedural success, and similarly, a cut-off of ≥0.95 has recently been proposed for post-PCI instantaneous wave free ratio (iFR). However, the stability of non-hyperaemic pressure ratios (NHPRs) and microcirculatory resistance post-PCI, is not well characterised. as submaximal hyperaemia post-PCI may affect them.
Purpose
We performed this study to assess stability and reproducibility of NHPRs measured immediately post-PCI and repeated at 30 minutes post-PCI.
Methods
Seventy-seven patients undergoing pressure wire guided PCI (age 63.77±10.67 years, male 71%,) had haemodynamic assessment done immediately post-PCI and after a recovery period 30 minutes (Figure A, B). Manual offline analysis was performed to derive resting pressure ratios during whole cycle: average ratio of distal coronary pressure to proximal aortic pressure at rest (Pd/Pa) and resting full cycle ratio (RFR); and during diastolic phase: average diastolic pressure ratio (dPR) and mathematically calculated iFRmat, measured by average Pd/Pa during wave free period (WFP) (from 25% into diastole until 5 msec before the end of diastole). We also measured coronary flow velocity by thermo-dilution time (Tmn) and basal microvascular resistance (BMR = Pa × Tmn × [(Pd − Pw) / (Pa − Pw)] baseline) corrected for coronary wedge pressure (Pw). Test-retest statistics was performed between NHPRs values immediately post-PCI and at 30 minutes. Moreover, crossover of NHPRs across the cut-off value of 0.95 was analysed to assess clinical utility of these indices for procedural success. p value of <0.05 was deemed statistically significant.
Results
There were no differences in the baseline characteristics of the study patients. Sub-maximal hyperaemia was demonstrated by Tmn of 0.54 sec (0.32, 0.75) immediately post-PCI which settled by 30 minutes, Tmn of 0.67 sec (0.43, 0.91), p=0.01 (Figure C). The median BMR increased from 49.25 mmHg sec (32.74, 61.61) to 59.60 mmHg sec (39.24, 76.91) at 30 minutes, p=0.04 (Figure D). Despite this, there were no significant differences in the values of resting whole cycle ratios (Pd/Pa and RFR) as well as diastolic ratios (dPR and iFRmat), with whole cardiac cycle NHPRs having best stability post-PCI (Table). Furthermore, crossover above or below the cut-off value of 0.95 occurred in approximately 1 in 5 diastolic NHPRs measurements but was three-fold lower for whole cycle NHPRs.
Conclusion
NHPRs remain stable post-PCI, despite submaximal hyperaemia being detected and may legitimately be used immediately post-PCI to determine procedural success. However, the test-retest reproducibility and clinical utility of diastolic NHPRs (dPR and iFR) was inferior to whole cycle NHPRs (Pd/Pa and RFR).
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NIHR
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Affiliation(s)
- M Aetesam-Ur-Rahman
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - T Zhao
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - K Paques
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - J Oliveira
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - B Khialani
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - S Kyranis
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - D Braganza
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - S Clarke
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - M Bennett
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - N West
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
| | - S Hoole
- Royal Papworth Hospital NHS Foundation Trust, Interventional Cardiology, Cambridge, United Kingdom
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Wiebe J, Hofmann FJ, West N, Baumbach A, Carrie D, Bermudez EP, Cayla G, Hernandez FH, de la Torre Hernandez JM, Koning R, Loi B, Moscarella E, Tarantini G, Zaman A, Lober C, Riemer T, Achenbach S, Hamm CW, Nef HM. Outcomes of 10,312 patients treated with everolimus-eluting bioresorbable scaffolds during daily clinical practice - results from the European Absorb Consortium. Catheter Cardiovasc Interv 2021; 99:533-540. [PMID: 34463427 DOI: 10.1002/ccd.29932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To asses mid-term clinical outcomes of bioresorbable vascular scaffolds (BVS) for the treatment of coronary artery disease in a large-scale all-comers population. BACKGROUND Several clinical settings are underrepresented in randomized studies investigating BVS against drug-eluting stents. Whether their results can be translated into the heterogeny patient population seen during daily routine requires further investigation. METHODS The European ABSORB Consortium comprises the following European registries: GABI-R, ABSORB UK Registry, ABSORB France, BVS RAI Registry, and REPARA BVS Registry, which all prospectively collected patient-level data regarding outcomes following unrestricted BVS implantation. The primary endpoint of target lesion failure (TLF) includes cardiac death, target-vessel myocardial infarction (TVMI) and target-lesion revascularisation (TLR) at 12 months. The incidence of scaffold thrombosis (ST) according to ARC criteria was also assessed. Multivariable analysis was used to adjust for differences in patient and lesion characteristics. RESULTS A total of 10,312 patients (mean age 58.4 ± 11.4 y) underwent BVS implantation during routine practice. The 12-month follow-up was complete in 95.5% of patients. At 12 months, the primary endpoint of TLF occurred in 3.6%; its components cardiac death, TVMI and TLR were documented in 1.2%, 1.8%, and 2.6%, respectively. The definite/probable ST rate was 1.7%. Absence of predilatation, discontinuation of DAPT and scaffold diameter below 3 mm were independent predictors of ST. CONCLUSIONS The EAC demonstrates reasonable real-world clinical outcome data after BVS implantation. However, the rate of scaffold thrombosis remains high.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Deutsches Herzzentrum Muenchen, Munich, Germany
| | - Felix J Hofmann
- Medizinische Klinik I, University of Giessen, Giessen, Germany
| | - Nick West
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | | | - Didier Carrie
- Sevice de cardiologie, CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Guillaume Cayla
- Service de cardiologie, CHU Nîmes, Université de Montpellier, Montpellier, France
| | | | | | - René Koning
- Département de Cardiologie, Clinique Saint-Hilaire, Rouen, France
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | | | | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane Lober
- IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Thomas Riemer
- IHF GmbH Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
| | - Christian W Hamm
- Medizinische Klinik I, University of Giessen, Giessen, Germany.,Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Holger M Nef
- Medizinische Klinik I, University of Giessen, Giessen, Germany
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West N, Willis N, Adams J, Kennedy M, Jenkins G, Iqbal M, Davidson Z. PO-0996 Dose guided surgery and its impact on the surgical management of mandibular osteoradionecrosis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07447-8] [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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Khuddus M, Darki A, Padaliya B, Secemsky E, West N, Rapoza R, Buccola J, Amis G, Chehab B. Effect of Workflow Training and a Standardized Optical Coherence Tomography (OCT) Workflow on Imaging Proficiency and Treatment Decisions During Percutaneous Coronary Intervention (PCI) in a Real-World Setting: Results From the Lightlab Initiative. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.071] [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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Secemsky EA, Darki A, Khuddus M, Padaliya B, West N, Rapoza R, Buccola J, Cabrera HG, Amis G, Chehab B. IMPROVING PROCEDURAL EFFICIENCY DURING PERCUTANEOUS CORONARY INTERVENTIONS UTILIZING A STANDARDIZED OPTICAL COHERENCE TOMOGRAPHY (OCT) WORKFLOW: INSIGHTS FROM THE LIGHTLAB INITIATIVE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02308-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bergmark B, Golomb M, Buccola J, Wollmuth J, Lopez J, Bezerra H, Rauch J, Chehab B, Rapoza R, West N, Croce K. COMPARISON OF ISR VS DE NOVO LESION TREATMENT DURING OCT GUIDED PCI: INSIGHTS FROM THE LIGHTLAB INITIATIVE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02306-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wilkins A, Fontana E, Nyamundanda G, Ragulan C, Patil Y, Mansfield D, Kingston J, Errington-Mais F, Bottomley D, von Loga K, Bye H, Carter P, Tinkler-Hundal E, Noshirwani A, Downs J, Dillon M, Demaria S, Sebag-Montefiore D, Harrington K, West N, Melcher A, Sadanandam A. Differential and longitudinal immune gene patterns associated with reprogrammed microenvironment and viral mimicry in response to neoadjuvant radiotherapy in rectal cancer. J Immunother Cancer 2021; 9:e001717. [PMID: 33678606 PMCID: PMC7939016 DOI: 10.1136/jitc-2020-001717] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Accepted: 01/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rectal cancers show a highly varied response to neoadjuvant radiotherapy/chemoradiation (RT/CRT) and the impact of the tumor immune microenvironment on this response is poorly understood. Current clinical tumor regression grading systems attempt to measure radiotherapy response but are subject to interobserver variation. An unbiased and unique histopathological quantification method (change in tumor cell density (ΔTCD)) may improve classification of RT/CRT response. Furthermore, immune gene expression profiling (GEP) may identify differences in expression levels of genes relevant to different radiotherapy responses: (1) at baseline between poor and good responders, and (2) longitudinally from preradiotherapy to postradiotherapy samples. Overall, this may inform novel therapeutic RT/CRT combination strategies in rectal cancer. METHODS We generated GEPs for 53 patients from biopsies taken prior to preoperative radiotherapy. TCD was used to assess rectal tumor response to neoadjuvant RT/CRT and ΔTCD was subjected to k-means clustering to classify patients into different response categories. Differential gene expression analysis was performed using statistical analysis of microarrays, pathway enrichment analysis and immune cell type analysis using single sample gene set enrichment analysis. Immunohistochemistry was performed to validate specific results. The results were validated using 220 pretreatment samples from publicly available datasets at metalevel of pathway and survival analyses. RESULTS ΔTCD scores ranged from 12.4% to -47.7% and stratified patients into three response categories. At baseline, 40 genes were significantly upregulated in poor (n=12) versus good responders (n=21), including myeloid and stromal cell genes. Of several pathways showing significant enrichment at baseline in poor responders, epithelial to mesenchymal transition, coagulation, complement activation and apical junction pathways were validated in external cohorts. Unlike poor responders, good responders showed longitudinal (preradiotherapy vs postradiotherapy samples) upregulation of 198 immune genes, reflecting an increased T-cell-inflamed GEP, type-I interferon and macrophage populations. Longitudinal pathway analysis suggested viral-like pathogen responses occurred in post-treatment resected samples compared with pretreatment biopsies in good responders. CONCLUSION This study suggests potentially druggable immune targets in poor responders at baseline and indicates that tumors with a good RT/CRT response reprogrammed from immune "cold" towards an immunologically "hot" phenotype on treatment with radiotherapy.
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Affiliation(s)
- Anna Wilkins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- The Francis Crick Institute, London, UK
| | - Elisa Fontana
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Current Affiliation: Sarah Cannon Research Institute, London, UK
| | - Gift Nyamundanda
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | | | - Yatish Patil
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - David Mansfield
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Jennifer Kingston
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Fiona Errington-Mais
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Daniel Bottomley
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Katharina von Loga
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Hannah Bye
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Paul Carter
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Emma Tinkler-Hundal
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Amir Noshirwani
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jessica Downs
- Division of Cancer Biology, Institute of Cancer Research, London, UK
| | - Magnus Dillon
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | | | | | - Kevin Harrington
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Nick West
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alan Melcher
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Anguraj Sadanandam
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
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Ali Z, Karimi Galougahi K, Maehara A, Shlofmitz R, Fabbiocchi F, Guagliumi G, Alfonso F, Akasaka T, Matsumura M, Mintz G, Ben-Yehuda O, Zhang Z, Rapoza R, West N, Stone G. Outcomes of optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation: one-year results from the ILUMIEN III: OPTIMIZE PCI trial. EUROINTERVENTION 2021; 16:1085-1091. [PMID: 32540793 PMCID: PMC9724851 DOI: 10.4244/eij-d-20-00498] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact on clinical outcomes is unknown. The aim of the present study was to report the 12-month clinical follow-up data from the ILUMIEN III study. METHODS AND RESULTS OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months were adjudicated by a blinded clinical events committee. There were no significant differences in the rates of TLF (2.0% OCT, 3.7% IVUS, 1.4% angiography), MACE (9.8% OCT, 9.1% IVUS, 7.9% angiography), or any of the individual components of these outcomes among the groups. No independent predictors of 12-month stent-related clinical events were identified from final OCT. CONCLUSIONS In this underpowered study, OCT-guided PCI of non-complex lesions did not show a statistical difference in clinical outcomes at 12 months compared with IVUS or angiography guidance. An appropriately powered trial, including only complex patients and lesions, is underway to substantiate the potential clinical benefit of OCT-guided PCI. TRIAL REGISTRATION NCT02471586.
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Affiliation(s)
- Ziad Ali
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA. E-mail:
| | | | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Madrid, Spain
| | | | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gary Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Nick West
- Abbott Vascular, Santa Clara, CA, USA
| | - Gregg Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ali Z, Landmesser U, Karimi Galougahi K, Maehara A, Matsumura M, Shlofmitz R, Guagliumi G, Price M, Hill J, Akasaka T, Prati F, Bezerra H, Wijns W, Mintz G, Ben-Yehuda O, McGreevy R, Zhang Z, Rapoza R, West N, Stone G. Optical coherence tomography-guided coronary stent implantation compared to angiography: a multicentre randomised trial in PCI - design and rationale of ILUMIEN IV: OPTIMAL PCI. EUROINTERVENTION 2021; 16:1092-1099. [PMID: 32863246 PMCID: PMC9725042 DOI: 10.4244/eij-d-20-00501] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Randomised trials have demonstrated improvement in clinical outcomes with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III trial demonstrated non-inferiority of an optical coherence tomography (OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen dimensions. ILUMIEN IV is a large-scale, multicentre, randomised trial designed to demonstrate the superiority of OCT- versus angiography-guided stent implantation in patients with high-risk clinical characteristics (diabetes) and/or complex angiographic lesions in achieving larger post-PCI lumen dimensions and improving clinical outcomes. METHODS AND RESULTS ILUMIEN IV is a prospective, single-blind clinical investigation that will randomise between 2,490 and 3,656 patients using an adaptive design to OCT-guided versus angiography-guided coronary stent implantation in a 1:1 ratio. The primary endpoints are: (1) post-PCI minimal stent area assessed by OCT in each randomised arm, and (2) target vessel failure, the composite of cardiac death, target vessel myocardial infarction, or ischaemia-driven target vessel revascularisation. Clinical follow-up will continue for up to two years. The trial is currently enrolling, and the principal results are expected in 2022. CONCLUSIONS The large-scale ILUMIEN IV randomised controlled trial will evaluate the effectiveness of OCT-guided versus angiography-guided PCI in improving post-PCI lumen dimensions and clinical outcomes in patients with diabetes and/or with complex coronary lesions. TRIAL REGISTRATION NCT03507777.
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Affiliation(s)
- Ziad Ali
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA. E-mail:
| | - Ulf Landmesser
- Department of Cardiology, Charité-University Medicine Berlin, Berlin, Germany,Berlin Institute of Health, Berlin, Germany,German Centre for Cardiovascular Research, Berlin, Germany
| | - Keyvan Karimi Galougahi
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Matthew Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | | | | | | | - Hiram Bezerra
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - William Wijns
- The Lambe Institute for Translational Research, NUI Galway, Galway, Ireland,Saolta University Healthcare Group, Galway, Ireland
| | - Gary Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Nick West
- Abbott Vascular, Santa Clara, CA, USA
| | - Gregg Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shiozawa M, Ueno H, Shiomi A, Kim NK, Kim JC, Tsarkov P, Grützmann R, Dulskas A, Liang JT, Samalavičius N, West N, Sugihara K. Study protocol for an International Prospective Observational Cohort Study for Optimal Bowel Resection Extent and Central Radicality for Colon Cancer (T-REX study). Jpn J Clin Oncol 2021; 51:145-155. [PMID: 33215206 PMCID: PMC7767979 DOI: 10.1093/jjco/hyaa115] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 01/04/2023] Open
Abstract
This is a prospective observational cohort study aiming to include 4000 patients with stages I to III colon cancer treated at 35 specialist institutions in Japan, South Korea, Germany, Russia, Lithuania and Taiwan. The anatomical distribution of lymph nodes and feeding arteries are investigated using surgical specimens according to pre-specified categorizing methods using intraoperative anatomical markings. Primary analyses are performed to identify the general principles of metastatic lymph node distribution in terms of its relation to the location of the primary tumor and feeding arteries. Secondary analyses will be used to estimate prognostic outcomes according to bowel resection length and central radicality and will be used to evaluate the quality of resected surgical specimens. Through in-depth lymph node mapping, standardized criteria for the definite area of ‘regional’ lymph node resection in routine surgical procedures can be identified, which is expected to contribute to international standardization in colon cancer surgery (ClinicalTrials.gov NCT02938481).
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Affiliation(s)
- Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nan Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surger, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Petr Tsarkov
- Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Audrius Dulskas
- Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Narimantas Samalavičius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Nick West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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West N, Goss C, Heltshe S, Skalland M, Sanders D, Jain R, Barto T, Fogarty B, Marshall B, VanDevanter D, Flume. P. WS09.6 A randomised clinical trial of antimicrobial duration for treatment of cystic fibrosis pulmonary exacerbations (STOP2). J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00968-1] [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: 12/01/2022]
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Iqbal MS, West N, Richmond N, Kovarik J, Gray I, Willis N, Morgan D, Yazici G, Cengiz M, Paleri V, Kelly C. A systematic review and practical considerations of stereotactic body radiotherapy in the treatment of head and neck cancer. Br J Radiol 2021; 94:20200332. [PMID: 32960652 PMCID: PMC7774675 DOI: 10.1259/bjr.20200332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Stereotactic radiotherapy (SBRT) is gaining popularity although its use in head and neck cancer (HNC) is not well defined. The primary objective was to review the published evidence regarding the use of stereotactic radiotherapy in HNC. METHODS A literature search was performed by using MEDLINE and EMBASE databases for eligible studies from 2000 to 2019 and 26 relevant studies were identified. RESULTS Literature demonstrates a heterogeneous use of this technique with regards to patient population, primary or salvage treatment, dose fractionation regimens, outcomes and follow-up protocols. Carotid blow out syndrome is a risk as with other forms of reirradiation but alternative treatment regimens may reduce this risk. CONCLUSION At present there is a lack of evidence regarding SBRT as a primary treatment option for HNC and definitive answers regarding efficacy and tolerability cannot be provided but there is growing evidence that SBRT reirradiation regimens are safe and effective. In lieu of evidence from large Phase III trials, we define appropriate organ at risk constraints and prescription doses, with accurate plan summation approaches. Prospective randomised trials are warranted to validate improved treatment outcomes and acceptable treatment morbidity. ADVANCES IN KNOWLEDGE This article provides a comprehensive review of evidence of use of stereotactic radiotherapy in HNC site (either as a primary treatment or as reirradiation). We also provide an evidence-based approach to the implementation and practical consideration of stereotactic radiotherapy in HNC.
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Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nick West
- Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Neil Richmond
- Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Josef Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Isabel Gray
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nick Willis
- Department of Radiotherapy Dosimetry, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David Morgan
- Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - Vinidh Paleri
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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West N, Pearson R, Hashmi A, Jiang X, Ogilvie A, Simmons T. PO-1250: Palliation of vertebral metastases and cord compressions: single field or VMAT? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01268-8] [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]
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36
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Gao C, Kerkmeijer L, Tijssen R, Kraak R, Tijssen J, Onuma Y, Chevalier B, West N, Morice M, De Winter R, Smits P, Wykrzykowska J, Van Geuns R. Impact of diabetes mellitus on 2-year outcomes of Absorb BVS compared to Xience EES: a pooled analysis of the COMPARE-ABSORB and AIDA trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2546] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Diabetes mellitus (DM) is associated with increased risk of cardiovascular events after percutaneous coronary intervention (PCI). To evaluate the impact of Absorb bioresorbable vascular scaffold (BVS) in patients with DM, we aimed to compare the 2-year outcomes of Absorb BVS versus 2nd generation drug eluting stents Xience (EES) by pooling diabetic patients treated with BVS or EES from two large, randomized controlled trial.
Methods
Patients with medically-treated DM and treated by Absorb BVS in the COMPARE-ABSORB and AIDA trial were pooled for analysis. The primary efficacy outcomes measure was target lesion failure (cardiac death, target-vessel myocardial infarction or target lesion revascularization), and the primary safety outcome measure was device thrombosis at 2-year follow-up.
Results
Out of a total 3515 enrolled subjects in the two trials, 913 were diabetics. Compared with the non-diabetic patients, those with DM were older, more often to have a history of hypercholesterolemia, chronic renal failure, stroke, hypertension, heart failure, peripheral vascular disease and previous PCI. At 2-years, target lesion failure occurred in 10.8% of BVS DM patients and 7.6% of EES DM patients (adjusted HR 1.43, 95% CI: 0.87–2.34, P=0.115). The 2-year rates of cardiac death (2.4% vs 1.6%, P=0.385), TV-MI (5% vs 1.6%, P=0.123) and TLR (7.8% vs 5.8%, P=0.416) showed not significant difference. The 2-year incidence of definite device thrombosis was 3.2% in Absorb BVS versus 0.7% in Xience EES (adjusted HR 4.77, 95% CI: 1.01–22.43, P=0.048).
Conclusion
This pooling of the diabetic patients from two large scale RCTs compared BVS versus 2nd generation DES, showed an increased rate of device thrombosis in BVS-treated patients at 2 years.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
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Affiliation(s)
- C Gao
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | | | | | - R Kraak
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - J Tijssen
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | | | - N West
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - M.C Morice
- Cardiovascular European Research Center, Massy, France
| | | | - P Smits
- Maasstad Hospital, Rotterdam, Netherlands (The)
| | | | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
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West N, Willis N, Adams J, Kennedy M, Iqbal S. PO-0789: Utilising radiotherapy dose to guide 3D surgical reconstructions for mandibular osteoradionecrosis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00806-9] [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]
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38
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Croce K, Golomb M, Buccola J, Rapoza R, West N, Lopez J, Wollmuth J, Bergmark B. TCT CONNECT-406 Effect of a Prescriptive Optical Coherence Tomography-Guided Strategy on Treatment of In-Stent Restenosis: Insights from the LightLab Initiative. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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39
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Ediebah D, Byrne C, Wang J, Rapoza R, Hermiller JB, Krucoff M, Sudhir K, West N. TCT CONNECT-376 A Novel Machine Learning Algorithm Enhances Prediction of Target Lesion Failure: An Analysis of 4,983 Patients From the XIENCE V USA Database. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.398] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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40
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Croce K, Bezerra H, Buccola J, Rapoza R, West N, Lopez J, Bergmark B, Wollmuth J. TCT CONNECT-407 Optical Coherence Tomography Influences Procedure and Vessel Preparation Decisions During Percutaneous Coronary Intervention: Insights From the LightLab Initiative. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Awad MM, Hutton ML, Quek AJ, Klare WP, Mileto SJ, Mackin K, Ly D, Oorschot V, Bosnjak M, Jenkin G, Conroy PJ, West N, Fulcher A, Costin A, Day CJ, Jennings MP, Medcalf RL, Sanderson-Smith M, Cordwell SJ, Law RHP, Whisstock JC, Lyras D. Human Plasminogen Exacerbates Clostridioides difficile Enteric Disease and Alters the Spore Surface. Gastroenterology 2020; 159:1431-1443.e6. [PMID: 32574621 DOI: 10.1053/j.gastro.2020.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS The protease plasmin is an important wound healing factor, but it is not clear how it affects gastrointestinal infection-mediated damage, such as that resulting from Clostridioides difficile. We investigated the role of plasmin in C difficile-associated disease. This bacterium produces a spore form that is required for infection, so we also investigated the effects of plasmin on spores. METHODS C57BL/6J mice expressing the precursor to plasmin, the zymogen human plasminogen (hPLG), or infused with hPLG were infected with C difficile, and disease progression was monitored. Gut tissues were collected, and cytokine production and tissue damage were analyzed by using proteomic and cytokine arrays. Antibodies that inhibit either hPLG activation or plasmin activity were developed and structurally characterized, and their effects were tested in mice. Spores were isolated from infected patients or mice and visualized using super-resolution microscopy; the functional consequences of hPLG binding to spores were determined. RESULTS hPLG localized to the toxin-damaged gut, resulting in immune dysregulation with an increased abundance of cytokines (such as interleukin [IL] 1A, IL1B, IL3, IL10, IL12B, MCP1, MP1A, MP1B, GCSF, GMCSF, KC, TIMP-1), tissue degradation, and reduced survival. Administration of antibodies that inhibit plasminogen activation reduced disease severity in mice. C difficile spores bound specifically to hPLG and active plasmin degraded their surface, facilitating rapid germination. CONCLUSIONS We found that hPLG is recruited to the damaged gut, exacerbating C difficile disease in mice. hPLG binds to C difficile spores, and, upon activation to plasmin, remodels the spore surface, facilitating rapid spore germination. Inhibitors of plasminogen activation might be developed for treatment of C difficile or other infection-mediated gastrointestinal diseases.
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Affiliation(s)
- Milena M Awad
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia
| | - Melanie L Hutton
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia
| | - Adam J Quek
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia
| | - William P Klare
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Steven J Mileto
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia
| | - Kate Mackin
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia
| | - Diane Ly
- Illawarra health and Medical Research Institute, Wollongong, Australia; School of Chemistry and Molecular Bioscience and Molecular Horizons, University of Wollongong, Wollongong, Australia
| | - Viola Oorschot
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia; Monash Micro Imaging, Monash University, Clayton, Australia
| | - Marijana Bosnjak
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia
| | - Grant Jenkin
- Monash Infectious Diseases, Monash Health, Clayton, Australia
| | - Paul J Conroy
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia
| | - Nick West
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, University of Queensland, St. Lucia, Australia
| | - Alex Fulcher
- Monash Micro Imaging, Monash University, Clayton, Australia
| | - Adam Costin
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia
| | | | | | - Robert L Medcalf
- Molecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Clayton, Australia
| | - Martina Sanderson-Smith
- Illawarra health and Medical Research Institute, Wollongong, Australia; School of Chemistry and Molecular Bioscience and Molecular Horizons, University of Wollongong, Wollongong, Australia
| | - Stuart J Cordwell
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Ruby H P Law
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia
| | - James C Whisstock
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging and Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Clayton, Australia; European Molecular Biology Laboratory Australia, Monash University, Clayton, Australia; South East University-Monash Joint Institute, Institute of Life Sciences, Southeast University, Nanjing, China
| | - Dena Lyras
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Australia.
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Aharmim B, Ahmed S, Anthony A, Barros N, Beier E, Bellerive A, Beltran B, Bergevin M, Biller S, Blucher E, Bonventre R, Boudjemline K, Boulay M, Cai B, Callaghan E, Caravaca J, Chan Y, Chauhan D, Chen M, Cleveland B, Cox G, Dai X, Deng H, Descamps F, Detwiler J, Doe P, Doucas G, Drouin PL, Dunford M, Elliott S, Evans H, Ewan G, Farine J, Fergani H, Fleurot F, Ford R, Formaggio J, Gagnon N, Gilje K, Goon J, Graham K, Guillian E, Habib S, Hahn R, Hallin A, Hallman E, Harvey P, Hazama R, Heintzelman W, Heise J, Helmer R, Hime A, Howard C, Huang M, Jagam P, Jamieson B, Jelley N, Jerkins M, Keeter K, Klein J, Kormos L, Kos M, Kraus C, Krauss C, Krüger A, Kutter T, Kyba C, Labe K, Land B, Lange R, LaTorre A, Law J, Lawson I, Lesko K, Leslie J, Levine I, Loach J, MacLellan R, Majerus S, Mak H, Maneira J, Martin R, Mastbaum A, McCauley N, McDonald A, McGee S, Miller M, Monreal B, Monroe J, Nickel B, Noble A, O’Keeffe H, Oblath N, Okada C, Ollerhead R, Orebi Gann G, Oser S, Ott R, Peeters S, Poon A, Prior G, Reitzner S, Rielage K, Robertson B, Robertson R, Schwendener M, Secrest J, Seibert S, Simard O, Sinclair D, Skensved P, Sonley T, Stonehill L, Tešić G, Tolich N, Tsui T, Van Berg R, VanDevender B, Virtue C, Wall B, Waller D, Wan Chan Tseung H, Wark D, Wendland J, West N, Wilkerson J, Wilson J, Winchester T, Wright A, Yeh M, Zhang F, Zuber K. Search for
hep
solar neutrinos and the diffuse supernova neutrino background using all three phases of the Sudbury Neutrino Observatory. Int J Clin Exp Med 2020. [DOI: 10.1103/physrevd.102.062006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Francis N, Penna M, Carter F, Mortensen NJ, Hompes R, Bandyopadhyay D, Black J, Campbell K, Chadwick M, Chase K, Chitsabesen P, Coleman M, Dalton S, Doeve J, Hendrickse C, Katory M, Knol J, Lee L, McArthur D, Miles T, Miskovic D, Ng P, Nicol D, Samad A, Talwar A, Kochupapy RT, Theobald I, Wegstapel H, West N, Wood S, Wynn G, Ziyaie D. Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK. Colorectal Dis 2020; 22:756-767. [PMID: 32065425 DOI: 10.1111/codi.15022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
AIM Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons but its technical challenges may underlie the early reports of visceral injuries and oncological concerns. The aim of this study was to report on the feasibility, development and the outcome of the national pilot training initiative for TaTME-UK. METHODS TaTME-UK was successfully launched in September 2017 in partnership with the healthcare industry and endorsed by the Association of Coloproctology of Great Britain and Ireland. This multi-modal training curriculum consisted of three phases: (i) set-up; (ii) selection of pilot sites; and (iii) formal proctorship programme. Bespoke Global Assessment Scoring (GAS) forms were designed and completed by both trainees and mentors. Data were collected on patient demographics, tumour characteristics and perioperative clinical and histological outcomes. RESULTS Twenty-four proctored cases were performed by 10 colorectal surgeons from five selected pilot sites. Median operative time was 331 ± 90 (195-610) min which was reduced to 283 ± 62 (195-340) min in the final case. Independent performance (GAS score of 5) was achieved for most operative steps by case 5. There was one conversion (4.2%), but no visceral injuries. Pathological data confirmed no bowel perforation and intact quality of the mesorectal TME specimens with clear distal margin in all cases and circumferential margins in 23/24 cases (96%). CONCLUSION This exploratory study demonstrates acceptable early outcomes in a small cohort suggesting that a competency-based multi-modal training programme for TaTME can be feasible and safe to implement at a national level.
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Affiliation(s)
- N Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Faculty of Science, University of Bath, Bath, UK
| | - M Penna
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - F Carter
- South West Surgical Training Network c.i.c., Yeovil, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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44
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Ruiz-Rodríguez M, Scheifler M, Sanchez-Brosseau S, Magnanou E, West N, Suzuki M, Duperron S, Desdevises Y. Host Species and Body Site Explain the Variation in the Microbiota Associated to Wild Sympatric Mediterranean Teleost Fishes. Microb Ecol 2020; 80:212-222. [PMID: 31932881 DOI: 10.1007/s00248-020-01484-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/06/2020] [Indexed: 05/10/2023]
Abstract
Microorganisms are an important component in shaping the evolution of hosts and as such, the study of bacterial communities with molecular techniques is shedding light on the complexity of symbioses between bacteria and vertebrates. Teleost fish are a heterogeneous group that live in a wide variety of habitats, and thus a good model group to investigate symbiotic interactions and their influence on host biology and ecology. Here we describe the microbiota of thirteen teleostean species sharing the same environment in the Mediterranean Sea and compare bacterial communities among different species and body sites (external mucus, skin, gills, and intestine). Our results show that Proteobacteria is the dominant phylum present in fish and water. However, the prevalence of other bacterial taxa differs between fish and the surrounding water. Significant differences in bacterial diversity are observed among fish species and body sites, with higher diversity found in the external mucus. No effect of sampling time nor species individual was found. The identification of indicator bacterial taxa further supports that each body site harbors its own characteristic bacterial community. These results improve current knowledge and understanding of symbiotic relationships among bacteria and their fish hosts in the wild since the majority of previous studies focused on captive individuals.
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Affiliation(s)
- M Ruiz-Rodríguez
- Biologie Intégrative des Organismes Marins, BIOM, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France.
| | - M Scheifler
- Biologie Intégrative des Organismes Marins, BIOM, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
| | - S Sanchez-Brosseau
- Biologie Intégrative des Organismes Marins, BIOM, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
| | - E Magnanou
- Biologie Intégrative des Organismes Marins, BIOM, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
| | - N West
- FR3724, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
| | - M Suzuki
- FR3724, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
| | - S Duperron
- Molécules de Communication et Adaptation des Micro-organismes, MCAM, Muséum National d'Histoire Naturelle, CNRS, 12 rue Buffon, Paris, France
| | - Y Desdevises
- Biologie Intégrative des Organismes Marins, BIOM, Sorbonne Université, CNRS, Observatoire Océanologique de Banyuls-sur-Mer. Avenue Pierre Fabre., F-66650, Banyuls/Mer, France
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Stracker N, Hanrahan C, Mmolawa L, Nonyane B, Tampi R, Tucker A, West N, Lebina L, Martinson N, Dowdy D. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. Int J Tuberc Lung Dis 2020; 23:756-763. [PMID: 31315710 DOI: 10.5588/ijtld.18.0519] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec> <title>SETTING</title> Fifty-five public clinics in northern South Africa. </sec> <sec> <title>OBJECTIVE</title> To estimate patient costs and identify the factors associated with catastrophic costs among individuals treated for tuberculosis (TB). </sec> <sec> <title>DESIGN</title> We performed cross-sectional interviews of consecutive patients at public clinics from October 2017 to January 2018. 'Catastrophic costs' were defined as costs totalling ≥20% of annual household income. For participants with no reported income, we considered scenarios where costs were considered non-catastrophic if 1) costs totalled <US$7.70 (ZAR100) or 2) a multidimensional poverty index was above a certain threshold. </sec> <sec> <title>RESULTS</title> Among 327 participants, the estimated mean TB episode costs were US$365 (95%CI 233-498): out-of-pocket costs comprised 58% of costs, wages lost due to health care-seeking represented 26%, and income reduction accounted for 16% of costs. Ninety (28%) participants experienced catastrophic costs, which were associated with clinic travel times of 60-90 min (adjusted prevalence ratio [aPR] 1.7, 95%CI 0.9-3.1), unemployment (aPR 2.0, 95%CI 1.0-4.0) and having fewer household members (aPR 0.6, 95%CI 0.3-1.0). </sec> <sec> <title>CONCLUSIONS</title> In rural South Africa, catastrophic costs from TB are common and associated with distance to clinics, unemployment, and household size. These findings can help tailor social protection programs and enhance service delivery to patients at greatest risk of experiencing financial hardship. </sec>.
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Affiliation(s)
| | | | - L Mmolawa
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - B Nonyane
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R Tampi
- Departments of Epidemiology and
| | | | - N West
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L Lebina
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - N Martinson
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA
| | - D Dowdy
- Departments of Epidemiology and, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA
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West N, Iqbal M. Is it safe to deliver high dose thoracic palliative radiotherapy using volumetric modulated arc therapy in non-small cell lung cancer? Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30127-6] [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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Taylor J, Wright P, Rossington H, Mara J, Glover A, West N, Morris E, Quirke P. Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP). BMJ Open 2019; 9:e030618. [PMID: 31772088 PMCID: PMC6886907 DOI: 10.1136/bmjopen-2019-030618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Although colorectal cancer outcomes in England are improving, they remain poorer than many comparable countries. Yorkshire Cancer Research has, therefore, established a Bowel Cancer Improvement Programme (YCR BCIP) to improve colorectal cancer outcomes within Yorkshire and Humber, a region representative of the nation. It aims to do this by quantifying variation in practice, engaging with the colorectal multidisciplinary teams (MDTs) to understand this and developing educational interventions to minimise it and improve outcomes. METHODS AND ANALYSIS Initially, routine health datasets will be used to quantify variation in the demographics, management and outcomes of patients across the Yorkshire and Humber region and results presented to MDTs. The YCR BCIP is seeking to supplement these existing data with patient-reported health-related quality of life information (patient-reported outcome measures, PROMs) and tissue sample analysis. Specialty groups (surgery, radiology, pathology, clinical oncology, medical oncology, clinical nurse specialists and anaesthetics) have been established to provide oversight and direction for their clinical area within the programme, to review data and analysis and to develop appropriate educational initiatives. ETHICS AND DISSEMINATION The YCR BCIP is aiming to address the variation in practice to significantly improve colorectal cancer outcomes across the Yorkshire and Humber region. PROMs and tissue sample collection and analysis will help to capture the information required to fully assess care in the region. Engagement of the region's MDTs with their data will lead to a range of educational initiatives, studies and clinical audits that aim to optimise practice across the region.
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Affiliation(s)
- John Taylor
- Section of Epidemiology and Biostatistics, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Penny Wright
- Section of Patient Centred Outcome Research, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Hannah Rossington
- Section of Epidemiology and Biostatistics, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Jackie Mara
- Section of Epidemiology and Biostatistics, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Amy Glover
- Section of Pathology and Tumour Biology, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Nick West
- Section of Pathology and Tumour Biology, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Eva Morris
- Section of Epidemiology and Biostatistics, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Phillip Quirke
- Section of Pathology and Tumour Biology, University of Leeds, Leeds Institute of Cancer and Pathology, Leeds, UK
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Erlinger S, Stracker N, Hanrahan C, Nonyane B, Mmolawa L, Tampi R, Tucker A, West N, Lebina L, Martinson N, Dowdy D. Tuberculosis patients with higher levels of poverty face equal or greater costs of illness. Int J Tuberc Lung Dis 2019; 23:1205-1212. [PMID: 31718757 PMCID: PMC6890494 DOI: 10.5588/ijtld.18.0814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
SETTING: Fifty-six public clinics in Limpopo Province, South Africa.OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index.DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time.RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62).CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.
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Affiliation(s)
- S. Erlinger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - N. Stracker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - C. Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - B.A.S. Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - L. Mmolawa
- Perinatal HIV Research Unit (PHRU), Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa. Johns Hopkins University Center for TB Research, Baltimore, MD
| | - R. Tampi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - A. Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - N. West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
| | - L. Lebina
- Perinatal HIV Research Unit (PHRU), Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa. Johns Hopkins University Center for TB Research, Baltimore, MD
| | - N.A. Martinson
- Perinatal HIV Research Unit (PHRU), Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa. Johns Hopkins University Center for TB Research, Baltimore, MD
| | - D. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
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49
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Chang CC, Onuma Y, Chevalier B, West N, Gori T, Barbato E, Tarantini G, Kocka V, Achenbach S, Dudek D, Escaned J, Abdel-Wahab M, Esposito G, Tijssen J, Morice MC, Smits P, Van Geuns RJ. TCT-166 Optimal Vessel Sizing for the Bioresorbable Scaffold Implantation and the Incidence of Scaffold Thrombosis: Insights From the COMPARE-ABSORB Trial. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.221] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Serruys PWJC, Walsh S, Sabate M, Davies J, Lesiak M, Moreno R, Cruz-Gonzalez I, West N, Piek J, Stables R, Van Mieghem NM, Farooq V, Escaned J, Banning A, Onuma Y. 278Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with three-vessel disease: 3-year follow-up of the SYNTAX II study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The clinical implication of state-of-art PCI at long term follow-up in patients with three vessel disease is undetermined.
Purpose
The purpose of the study was to investigate whether the favourable outcomes of state-of-the-art PCI in the SYNTAX-II trial, demonstrated up to 2 years, are maintained at 3-year follow-up.
Methods
The SYNTAX-II study was a multicentre, single arm study that investigated the impact of a state-of-art PCI strategy on clinical outcomes in patients with de novo three vessel coronary artery disease, without left main disease. State-of-art PCI includes: heart team decision-making utilizing the SYNTAX score II, hybrid iFR-FFR decision-making strategy, intravascular ultrasound guided stent implantation, contemporary chronic total occlusion revascularization techniques and guideline-directed medical therapy. The primary endpoint is major adverse cardiac and cerebrovascular events (MACCE – a composite of all-cause death, any stroke, myocardial infarction, or revascularization) at 3 years. Clinical outcomes in SYNTAX-II were compared to the predefined PCI (SYNTAX-I PCI) and coronary artery bypass graft (SYNTAX-I CABG) cohorts from the landmark SYNTAX Trial (SYNTAX-I), selected on the basis of equipoise for long-term (4-year) mortality utilising the SYNTAX Score II.
Results
Between February 2014 and November 2015, 454 patients out of 708 screened patients were enrolled in SYNTAX-II. In SYNTAX-I, 643 (58.8%) patients with 3VD without left main disease had an equipoise recommendation for CABG or PCI based on the SYNTAX Score II and were used as the comparator. At 2 years, MACCE rate in SYNTAX-II was significantly lower compared to SYNTAX-I PCI (13.2% vs. 21.9%, p=0.001). Furthermore, similar two-year outcomes for MACCE were evident between SYNTAX II-PCI and SYNTAX-I CABG (13.2 vs. 15.1%, p=0.42). Three-year results will be presented at ESC2019.
Conclusions
Three-year results of his study may offer an attractive option of revascularization strategy in predefined patients with de novo 3VD (SYNTAX Score II inclusion) even if the patients have moderate to severe anatomical complexity (anatomic SYNTAX score >22).
Acknowledgement/Funding
European Cardiovascular Research Institute (ECRI) with unrestricted research grants from Volcano and Boston Scientific
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Affiliation(s)
- P W J C Serruys
- Imperial College London, Department of Cardiology, London, United Kingdom
| | - S Walsh
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | - M Sabate
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J Davies
- Imperial College London, London, United Kingdom
| | - M Lesiak
- Poznan University of Medical Sciences, Poznan, Poland
| | - R Moreno
- University Hospital La Paz, Madrid, Spain
| | | | - N West
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Stables
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - V Farooq
- Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, United Kingdom
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | - A Banning
- John Radcliffe Hospital, Oxford, United Kingdom
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
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