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Tan IZ, Mitchell A, McNair H, Dunlop A, Herbert T, Nartey J, Lawes R, O'Connell N, De-Colle C, Han K, Hahn E, Nelms B, Russell N, Kirby A. A Multicenter Study of Clinical to Planning Target Volume Margins for Adjuvant Partial Breast Irradiation Delivered on the 1.5T MR-Linear Accelerator. Int J Radiat Oncol Biol Phys 2023; 117:e725. [PMID: 37786112 DOI: 10.1016/j.ijrobp.2023.06.2237] [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) Adjuvant partial breast irradiation (APBI) for early-stage breast cancer patients delivered on a conventional Linac commonly uses a clinical to planning target volume (CTV-PTV) margin of 10 mm. Published data suggest this margin could be reduced using an MR-guided workflow. This study quantifies the CTV to PTV margin for APBI delivered on the 1.5T MR-Linac (MRL) using an Adapt to Position (ATP) workflow. MATERIALS/METHODS All target contouring was done as per the IMPORT LOW trial and MRL Consortium guidelines. The CTV is the tumor bed defined by surgical clips including postsurgical changes. A single center cohort of ten patients was used to assess delineation error on ProKnow DS v1.28.0 by measuring CTV contour displacements on the CT planning scans (pCT) delineated by five breast radiation oncologists. All other error components were measured on treatment planning software on another single center cohort of ten patients. Target deformation error was measured as surgical clip displacements between the pCT and daily pre-treatment (pre-Tx) MRI scans. Intrafraction motion was determined by the CTV displacement between pre- and post-treatment MRIs (post-Tx) in available paired images from five patients. Matching error was estimated as the interobserver variation of three MRL radiographers registering the pCT with daily pre-Tx MRI. Technical delivery accuracy was estimated using the results from routine quality assurance measurements. Beam penumbral width (p) was estimated from the clinical treatment plans. The systematic (Σ) and random errors (σ) for each component were calculated in the left/right (X), superior/inferior (Y) and anterior/posterior (Z) directions. The contribution of these errors to the PTV margin, M was calculated using van Herk's formula with α and β being 2.50 and 1.64 respectively. RESULTS For APBI using an MRL ATP workflow, a CTV-PTV margin of 5.7 to 7.6 mm is required to achieve a 90% confidence of CTV coverage by the 95% isodose. Individual error components are in. Table 1 delineation error remains the largest component of error. CONCLUSION A minimum CTV-PTV margin of 6-8 mm is required for APBI using an MRL ATP workflow. Although smaller than margins used in conventional Linacs, the clinical benefits (in terms of fibrosis risk) of treating APBI patients on an MRL are likely to be modest. Further margin reductions may be possible using an "Adapt to Shape" workflow with daily online recontouring.
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Affiliation(s)
- I Z Tan
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Mitchell
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H McNair
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - T Herbert
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - J Nartey
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R Lawes
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - C De-Colle
- Tübingen University Hospital, Tübingen, Germany
| | - K Han
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B Nelms
- Canis Lupus LLC, Merrimac, WI
| | - N Russell
- Dutch Cancer Institute, Amsterdam, The Netherlands
| | - A Kirby
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Torere BE, Aiwuyo HO, Rash M, Gerlach G, Russell N, Robinson Dolye A. Subclavian Steal Syndrome as the Initial Presentation of Takayasu's Vasculitis in a Young Caucasian Female. Cureus 2023; 15:e37940. [PMID: 37220439 PMCID: PMC10200268 DOI: 10.7759/cureus.37940] [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] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Takayasu arteritis (TAK) is a rare but well-known inflammatory disease affecting large vessels that leads to thickening, narrowing, occlusion, or dilation of the affected arteries. The overall effect of the disease is arterial insufficiency of the brain and/or the distal part of the affected vessel. Subclavian steal syndrome has been observed as a form of presentation where there is occlusion of the proximal subclavian artery that results in a reversal of flow in the ipsilateral vertebral artery, consequently diverting or 'stealing' blood from the contralateral vertebral artery. Our patient is a 34-year-old Caucasian female presenting with subclavian steal syndrome as the initial presentation of TAK. She presented to the emergency department following a syncopal episode and six months prior history of intermittent lightheadedness, vertigo, left upper extremity pain, numbness, and tingling which was said to be aggravated with activity and alleviated with rest. Examination findings revealed non-palpable left brachial and radial pulses of the upper limb with an inaudible blood pressure reading on the ipsilateral side and blood pressure of 113/70 mmHg on the contralateral arm. Investigation revealed elevated acute phase reactant, normocytic anemia, and inflammation of the aorta on imaging. She was evaluated by the vascular surgery team who recommended medical management. The patient was managed with steroids and methotrexate, and her symptoms improved significantly with the normalization of laboratory findings. She is currently being followed up by the vascular surgery and rheumatology teams. We emphasize the importance of understanding the varied clinical spectrum of TAK and the need to have a high index of suspicion for TAK in a young female with recurrent syncope and unilateral upper extremity intermittent numbness and paresthesia.
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Affiliation(s)
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Max Rash
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Gene Gerlach
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Noah Russell
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
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De-Colle C, Kirby A, Russell N, Shaitelman S, Currey A, Donovan E, Hahn E, Han K, Anandadas C, Mahmood F, Lorenzen E, van den Bongard D, Groot Koerkamp M, Houweling A, Nachbar M, Thorwarth D, Zips D. Adaptive radiotherapy for breast cancer. Clin Transl Radiat Oncol 2023; 39:100564. [PMID: 36632056 PMCID: PMC9826896 DOI: 10.1016/j.ctro.2022.100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Research in the field of local and locoregional breast cancer radiotherapy aims to maintain excellent oncological outcomes while reducing treatment-related toxicity. Adaptive radiotherapy (ART) considers variations in target and organs at risk (OARs) anatomy occurring during the treatment course and integrates these in re-optimized treatment plans. Exploiting ART routinely in clinic may result in smaller target volumes and better OAR sparing, which may lead to reduction of acute as well as late toxicities. In this review MR-guided and CT-guided ART for breast cancer patients according to different clinical scenarios (neoadjuvant and adjuvant partial breast irradiation, whole breast, chest wall and regional nodal irradiation) are reviewed and their advantages as well as challenging aspects discussed.
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Affiliation(s)
- C. De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A. Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - N. Russell
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - S.F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - A. Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - E. Donovan
- Department of Radiation Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E. Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - K. Han
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C.N. Anandadas
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F. Mahmood
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - E.L. Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - M.L. Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - A.C. Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D. Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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McCarthy CM, Meaney S, McCarthy M, Conners N, Russell N. Induction of Labour: Reviewing the past to improve the future. AJOG Global Reports 2022; 2:100099. [PMID: 36338538 PMCID: PMC9633735 DOI: 10.1016/j.xagr.2022.100099] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women undergoing induction of labor should be empowered with accurate information. OBJECTIVE This study aimed to examine the characteristics of and indications for induction of labor and delivery outcomes to help inform practice and counseling. STUDY DESIGN We conducted a retrospective cohort study of all singleton pregnancies undergoing induction of labor over a 3-month period in a tertiary-level hospital in the Republic of Ireland. Data were obtained from paper and electronic registries. Descriptive and inferential statistics were performed on data collected. RESULTS There were 1084 women delivered, with an induction rate of 46.0% (n=499). Primiparous women were more likely to be induced compared with multiparous women (51.4%; n=254/494 vs 41.5%; n=245/590; P<.001), and were more likely to be induced for postmaturity (30.7%; n=78/254 vs 23.6%; 58/245; P≤.001). More than half (50.3%; 251/399) were induced before 40 weeks’ gestation, irrespective of parity. Multiparous women and those induced for maternal medical indications had a shorter overall time to delivery interval (21.7 hours [standard deviation, 13.0] vs 13.8 hours [standard deviation, 11.2]; P<.001 and 18.3 hours [standard deviation, 12.7] vs 14.7 hours [standard deviation, 12.4]; P<.01). CONCLUSION Information on induction of labor can aid in the guidance and education of women undergoing the process, educate clinicians for appropriate counseling, and facilitate shared decision-making.
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Spoor D, van Leeuwen F, Russell N, Boekel N, Jacob S, Combs S, Borm K, Vliegenthart R, Sikkema G, Sijtsema M, van der Schaaf A, Maduro J, Langendijk H, Schuit E, Crijns A. MO-0803 External Validation of NTCP-models for Acute Coronary Events after Breast Cancer Radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02439-2] [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: 11/30/2022]
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Dixon JM, Kunkler IH, Russell N, Thomssen C. Corrigendum to "Postmastectomy radiotherapy for all node positive patients: The case against" [Euro J Surg Oncol 47/10 (2021) 2515-2520]. Eur J Surg Oncol 2021; 47:3202. [PMID: 34625305 DOI: 10.1016/j.ejso.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- J M Dixon
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, Scotland, UK
| | - I H Kunkler
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, Scotland, UK.
| | - N Russell
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, Scotland, UK
| | - C Thomssen
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, Scotland, UK
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Leaf JB, Cihon JH, Leaf R, McEachin J, Liu N, Russell N, Unumb L, Shapiro S, Khosrowshahi D. Correction to: Concerns About ABA-Based Intervention: An Evaluation and Recommendations. J Autism Dev Disord 2021; 52:2854. [PMID: 34286395 DOI: 10.1007/s10803-021-05200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Justin B Leaf
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA.
| | - Joseph H Cihon
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - Ronald Leaf
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - John McEachin
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - Nicholas Liu
- University of California, Santa Barbara, CA, USA
| | - Noah Russell
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
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Leaf JB, Cihon JH, Leaf R, McEachin J, Liu N, Russell N, Unumb L, Shapiro S, Khosrowshahi D. Concerns About ABA-Based Intervention: An Evaluation and Recommendations. J Autism Dev Disord 2021; 52:2838-2853. [PMID: 34132968 PMCID: PMC9114057 DOI: 10.1007/s10803-021-05137-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 10/31/2022]
Abstract
For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.
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Affiliation(s)
- Justin B Leaf
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA.
| | - Joseph H Cihon
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - Ronald Leaf
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - John McEachin
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
| | - Nicholas Liu
- University of California, Santa Barbara, CA, USA
| | - Noah Russell
- Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA
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9
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Herzog N, Johnstone A, Bellamy T, Russell N. Characterization of neuronal viability and network activity under microfluidic flow. J Neurosci Methods 2021; 358:109200. [PMID: 33932456 DOI: 10.1016/j.jneumeth.2021.109200] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Microfluidics technology has the potential to allow precise control of the temporal and spatial aspects of solute concentration, making it highly relevant for the study of volume transmission mechanisms in neural tissue. However, full utilization of this technology depends on understanding how microfluidic flow at the rates needed for rapid solution exchange affects neuronal viability and network activity. NEW METHOD We designed a tape-based pressurized microfluidic flow system that is simple to fabricate and can be attached to commercial microelectrode arrays. The device is multi-layered, allowing the inclusion of a porous polycarbonate membrane to isolate neuronal cultures from shear forces while maintaining diffusive exchange of solutes. We used this system to investigate how flow affected survival and spiking patterns of cultured hippocampal neurons. RESULTS Viability and network activity of the cultures were reduced in proportion to flow rate. However, shear reduction measures did not improve survival or spiking activity; media conditioning in conjunction with culture age proved to be the critical factors for network stability. Diffusion simulations indicate that dilution of a small molecule accounts for the deleterious effects of flow on neuronal cultures. COMPARISON WITH EXISTING METHODS This work establishes the experimental conditions for real time measurement of network activity during rapid solution exchange, using multi-layered chambers with reversible bonding that allow for reuse of microelectrode arrays. CONCLUSIONS With correct media conditioning, the microfluidic flow system allows drug delivery on a subsecond timescale without disruption of network activity or viability, enabling in vitro reproduction of volume transmission mechanisms.
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Affiliation(s)
- Nitzan Herzog
- School of Electronic and Electrical Engineering, University of Nottingham, Nottingham, United Kingdom.
| | - Alexander Johnstone
- School of Electronic and Electrical Engineering, University of Nottingham, Nottingham, United Kingdom.
| | - Tomas Bellamy
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom.
| | - Noah Russell
- School of Electronic and Electrical Engineering, University of Nottingham, Nottingham, United Kingdom.
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10
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Watson W, Gonzalez C, Russell N, Azam H, Corey E, Morrissey C, Gallagher W, Prencipe M. Inhibition of serum response factor as a new strategy to overcome resistance to enzalutamide in prostate cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31207-7] [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: 10/23/2022]
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Hargreaves S, Nellums LB, Powis J, Jones L, Miller A, Rustage K, Russell N, Friedland J. Exploring the views of undocumented migrant women on access to maternity services in the UK. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migrant women face inequalities in access to health-care services and are known to experience poorer maternal and child outcomes than women born in the UK. The development of more restrictive health policies in the UK and Europe, including being denied or charged for healthcare at maternity services, may be exacerbating these outcomes, particularly among undocumented migrant women without permission to reside. We investigated undocumented migrant women's experiences of accessing maternity services in the UK and their impact on health outcomes.
Methods
We did semi-structured in-depth qualitative interviews with a purposive sample of migrant women (born outside the UK) who were aged 18 and over, and had experiences of pregnancy in the UK whilst undocumented. Participants were recruited through the Doctors of the World UK clinic. Interviews were transcribed and analysed using thematic analysis.
Results
We did interviews with 20 undocumented women (age range 31-40 years; mainly from Africa and Asia). Among participants, of whom 13 were pregnant at the time of interview, 10 (50%) first accessed antenatal care late (after the national target of 13 weeks). Women described an ongoing cycle of precariousness, defined by their legal status, social isolation, and poor economic status. Women reported receiving bills of up to £11,500 for maternity services (range £3,072 to £11.500). The impact of their experiences meant that they were deterred from seeking timely health care and were reluctant to present to health services, with women reporting fear and loss of trust in the health system.
Conclusions
These women's narratives illustrated the potential deterrent and detrimental impact of increasingly restrictive health policies on women's access to care and their health. UK and European health policies must be equitable, non-discriminatory, and better align with our commitments to promote universal health coverage among all individual residing in the region.
Key messages
Increasingly restrictive health policies may have a deterrent and detrimental impact on migrant women’s access to health care. Undocumented migrant women in the UK reported fear and loss of trust in the health system.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's University of London, London, UK
- University of Nottingham, London, UK
| | - J Powis
- Imperial College London, London, UK
| | - L Jones
- Doctors of the World UK, London, UK
| | - A Miller
- Doctors of the World UK, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - N Russell
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
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Hook AL, Flewellen JL, Dubern JF, Carabelli AM, Zaid IM, Berry RM, Wildman RD, Russell N, Williams P, Alexander MR. Simultaneous Tracking of Pseudomonas aeruginosa Motility in Liquid and at the Solid-Liquid Interface Reveals Differential Roles for the Flagellar Stators. mSystems 2019; 4:e00390-19. [PMID: 31551402 PMCID: PMC6759568 DOI: 10.1128/msystems.00390-19] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
Bacteria sense chemicals, surfaces, and other cells and move toward some and away from others. Studying how single bacterial cells in a population move requires sophisticated tracking and imaging techniques. We have established quantitative methodology for label-free imaging and tracking of individual bacterial cells simultaneously within the bulk liquid and at solid-liquid interfaces by utilizing the imaging modes of digital holographic microscopy (DHM) in three dimensions (3D), differential interference contrast (DIC), and total internal reflectance microscopy (TIRM) in two dimensions (2D) combined with analysis protocols employing bespoke software. To exemplify and validate this methodology, we investigated the swimming behavior of a Pseudomonas aeruginosa wild-type strain and isogenic flagellar stator mutants (motAB and motCD) within the bulk liquid and at the surface at the single-cell and population levels. Multiple motile behaviors were observed that could be differentiated by speed and directionality. Both stator mutants swam slower and were unable to adjust to the near-surface environment as effectively as the wild type, highlighting differential roles for the stators in adapting to near-surface environments. A significant reduction in run speed was observed for the P. aeruginosa mot mutants, which decreased further on entering the near-surface environment. These results are consistent with the mot stators playing key roles in responding to the near-surface environment.IMPORTANCE We have established a methodology to enable the movement of individual bacterial cells to be followed within a 3D space without requiring any labeling. Such an approach is important to observe and understand how bacteria interact with surfaces and form biofilm. We investigated the swimming behavior of Pseudomonas aeruginosa, which has two flagellar stators that drive its swimming motion. Mutants that had only either one of the two stators swam slower and were unable to adjust to the near-surface environment as effectively as the wild type. These results are consistent with the mot stators playing key roles in responding to the near-surface environment and could be used by bacteria to sense via their flagella when they are near a surface.
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Affiliation(s)
- Andrew L Hook
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - James L Flewellen
- Immune Receptor Activation Laboratory, The Francis Crick Institute, London, United Kingdom
- Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, United Kingdom
| | - Jean-Frédéric Dubern
- Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Alessandro M Carabelli
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
- Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Irwin M Zaid
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, United Kingdom
| | - Richard M Berry
- Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, United Kingdom
| | - Ricky D Wildman
- Department of Chemical and Environmental Engineering, School of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Noah Russell
- Marine Biological Association, The Laboratory, Plymouth, United Kingdom
| | - Paul Williams
- Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Morgan R Alexander
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
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Russell N, Hills R, Kjeldsen L, Spearing R, Burnett A. PF264 TREATMENT INTENSIFICATION WITH FLAG-IDA MAY IMPROVE DISEASE CONTROL IN YOUNGER PATIENTS WITH SECONDARY AML WHICH MANIFESTS ITSELF WITH LONGER FOLLOW-UP: LONG-TERM ANALYSIS OF THE MRC AML15 TRIAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559268.88438.2b] [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] Open
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14
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Vasmel J, Koerkamp MG, Kirby A, Russell N, Shaitelman S, Vesprini D, Anandadas C, Currey A, Keller B, Braunstein L, Han K, Kotte A, De Waard S, Philippens M, Houweling A, Verkooijen H, Van den Bongard D. EP-1312 Evaluation of MRI-based guidelines for contouring tumors for preoperative partial breast irradiation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Leggett G, Butler A, Massey D, Middleton S, Russell N, Woodward J, Green J, Bond D, Duncan S, Woolner L, Sharkey L. A summary of 10 years of transplant activity and outcomes from a UK centre for intestinal and multivisceral transplantation. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The importance of smoking in the aetiology of polycythaemia has been assessed in a group of patients referred to a general haematology clinic. All patients with true and relative polycythaemia (excluding those with polycythaemia rubra vera) were studied. Of the 21 such patients evaluated, 14 were smokers and had raised carboxyhaemoglobin levels and had no other demonstrable cause for their polycythaemia. The commonest physiological abnormality in these patients was a raised red cell mass combined with a low plasma volume. Six of the 14 patients were able to reduce their smoking with subsequent improvement in their haematocrits. These results suggest that smoking is a major cause of polycythaemia in an unselected series of referrals to a general haematology clinic. The early identification of these patients may be useful in planning therapy.
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Affiliation(s)
- R Aitchison
- Haematology Department, City Hospital, Nottingham
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Barron S, Jirström K, Jernström H, Ingvar C, Moran B, Wang CJA, Loughman T, Fender B, Dynoodt P, Lopez-Ruiz C, Russell N, Gallagher WM. Abstract P3-08-06: Prognostic value of OncoMasTR: A novel multigene signature based on master transcriptional regulators. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Multigene prognostic signatures (MGPS) enable identification of candidate patients for treatment de-escalation in early stage breast cancer (BC). Here we present OncoMasTR, a MGPS for classifying the risk of distant metastasis (DM) in ER-positive, HER2-negative BC patients with up to 3 involved lymph nodes (LNs). OncoMasTR was discovered via a novel transcriptional network analysis methodology that identified genes that regulate previously identified prognostic biomarkers. These upstream genes, termed master transcriptional regulators (MTRs), were shown to provide improved prognostic performance compared with downstream genes. OncoMasTR has been mechanistically verified by RT-qPCR, immunohistochemistry and chromatin immunoprecipitation. OncoMasTR has been further trained to include clinicopathological information (CPI) to maximise its prognostic performance.
Methods
Two independent sample sets: 225 patients from Malmö University Hospital and 100 patients from Skåne University Hospital were used for training, cross-validation and refinement of OncoMasTR. RNA extracted from 225 archived tissues was analysed by RT-qPCR to measure the expression levels of the MTRs. Statistical models of all possible combinations of MTRs were trained and cross-validated (1,000 times x 2-fold) using the first set of 225 samples. Statistical models with the best cross-validated performance were further evaluated on RT-qPCR data from the second independent set of 100 samples. Robustness of the data was verified by assessing the reproducibility of OncoMasTR across 6 days, using 6 unique kit lots, conducted by 4 operators on 3 RT-qPCR instruments.
Results
In the first training set of 225 patients, OncoMasTR classified up to 72% of LN0 patients and 58% of LN0-3 patients as low risk, with ≤ 5.0% DM within each group. When incorporating CPI, its prognostic performance further improved to a c (concordance) index > 0.8. Results showed that the OncoMasTR molecular score and CPI add statistically significant prognostic value to each other. In the independent verification set, all patients with DM were correctly classified as high risk (p<0.01). In relation to reproducibility, the OncoMasTR test displayed robust performance; the molecular score coefficient of variation was 2.6% across days, kit lots, operators and instruments. Individual MTR assays demonstrated linearity over >2000-fold RNA input range and PCR efficiencies ranged from 92% to 101%.
Conclusions
OncoMasTR development and verification results show analytical robustness and clinically accurate risk stratification. Furthermore, OncoMasTR's binary classification of risk avoids an ambiguous intermediate risk classification and has potential to provide clinicians with useful, actionable information to support treatment decisions. The OncoMasTR test is now ready for large-scale clinical validation.
Citation Format: Barron S, Jirström K, Jernström H, Ingvar C, Moran B, Wang C-JA, Loughman T, Fender B, Dynoodt P, Lopez-Ruiz C, Russell N, Gallagher WM. Prognostic value of OncoMasTR: A novel multigene signature based on master transcriptional regulators [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-06.
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Affiliation(s)
- S Barron
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - K Jirström
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - H Jernström
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C Ingvar
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - B Moran
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C-JA Wang
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - T Loughman
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - B Fender
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - P Dynoodt
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - C Lopez-Ruiz
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - N Russell
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - WM Gallagher
- OncoMark Ltd, Dublin, Ireland; Lund University and Skåne University Hospital, Lund, Sweden; School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
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Tilūnaitė A, Croft W, Russell N, Bellamy TC, Thul R. A Bayesian approach to modelling heterogeneous calcium responses in cell populations. PLoS Comput Biol 2017; 13:e1005794. [PMID: 28985235 PMCID: PMC5646906 DOI: 10.1371/journal.pcbi.1005794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/18/2017] [Accepted: 09/27/2017] [Indexed: 12/18/2022] Open
Abstract
Calcium responses have been observed as spikes of the whole-cell calcium concentration in numerous cell types and are essential for translating extracellular stimuli into cellular responses. While there are several suggestions for how this encoding is achieved, we still lack a comprehensive theory. To achieve this goal it is necessary to reliably predict the temporal evolution of calcium spike sequences for a given stimulus. Here, we propose a modelling framework that allows us to quantitatively describe the timing of calcium spikes. Using a Bayesian approach, we show that Gaussian processes model calcium spike rates with high fidelity and perform better than standard tools such as peri-stimulus time histograms and kernel smoothing. We employ our modelling concept to analyse calcium spike sequences from dynamically-stimulated HEK293T cells. Under these conditions, different cells often experience diverse stimulus time courses, which is a situation likely to occur in vivo. This single cell variability and the concomitant small number of calcium spikes per cell pose a significant modelling challenge, but we demonstrate that Gaussian processes can successfully describe calcium spike rates in these circumstances. Our results therefore pave the way towards a statistical description of heterogeneous calcium oscillations in a dynamic environment. Upon stimulation a large number of cell types respond with transient increases of the intracellular calcium concentration, which often take the form of repetitive spikes. It is therefore believed that calcium spikes play a central role in cellular signal transduction. A critical feature of these calcium spikes is that they occur randomly, which raises the question of how we can predict the timing of calcium spikes. We here show that by using Bayesian ideas and concepts from stochastic processes, we can quantitatively compute the calcium spike rate for a given stimulus. Our analysis also demonstrates that traditional methods for spike rate estimation perform less favourably compared to a Bayesian approach when small numbers of cells are investigated. To test our methodology under conditions that closely mimic those experienced in vivo we challenged cells with agonist concentrations that vary both in space and time. We find that cells that experience similar stimulus profiles are described by similar calcium spike rates. This suggests that calcium spike rates may constitute a quantitative description of whole-cell calcium spiking that reflects both the randomness and the spatiotemporal organisation of the calcium signalling machinery.
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Affiliation(s)
- Agne Tilūnaitė
- School of Mathematical Sciences, University of Nottingham, Nottingham, England, United Kingdom
| | - Wayne Croft
- School of Life Sciences, University of Nottingham, Nottingham, England, United Kingdom
| | - Noah Russell
- Department of Electrical and Electronic Engineering, University of Nottingham, Nottingham, England, United Kingdom
| | - Tomas C Bellamy
- School of Life Sciences, University of Nottingham, Nottingham, England, United Kingdom
| | - Rüdiger Thul
- School of Mathematical Sciences, University of Nottingham, Nottingham, England, United Kingdom
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19
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Damstra RJ, Halk AB, Damstra R, Halk B, van den Berg J, Born Y, Butter E, van Dorst E, van Everdingen J, Feenstra C, Gielink P, de Haas M, van der Heide-Schoon G, Hendrickx A, Hidding J, Storm van Leeuwen J, Nijland S, Oskam E, Paulusma I, Russell N, Rutgers-van Wijlen K, Sissingh I, Strobbe L, Verhoeff- Braat C, Verwaard R, van der Vleuten C, Voesten H, Hartog A, Urgert M. The Dutch lymphedema guidelines based on the International Classification of Functioning, Disability, and Health and the chronic care model. J Vasc Surg Venous Lymphat Disord 2017; 5:756-765. [DOI: 10.1016/j.jvsv.2017.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/10/2017] [Indexed: 12/17/2022]
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20
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Kok M, Horlings H, van de Vijver K, Wiersma T, Russell N, Voorwerk L, Sikorska K, van Werkhoven E, Mandjes I, Kemper I, Foekema J, Wilgenhof S, Chalabi M, Stouthard J, Sonke G, Cullen D, Salgado R, Schumacher T, Blank C, Linn S. Adaptive phase II randomized non-comparative trial of nivolumab after induction treatment in triple negative breast cancer: TONIC-trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Hayes-Ryan D, McNamara K, Russell N, Kenny L, O'Donoghue K. Maternity Ultrasound in the Republic of Ireland 2016; A Review. Ir Med J 2017; 110:598. [PMID: 29341510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Antenatal ultrasound, comprising of a dating ultrasound in the late first trimester followed by a fetal anomaly scan, is a recognised and necessary component of good antenatal care. We conducted a telephone survey of all 19 obstetric units to ascertain the status of maternity ultrasound provision in Ireland. Fetal anomaly ultrasound is offered universally to all women in 7/19 (37%) units, selectively to some women in 7/19 (37%) units and not offered at all in the remaining 5/19 (26%) units. Overall ? 41,700 (64%) women receive a fetal anomaly ultrasound nationally. Universal first trimester ultrasound, performed in a dedicated ultrasound department by a suitably qualified sonographer, is offered to 47% of women nationally. This study highlights the lack of development in Irish maternity ultrasound services over the last decade. Substantial investment by health care policy makers is urgently needed.
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Affiliation(s)
- D Hayes-Ryan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
| | - K McNamara
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
| | - N Russell
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
| | - L Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
| | - K O'Donoghue
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
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22
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Thomas JS, Hanby AM, Russell N, van Tienhoven G, Riddle K, Anderson N, Cameron DA, Bartlett JMS, Piper T, Cunningham C, Canney P, Kunkler IH. The BIG 2.04 MRC/EORTC SUPREMO Trial: pathology quality assurance of a large phase 3 randomised international clinical trial of postmastectomy radiotherapy in intermediate-risk breast cancer. Breast Cancer Res Treat 2017; 163:63-69. [PMID: 28190252 PMCID: PMC5387007 DOI: 10.1007/s10549-017-4145-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/13/2017] [Accepted: 02/06/2017] [Indexed: 12/17/2022]
Abstract
Introduction SUPREMO is a phase 3 randomised trial evaluating radiotherapy post-mastectomy for intermediate-risk breast cancer. 1688 patients were enrolled from 16 countries between 2006 and 2013. We report the results of central pathology review carried out for quality assurance. Patients and methods A single recut haematoxylin and eosin (H&E) tumour section was assessed by one of two reviewing pathologists, blinded to the originally reported pathology and patient data. Tumour type, grade and lymphovascular invasion were reviewed to assess if they met the inclusion criteria. Slides from potentially ineligible patients on central review were scanned and reviewed online together by the two pathologists and a consensus reached. A subset of 25 of these cases was double-reported independently by the pathologists prior to the online assessment. Results The major contributors to the trial were the UK (75%) and the Netherlands (10%). There is a striking difference in lymphovascular invasion (LVi) rates (41.6 vs. 15.1% (UK); p = <0.0001) and proportions of grade 3 carcinomas (54.0 vs. 42.0% (UK); p = <0.0001) on comparing local reporting with central review. There was no difference in the locally reported frequency of LVi rates in node-positive (N+) and node-negative (N−) subgroups (40.3 vs. 38.0%; p = 0.40) but a significant difference in the reviewed frequency (16.9 vs. 9.9%; p = 0.004). Of the N− cases, 104 (25.1%) would have been ineligible by initial central review by virtue of grade and/or lymphovascular invasion status. Following online consensus review, this fell to 70 cases (16.3% of N− cases, 4.1% of all cases). Conclusions These data have important implications for the design, powering and interpretation of outcomes from this and future clinical trials. If critical pathology criteria are determinants for trial entry, serious consideration should be given to up-front central pathology review. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4145-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J S Thomas
- Department of Pathology, Western General Hospital, Edinburgh, EH4 2XU, UK.
| | - A M Hanby
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - N Russell
- Department of Radiation Oncology, Netherlands Cancer Institute, Postbus 90203, 1006 BE, Amsterdam, Netherlands
| | - G van Tienhoven
- Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, Netherlands
| | - K Riddle
- Scottish Clinical Trials Research Unit, NHS National Services Scotland, Edinburgh, EH12 9EB, UK
| | - N Anderson
- Centre of Population Health Sciences, Edinburgh University Medical School, Edinburgh, EH8 9AG, UK
| | - D A Cameron
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - J M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, M5G0A3, Canada
| | - T Piper
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - C Cunningham
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - P Canney
- Beatson Oncology Centre, Gartnavel Campus, Glasgow, G12 0YN, UK
| | - I H Kunkler
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU, UK
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23
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Ambrose T, Sharkey LM, Louis-Auguste J, Rutter CS, Duncan S, English S, Gkrania-Klotsas E, Carmichael A, Woodward JM, Russell N, Massey D, Butler A, Middleton S. Cytomegalovirus Infection and Rates of Antiviral Resistance Following Intestinal and Multivisceral Transplantation. Transplant Proc 2017; 48:492-6. [PMID: 27109985 DOI: 10.1016/j.transproceed.2015.09.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. METHODS We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution. RESULTS Forty-eight transplantations were performed, with 40% of the patients (19/48) having ≥1 episode of CMV viremia, which rose to 90% in the "donor-positive, recipient-negative" (DPRN) serologic mismatch group. The median time to 1st episode following transplantation was 22.3 weeks (range, 1-78) and median duration of each episode was 4.9 weeks (range, 1.6-37.4). Six of the 19 viremic patients (31.6%) developed virologic resistance with 4 of these occurring in the DPRN group. Four of the 6 patients with drug-resistant CMV died with CMV viremia. All patients with drug resistance acquired ganciclovir resistance; these patients were more challenging to manage with second-line toxicity-limited treatments, including foscarnet, cidofovir, and leflunomide. CMV immunoglobulin has been used and we briefly discuss the use of CMV-specific adoptive T-lymphocyte transfer in the management of 1 case. CONCLUSIONS Post-transplantation CMV disease continues to be challenging to manage, and there is little consensus on optimal management strategies in this patient group, with a significant requirement for novel therapies; these may be pharmacologic or cell based. Extensive multidisciplinary discussion is important for most cases, but particularly for those patients who acquire virologic resistance.
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Affiliation(s)
- T Ambrose
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L M Sharkey
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Louis-Auguste
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C S Rutter
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Duncan
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S English
- Department of Clinical Virology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - E Gkrania-Klotsas
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Carmichael
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J M Woodward
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Russell
- Department of Transplant Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - D Massey
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Butler
- Department of Transplant Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Middleton
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Genadieva-Stavrik S, Boumendil A, Dreger P, Peggs K, Briones J, Corradini P, Bacigalupo A, Socié G, Bonifazi F, Finel H, Velardi A, Potter M, Bruno B, Castagna L, Malladi R, Russell N, Sureda A. Myeloablative versus reduced intensity allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Ann Oncol 2016; 27:2251-2257. [DOI: 10.1093/annonc/mdw421] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/14/2022] Open
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25
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Robinson SP, Boumendil A, Finel H, Schouten H, Ehninger G, Maertens J, Crawley C, Rambaldi A, Russell N, Anders W, Blaise D, Yakoub-Agha I, Ganser A, Castagna L, Volin L, Cahn JY, Montoto S, Dreger P. Reduced intensity allogeneic stem cell transplantation for follicular lymphoma relapsing after an autologous transplant achieves durable long-term disease control: an analysis from the Lymphoma Working Party of the EBMT†. Ann Oncol 2016; 27:1088-1094. [PMID: 26961149 DOI: 10.1093/annonc/mdw124] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with follicular lymphoma (FL) relapsing after an autologous transplant (autoSCT) may be treated with a variety of therapies, including a reduced intensity allogeneic transplant (RICalloSCT). We conducted a retrospective analysis of a large cohort of patients undergoing RICalloSCT for FL in this setting. PATIENTS AND METHODS A total of 183 patients, median age 45 years (range 21-69), had undergone an autoSCT at a median of 30 months before the RICalloSCT. Before the RICalloSCT, they had received a median of four lines (range 3-10) of therapy and 81% of patients had chemosensitive disease and 16% had chemoresistant disease. Grafts were donated from sibling (47%) or unrelated donors (53%). RESULTS With a median follow-up of 59 months, the non-relapse mortality (NRM) was 27% at 2 years. The median remission duration post-autoSCT and RICalloSCT was 14 and 43 months, respectively. The 5-year relapse/progression rate, progression-free survival and overall survival were 16%, 48% and 51%, respectively, and were associated with age and disease status at RICalloSCT. CONCLUSION These data suggest that an RICalloSCT is an effective salvage strategy in patients with FL recurring after a prior autoSCT and might overcome the poor prognostic impact of early relapse after autoSCT.
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Affiliation(s)
- S P Robinson
- BMT Unit, University Hospital Bristol NHS Foundation Trust, Bristol, UK; Lymphoma Working Party EBMT, Paris, France.
| | | | - H Finel
- Lymphoma Working Party EBMT, Paris, France
| | - H Schouten
- Department of Haematology, University Hospital, Maastricht, The Netherlands
| | - G Ehninger
- Department of Haematology, Universitaetsklinikum, Dresden, Germany
| | - J Maertens
- Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - C Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - A Rambaldi
- Haematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - N Russell
- Department of Haematology, City Hospital, Nottingham, UK
| | - W Anders
- Department of Haematology, University Hospital, Umea, Sweden
| | - D Blaise
- Department of Haematology, Institut Paoli Calmettes, Marseille
| | - I Yakoub-Agha
- Department of Haematology, Hôpital Claude Huriez, Lille, France
| | - A Ganser
- Department of Haematology, Medical School, Hannover, Germany
| | - L Castagna
- Department of Haematology, Istituto Clinico Humanitas, Milano, Italy
| | - L Volin
- HUH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - J-Y Cahn
- Haematology, Clinique Universitaire d'Hématologie CHU Grenoble UMR 38043, Grenoble Cedex 09, France
| | - S Montoto
- Lymphoma Working Party EBMT, Paris, France; Department of Haematology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - P Dreger
- Lymphoma Working Party EBMT, Paris, France; Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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Pol RR, Russell N, Das-Gupta E, Watson L, Rachael L, Byrne J. Incidence and management of hepatic severe veno-occlusive disease in 273 patients in a single centre with defibrotide. Bone Marrow Transplant 2016; 51:1262-4. [PMID: 27111044 DOI: 10.1038/bmt.2016.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R R Pol
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - N Russell
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - E Das-Gupta
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Watson
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Rachael
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Byrne
- BMT Unit, Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, West A, Hettiarachchi G, Mukherjee D, Samuel J, Bentley A, Dowson L, Miles J, Ryan F, Yoneda K, Chauhan A, Corcoran J, Psallidas I, Wrightson JM, Hallifax R, Davies HE, Lee YCG, Hedley EL, Seaton D, Russell N, Chapman M, McFadyen BM, Shaw RA, Davies RJO, Maskell NA, Nunn AJ, Miller RF. S20 Primary Result of the 1st Therapeutic Interventions in Malignant Effusion (TIME1) Trial: A 2 × 2 factorial, randomised trial of chest tube size and analgesic strategy for pleurodesis in malignant pleural effusion. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- N Russell
- Department of General Medicine, Austin Health, Melbourne, Victoria.,Department of Medicine, University of Melbourne (Austin Health), Melbourne, Victoria
| | - A D Stevenson
- Academic Unit of General Practice, Australian National University, Canberra, Australian Capital Territory, Australia.,Garema Place Surgery, Canberra, Australian Capital Territory, Australia
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Peffault de Latour R, Labopin M, Cornelissen J, Vigouroux S, Craddock C, Blaise D, Huyn A, Vindelov L, Maertens J, Chevallier P, Fegueux N, Socié G, Cahn JY, Petersen E, Schouten H, Lioure B, Russell N, Corral LL, Ciceri F, Nagler A, Mohty M. In patients older than 55 years with AML in first CR, should we search for a matched unrelated donor when an old sibling donor is available? Bone Marrow Transplant 2015; 50:1411-5. [PMID: 26367237 DOI: 10.1038/bmt.2015.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/05/2015] [Accepted: 07/08/2015] [Indexed: 01/08/2023]
Abstract
Allogeneic hematopoietic transplantation is increasingly used in patients aged 55 years or more with AML. The question of whether outcomes can be improved with an allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD, more than 55 years) is still unanswered. We thus analyzed outcomes in 714 patients aged 55 years and older with AML in first CR (CR1) who received PBSCs after a reduced-intensity conditioning hematopoietic cell transplant from a MUD (n=310) or a MSD (n=404) in a recent period (2005-2010). The 3-year cumulative incidences (CIs) of non-relapse mortality were 17% and 23% with MSD and MUD, respectively (P=0.17). The 3-year CIs of relapse were 37% and 30%, respectively (P=0.12), resulting in a 3-year CI of leukemia-free survival of 46% and 47%, respectively (P=0.51). The 3-year overall survival was 49% with both MSD and MUD. In conclusion, HLA-identical sibling donors aged 55 years or more should not be excluded because of age for patients aged 55 years and older with AML in CR1.
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Affiliation(s)
- R Peffault de Latour
- Service d'Hématologie Greffe, AP-HP-Hôpital Saint Louis, Paris, France.,Paris Diderot University, EA 3518, Paris, France
| | - M Labopin
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, AP-HP-Hôpital Saint Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France.,INSERM, UMRs 938, Paris, France
| | - J Cornelissen
- Hematology Department, Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - S Vigouroux
- CHU Bordeaux-Hôpital Haut-levêque, Pessac, France
| | - C Craddock
- BMT unit, Centre for Clinical Haematology-Queen Elizabeth Hospital, Birmingham, UK
| | - D Blaise
- Institut Paoli Calmettes-Unité de Transplantation et de Thérapie Cellulaire-Inserm UMR 891, Marseille, France
| | - A Huyn
- Department of Hematology, Hopital de Purpan-CHU, Toulouse, France
| | - L Vindelov
- Bone Marrow Transplant Unit L 4043, Rigshospitalet, Copenhagen, Denmark
| | - J Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - P Chevallier
- Department of Hematology, Hopital Hotel Dieu-CHU, Nantes, France
| | - N Fegueux
- CHU Lapeyronie-Service d'Hématologie et Oncologie, Montpellier, France
| | - G Socié
- Service d'Hématologie Greffe, AP-HP-Hôpital Saint Louis, Paris, France.,Université Paris Diderot, Paris, France.,INSERM 1160, Paris, France
| | - J Y Cahn
- Department of Hematology, University Hospital, Grenoble, France.,University Medical Centre UMR 525 CNRS, Grenoble, France
| | - E Petersen
- Department of Hematology, Utrecht, The Netherlands
| | - H Schouten
- Department Internal Medicine Hematology/Oncology, University Hospital Maastricht, Maastricht, The Netherlands
| | - B Lioure
- Department of Onco-Hematologiy, CHU Hautepierre, Strasbourg, France
| | - N Russell
- Division of Hematology and BMT, Nottingham City Hospital, Nottingham, UK
| | - L L Corral
- Hospital Clínico-Servicio de Hematología, Salamanca, Spain
| | - F Ciceri
- Hematology and BMT Unit, EBMT CIC 813, San Raffaele Scientific Institute, Milano, Italy
| | - A Nagler
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - M Mohty
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, AP-HP-Hôpital Saint Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France.,INSERM, UMRs 938, Paris, France
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Belkacemi Y, Kaidar-Person O, Poortmans P, Ozsahin M, Valli MC, Russell N, Kunkler I, Hermans J, Kuten A, van Tienhoven G, Westenberg H. Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey. Ann Oncol 2014; 26:529-35. [PMID: 25480875 DOI: 10.1093/annonc/mdu561] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Predicting outcome of breast cancer (BC) patients based on sentinel lymph node (SLN) status without axillary lymph node dissection (ALND) is an area of uncertainty. It influences the decision-making for regional nodal irradiation (RNI). The aim of the NORA (NOdal RAdiotherapy) survey was to examine the patterns of RNI. METHODS A web-questionnaire, including several clinical scenarios, was distributed to 88 EORTC-affiliated centers. Responses were received between July 2013 and January 2014. RESULTS A total of 84 responses were analyzed. While three-dimensional (3D) radiotherapy (RT) planning is carried out in 81 (96%) centers, nodal areas are delineated in only 51 (61%) centers. Only 14 (17%) centers routinely link internal mammary chain (IMC) and supraclavicular node (SCN) RT indications. In patients undergoing total mastectomy (TM) with ALND, SCN-RT is recommend by 5 (6%), 53 (63%) and 51 (61%) centers for patients with pN0(i+), pN(mi) and pN1, respectively. Extra-capsular extension (ECE) is the main factor influencing decision-making RNI after breast conserving surgery (BCS) and TM. After primary systemic therapy (PST), 49 (58%) centers take into account nodal fibrotic changes in ypN0 patients for RNI indications. In ypN0 patients with inner/central tumors, 23 (27%) centers indicate SCN-RT and IMC-RT. In ypN1 patients, SCN-RT is delivered by less than half of the centers in patients with ypN(i+) and ypN(mi). Twenty-one (25%) of the centers recommend ALN-RT in patients with ypN(mi) or 1-2N+ after ALND. Seventy-five (90%) centers state that age is not considered a limiting factor for RNI. CONCLUSION The NORA survey is unique in evaluating the impact of SLNB/ALND status on adjuvant RNI decision-making and volumes after BCS/TM with or without PST. ALN-RT is often indicated in pN1 patients, particularly in the case of ECE. Besides the ongoing NSABP-B51/RTOG and ALLIANCE trials, NORA could help to design future specific RNI trials in the SLNB era without ALND in patients receiving or not PST.
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Affiliation(s)
- Y Belkacemi
- APHP, GH Henri Mondor Breast Center, Radiation Oncology Department, University Paris-East Creteil, France Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org)
| | - O Kaidar-Person
- Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, Rambam, Haifa, Israel
| | - P Poortmans
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Ozsahin
- Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, CHUV, Lausanne
| | - M-C Valli
- Radiation Oncology Department, Oncology Institute of Southern Switzerland, Switzerland
| | - N Russell
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I Kunkler
- Edinburgh Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - J Hermans
- EORTC Breast Working Party of the Radiation Oncology Group (ROG), EORTC, Brussels, Belgium
| | - A Kuten
- Association of Radiotherapy and Oncology of the Mediterranean Area (www.aromecancer.org) Department of Radiation Oncology, Rambam, Haifa, Israel Italian Hospital, Haifa, Israel
| | - G van Tienhoven
- Department of Radiation Oncology, Academisch Medisch Centrum, Amsterdam
| | - H Westenberg
- Institute for Radiation Oncology Arnhem (ARTI), Arnhem, The Netherlands
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Bradbury C, Houlton AE, Akiki S, Gregg R, Rindl M, Khan J, Ward J, Khan N, Griffiths M, Nagra S, Hills R, Burnett A, Russell N, Vyas P, Grimwade D, Craddock C, Freeman SD. Prognostic value of monitoring a candidate immunophenotypic leukaemic stem/progenitor cell population in patients allografted for acute myeloid leukaemia. Leukemia 2014; 29:988-91. [PMID: 25425198 PMCID: PMC4391965 DOI: 10.1038/leu.2014.327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- C Bradbury
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - A E Houlton
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - R Gregg
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - M Rindl
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - J Khan
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - J Ward
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - N Khan
- Department of Clinical Immunology, University of Birmingham, Birmingham, UK
| | - M Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - S Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Hills
- Department of Haematology, Cardiff University, Cardiff, UK
| | - A Burnett
- Department of Haematology, Cardiff University, Cardiff, UK
| | - N Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - P Vyas
- 1] MRC Molecular Haematology Unit, WIMM, University of Oxford, Oxford, UK [2] Department of Haematology, Radcliffe Hospitals NHS Trust, Oxford, UK
| | - D Grimwade
- 1] Department of Medical & Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK [2] Department of Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - C Craddock
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S D Freeman
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Department of Clinical Immunology, University of Birmingham, Birmingham, UK
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Belkacemi Y, Kaidar-Person O, Poortmans P, Ozsahin M, Valli M, Russell N, Kunkler I, Hermans J, Kuten A, van Tienhoven G, Westenberg H. Patterns of Practice of Nodal Radiation Therapy in Breast Cancer: Results of the EORTC “NORA” Survey. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.879] [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: 10/24/2022]
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Fox CP, Bishton MJ, O'Connor S, Hughes S, Byrne JL, Russell N. EBV-driven relapse of peripheral T-cell lymphoma, masquerading as a post transplant lymphoproliferative disorder following allo-SCT. Bone Marrow Transplant 2013; 49:150-2. [PMID: 23933761 DOI: 10.1038/bmt.2013.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- C P Fox
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M J Bishton
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S O'Connor
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Hughes
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J L Byrne
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - N Russell
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Marsh JC, Pearce RM, Koh MBC, Lim Z, Pagliuca A, Mufti GJ, Perry J, Snowden JA, Vora AJ, Wynn RT, Russell N, Gibson B, Gilleece M, Milligan D, Veys P, Samarasinghe S, McMullin M, Kirkland K, Cook G. Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2013; 49:42-8. [PMID: 23912664 DOI: 10.1038/bmt.2013.115] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/28/2013] [Accepted: 06/26/2013] [Indexed: 11/09/2022]
Abstract
This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients.
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Affiliation(s)
- J C Marsh
- Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK
| | - R M Pearce
- BSBMT Data Registry, Guy's Hospital, London, UK
| | - M B C Koh
- Department of Haematology, St George's Hospital and Medical School, London, UK
| | - Z Lim
- Department of Haematology-Oncology, National University Cancer Institute, National Hospital Singapore, Singapore
| | - A Pagliuca
- Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK
| | - G J Mufti
- Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK
| | - J Perry
- BSBMT Data Registry, Guy's Hospital, London, UK
| | - J A Snowden
- 1] Department of Haematology, Sheffield Teaching Hospitals, Sheffield, UK [2] Department of Oncology, University of Sheffield, Sheffield, UK
| | - A J Vora
- Department of Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - R T Wynn
- Department of Paediatric Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - N Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, UK
| | - B Gibson
- Department of Haematology, Royal Hospital for Sick Children, Glasgow, Scotland, UK
| | - M Gilleece
- Department of Haematology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - D Milligan
- Centre for Haematology and Transplantation, Heartlands Hospital, Birmingham, UK
| | - P Veys
- Department of Haematology, Great Ormond Hospital for Sick Children, London, UK
| | - S Samarasinghe
- Department of Paediatric and Adolescent Haematology, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - M McMullin
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - K Kirkland
- BSBMT Data Registry, Guy's Hospital, London, UK
| | - G Cook
- Department of Haematology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
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Hayes Ryan D, Paramanathan P, Russell N, Coulter J. Primary urachal malignancy: case report and literature review. Ir J Med Sci 2013; 182:739-41. [PMID: 23677557 DOI: 10.1007/s11845-013-0964-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- D Hayes Ryan
- South Infirmary Victoria University Hospital, Cork, Ireland,
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Lim D, Todd M, Kourtoglou N, Gerasimidis K, Gardner-Medwin J, Watson L, Tullus K, Pilkington C, Chesters C, Marks SD, Newland P, Jones C, Beresford MW, O'Neill P, Lee H, Tattersall R, McErlane F, Beresford M, Baildam E, Alice Chieng SE, Davidson J, Foster H, Gardner-Medwin J, Lunt M, Wedderburn LR, Thomson W, Hyrich KL, Kavirayani A, Thyagarajan MS, Ellis J, Helen Strike CNS, Ramanan AV, Coda A, Davidson J, Fowlie P, Walsh J, Carline T, Santos D, Brimlow KW, Rangaraj S, Grant C, Little J, Helen Strike CNS, Hinchcliffe A, Dick A, Ramanan A, Ekdawy D, Nagra G, Camina N, Edgerton J, Choi J, Lamb K, Hawley D, Rangaraj S, Cruikshank M, Sen E, Pain C, Leone V, Cruikshank M, Walsh J, Tattersall R, Hawley D, Dunkley L, Lee H, McMahon AM, Bale P, Armon K, Amin T, Wood M, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kearsley-Fleet L, Baildam E, Beresford M, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Agarwal M, Kavirayani A, Ramanan AV, Ellis J, Smith E, Gray W, Taylor-Robinson D, Foster HE, Beresford MW, Morgan T, Watson L, Beresford MW, Gohar F, Watson L, Beresford MW, Artim-Esen B, Radziszewska A, Pericleous C, Rahman A, Giles I, Ioannou Y, Jashek D, Mosley E, Rangaraj S, Moraitis E, Arnold K, Pilkington C, Russell NJ, Roderick M, Ramanan A, Roderick M, Russell N, Ramanan AV, Smith NSM, Wilson N, Gardner-Medwin J, Sen E, Chan M, Hardy E, Rapley T, Hensman P, Wraith JE, Foster H, Clarkson J, Gardner-Medwin J, Choudhery V, McVitty C, Davidson J, Hughes DH, Martin N, Warrier K, Sen E, Abinun M, Jandial S, O'Leary D, Staunton D, Lowry C, McSweeney N, Sen E, Abinun M, Friswell M, Foster H, Walsh A, Lowry C, Raja A. BSPAR ANNUAL CONFERENCE ABSTRACTS * Oral presentations * O1. The impact of modern management on outcomes of JIA compared with healthy controls. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ket116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lovric V, Russell N, Heuberer P, Goldberg J, Walsh W. Demineralized bone matrix augmented tendon-bone healing in transosseous-equivalent sheep rotator cuff model. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lim D, Todd M, Kourtoglou N, Gerasimidis K, Gardner-Medwin J, Watson L, Tullus K, Pilkington C, Chesters C, Marks SD, Newland P, Jones C, Beresford MW, O'Neill P, Lee H, Tattersall R, McErlane F, Beresford M, Baildam E, Alice Chieng SE, Davidson J, Foster H, Gardner-Medwin J, Lunt M, Wedderburn LR, Thomson W, Hyrich KL, Kavirayani A, Thyagarajan MS, Ellis J, Helen Strike CNS, Ramanan AV, Coda A, Davidson J, Fowlie P, Walsh J, Carline T, Santos D, Brimlow KW, Rangaraj S, Grant C, Little J, Helen Strike CNS, Hinchcliffe A, Dick A, Ramanan A, Ekdawy D, Nagra G, Camina N, Edgerton J, Choi J, Lamb K, Hawley D, Rangaraj S, Cruikshank M, Sen E, Pain C, Leone V, Cruikshank M, Walsh J, Tattersall R, Hawley D, Dunkley L, Lee H, McMahon AM, Bale P, Armon K, Amin T, Wood M, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kearsley-Fleet L, Baildam E, Beresford M, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Agarwal M, Kavirayani A, Ramanan AV, Ellis J, Smith E, Gray W, Taylor-Robinson D, Foster HE, Beresford MW, Morgan T, Watson L, Beresford MW, Gohar F, Watson L, Beresford MW, Artim-Esen B, Radziszewska A, Pericleous C, Rahman A, Giles I, Ioannou Y, Jashek D, Mosley E, Rangaraj S, Moraitis E, Arnold K, Pilkington C, Russell NJ, Roderick M, Ramanan A, Roderick M, Russell N, Ramanan AV, Smith NSM, Wilson N, Gardner-Medwin J, Sen E, Chan M, Hardy E, Rapley T, Hensman P, Wraith JE, Foster H, Clarkson J, Gardner-Medwin J, Choudhery V, McVitty C, Davidson J, Hughes DH, Martin N, Warrier K, Sen E, Abinun M, Jandial S, O'Leary D, Staunton D, Lowry C, McSweeney N, Sen E, Abinun M, Friswell M, Foster H, Walsh A, Lowry C, Raja A. BSPAR ANNUAL CONFERENCE ABSTRACTS * Oral presentations * O1. The impact of modern management on outcomes of JIA compared with healthy controls. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pallis M, Hills R, White P, Grundy M, Russell N, Burnett A. Analysis of the interaction of induction regimens with p-glycoprotein expression in patients with acute myeloid leukaemia: results from the MRC AML15 trial. Blood Cancer J 2011; 1:e23. [PMID: 22829167 PMCID: PMC3255268 DOI: 10.1038/bcj.2011.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/30/2011] [Accepted: 04/27/2011] [Indexed: 11/16/2022] Open
Abstract
Retrospective analyses in non-randomised cohorts suggest that regimens containing fludarabine/Ara C and/or idarubicin/ara C may be more effective than daunorubicin/AraC (DA)-containing regimens in cases of acute myeloid leukaemia (AML) overexpressing p-glycoprotein (Pgp). We prospectively measured Pgp protein and function by flow cytometry in CD45-gated blasts from 434 AML15 trial patients randomised to remission induction therapy with two courses of FLAG-Ida or DA±etoposide (DA/ADE). In all, 34% were positive for Pgp protein and 38% for function. Pgp protein-positive cases had a higher incidence of resistant disease (14% vs 5%), adjusted odds ratio 2.67 (1.14–6.24). There was a trend towards a higher cumulative incidence of relapse at 5 years for Pgp-positive cases (46% vs 55%), adjusted hazard ratio 1.42 (0.98–2.07) (P=0.06). For patients treated with FLAG-Ida, the complete remission (CR) rate was 86% for both Pgp-positive and Pgp-negative patients. In patients treated with DA/ADE, 78% of Pgp-positive and 90% of Pgp-negative cases achieved CR (P=0.06). In analyses of overall survival, there was no interaction between treatment received and Pgp expression. Data for Pgp function followed similar trends. Our data suggest that FLAG-Ida may improve the remission rate for Pgp-positive AML, but the malignant clone is reduced rather than eradicated such that the relapse rate remains high in Pgp-positive patients.
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Burnett AK, Hills RK, Hunter A, Milligan D, Kell J, Wheatley K, Yin J, McMullin MF, Cahalin P, Craig J, Bowen D, Russell N. The addition of arsenic trioxide to low-dose Ara-C in older patients with AML does not improve outcome. Leukemia 2011; 25:1122-7. [PMID: 21475252 PMCID: PMC6485444 DOI: 10.1038/leu.2011.59] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most patients with acute myeloid leukaemia (AML) are older, with many unsuitable for conventional chemotherapy. Low-dose Ara-C (LDAC) is superior to best supportive care but is still inadequate. The combination of arsenic trioxide (ATO) and LDAC showed promise in an unrandomised study. We report a randomised trial of LDAC versus LDAC+ATO. Patients with AML according to WHO criteria or myelodysplastic syndrome with >10% blasts, considered as unfit for conventional chemotherapy, were randomised between subcutaneous Ara-C (20 mg b.d. for 10 days) and the same LDAC schedule with ATO (0.25 mg/kg) on days 1-5, 9 and 11, for at least four courses every 4 to 6 weeks. Overall 166 patients were entered; the trial was terminated on the advice of the DMC, as the projected benefit was not observed. Overall 14% of patients achieved complete remission (CR) and 7% CRi. Median survival was 5.5 months and 19 months for responders (CR: not reached; CRi: 14 months; non-responders: 4 months). There were no differences in response or survival between the arms. Grade 3/4 cardiac and liver toxicity, and supportive care requirements were greater in the ATO arm. This randomised comparison demonstrates that adding ATO to LDAC provides no benefit for older patients with AML.
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Affiliation(s)
- A K Burnett
- Department of Haematology, Cardiff University School of Medicine, Heath Park, Cardiff, UK.
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Scharpfenecker M, Floot B, Stewart F, Russell N. MECHANISMS OF LATE MICRO-VASCULAR DAMAGE IN IRRADIATED BREAST CANCER PATIENTS. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71747-9] [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: 11/27/2022]
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Scharpfenecker M, Floot B, Russell N, Stewart F. MECHANISMS OF LATE VASCULAR DAMAGE AFTER RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71735-2] [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: 10/14/2022]
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Langdon D, Russell N, Field A, Fox L. POI05 StayingSmart--an online web resource about cognitive deficits in multiple sclerosis for patients, carers and professionals. J Neurol Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Balakrishnan S, Jackson C, Russell N, Bellamy TC. Ectopic release sites lack fast vesicle recycling mechanisms, causing long-term depression of neuron-glial transmission in rat cerebellum. Glia 2010; 59:82-93. [PMID: 20967883 DOI: 10.1002/glia.21078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/16/2010] [Accepted: 08/18/2010] [Indexed: 11/09/2022]
Abstract
Classical synaptic transmission occurs at active zones within the synaptic cleft, but increasing evidence suggests that vesicle fusion can also occur outside of these zones, releasing transmitter directly into the extrasynaptic space. The role of such "ectopic" release is unclear, but in the cerebellar molecular layer it is thought to guide the processes of Bergmann glia toward synaptic terminals through activation of glial α-amino-3-hydroxyl-5-methyl-4-isoxazolepropionate (AMPA) receptors. Once surrounding the terminal, the glial process is presumed to limit spillover of neurotransmitter between synapses by rapid uptake of glutamate. We have previously reported that this route for neuron-glial transmission exhibits long-term depression following repetitive stimulation at frequencies in the 0.1-1 Hz range, in ex vivo slices from rat cerebellum. Here, we present evidence that LTD arises because ectopic sites lack the fast recycling mechanisms that operate at the active zone. Consequently, ectopic vesicles constitute an exhaustible pool that is depleted at normal synaptic firing rates and only recovers slowly. This effect is cumulative, meaning that the strength of ectopic transmission provides a read-out of the average frequency of presynaptic firing over several minutes. Glial processes are therefore likely to interact most closely with terminals that fire infrequently; conditions that may promote elimination of, rather than support for, the connection.
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Affiliation(s)
- Saju Balakrishnan
- Laboratory for Molecular Signalling, Babraham Institute, Babraham, Cambridge, United Kingdom
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Aukema T, Rutgers E, Vogel W, Teertstra H, Oldenburg H, Vrancken Peeters M, Wesseling J, Russell N, Valdés Olmos R. The Role of FDG PET/CT in Patients with Locoregional Breast Cancer Recurrence and a Comparison to Conventional Imaging. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognosis and clinical management of patients with locoregional recurrence of breast cancer depends on the extent of the disease. Conventional work-up, consisting of bone scintigraphy, liver ultrasound, X-ray or CT of the thorax and MRI of the thoracic wall, may underestimate the local extent or miss the presence of distant metastases. The aim of this study was to evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) on clinical management in patients with locoregional breast cancer recurrence amenable for locoregional treatment and compare the results with conventional imaging.Material and Methods: We performed a retrospective analysis of all patients referred for FDG PET/CT with locoregional breast cancer recurrence between January 2006 and August 2008. PET/CT findings were compared with results of additional imaging, pathology and follow-up. The impact of FDG PET/CT findings on clinical management of patients, was evaluated on the basis of clinical decisions obtained from patient files.Results: 56 patients were included. In 93% of the patients FDG PET/CT confirmed the locoregional recurrence. In 32 patients (57%) FDG PET/CT revealed additional tumour localisations. Distant metastases were detected in 11 patients on conventional imaging and in 23 patients on FDG PET/CT images (p<0,01). In 25 patients (45%), FDG PET/CT detected additional lesions not visible on conventional imaging. FDG PET/CT had an impact on clinical management in 27 patients (48%) by detecting more extensive locoregional disease or distant metastases. In 20 patients (36%) unnecessary mutilating surgery was prevented and treatment was changed to palliative systemic treatment. The sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were respectively 97%, 92%, 95%, 94% and 96%.Discussion: FDG PET/CT, in addition to conventional imaging, plays an important role in staging patients with locoregional breast cancer recurrence since its result changed the clinical management in almost half of the patients. FDG PET/CT could potentially replace conventional staging imaging in patients with a locoregional breast cancer recurrence.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5011.
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Affiliation(s)
- T. Aukema
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - E. Rutgers
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - W. Vogel
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - H. Teertstra
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - H. Oldenburg
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - M. Vrancken Peeters
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - J. Wesseling
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N. Russell
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
| | - R. Valdés Olmos
- 1The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, The Netherlands
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Fowler CJ, Panicker JN, Drake M, Harris C, Harrison SCW, Kirby M, Lucas M, Macleod N, Mangnall J, North A, Porter B, Reid S, Russell N, Watkiss K, Wells M. A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 85:552-9. [PMID: 19372287 DOI: 10.1136/jnnp.2008.159178] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [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: 11/04/2022]
Abstract
Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients' continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed.
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Affiliation(s)
- C J Fowler
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
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Knight S, Russell N, Barcena L, Morris P. DOES MYCOPHENOLATE MOFETIL CONFER CLINICAL BENEFIT OVER AZATHIOPRINE IN RENAL TRANSPLANTATION? A SYSTEMATIC REVIEW AND META-ANALYSIS. Transplantation 2008. [DOI: 10.1097/01.tp.0000332643.54887.87] [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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Eaton J, Perry M, Nicholson S, Guckian M, Russell N, Whelan M, Kirby R. Allogeneic whole-cell vaccine: a phase I/II study in men with hormone-refractory prostate cancer. BJU Int 2008. [DOI: 10.1046/j.1464-410x.2002.02572.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mony U, Jawad M, Seedhouse C, Russell N, Pallis M. Resistance to FLT3 inhibition in an in vitro model of primary AML cells with a stem cell phenotype in a defined microenvironment. Leukemia 2008; 22:1395-401. [PMID: 18509353 DOI: 10.1038/leu.2008.125] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Relapse in acute myeloid leukaemia (AML) is mediated by survival of leukaemic stem cells following remission-induction chemotherapy. It would therefore be useful to identify therapeutic agents that target leukaemic stem cells. We devised a flow cytometric chemosensitivity assay allowing 48 h culture of leukaemic blasts in a defined microenvironment followed by enumeration of viable CD34+CD38-CD123+ leukaemic stem and progenitor cells (LSPC). The assay was used to investigate the LSPC response to cytosine arabinoside (Ara-C) and to the FLT3 inhibitor AG1296. There was a 3.6-fold increase in Ara-C-treated LSPC survival under defined 'niche-like' conditions compared to culture without microenvironmental support. Nine AML samples with internal tandem duplications of FLT3 (FLT3/ITDs) were treated with AG1296. Three samples were very sensitive (>50% kill) and 4 were moderately sensitive (10-50% kill) in bulk suspension culture without microenvironmental support. However, under defined 'niche-like' conditions, the survival of LSPC was enhanced rather than inhibited by AG1296 treatment. We conclude that an interaction between LSPC and a defined in vitro microenvironment models a chemoresistant niche. Our data point to a need to investigate more novel chemotherapeutic agents under these stringent conditions to identify agents that may be suitable to target minimal residual disease in AML.
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Affiliation(s)
- U Mony
- Division of Haematology, University of Nottingham, Nottingham, UK
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Labarthe MC, Theocharous P, Russell N, Todryk S, Bangma C, Thraves P, Dalgleish AG, Whelan MA. A novel murine model of allogeneic vaccination against prostate cancer. Cancer Immunol Immunother 2008; 57:453-65. [PMID: 17805533 PMCID: PMC11030044 DOI: 10.1007/s00262-007-0384-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 04/12/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
Prostate cancer continues to be a major cause of death in men. Surgical and medical treatments of the disease have improved, but metastasic disease remains a significant clinical problem. Novel therapies such as whole cell vaccination offer the potential of treating disease by stimulating the immune system. To study the efficacy of a whole cell vaccine in prostate cancer two strains of mice were used: C57BL/6 (H-2Kb) and C3H/HeJ (H-2K(k)) in combination with four different cell lines. Thus, a model was constructed of allogeneic and syngeneic vaccine, as well as a challenge tumour for each strain. Two novel cell lines were developed during this study. Firstly, the non tumourigeneic PMC-1 was derived from a normal mouse prostate and immortalized with HPV16. Secondly, the tumourigeneic PMC-1 C6ras1p1 was transformed with human ras gene which formed tumours in both SCID and C3H/HeJ mice. Protection, and the nature of the immune response to syngeneic and allogeneic vaccine, in males and females was examined in both strains. Vaccination with both syngeneic and allogeneic irradiated whole cell vaccines induced protection from syngeneic challenge in females. However, no protection was observed when allogeneic vaccine was given to male mice. This correlated with the immune response. Two types of cellular immune responses were generated in females. A NK-mediated response was observed in C57BL/6 mice, whilst C3H/HeJ mice developed a CTL response. Little or no cellular immune response was observed in males. The cytokine profile in C3H/HeJ females was a mixture of Th1 and Th2 whilst a mainly Th1 profile was observed in C57BL/6 mice. Male mice showed a diminished cytokine secretion compared to females which was further depressed after challenge. The difference in immunity was largely as expected, since tolerance to prostate antigens should not normally develop in female mice. However, this makes this model particularly relevant clinically since it directly mimics the human situation and thus may accelerate the development of whole cell vaccines for clinical use.
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Affiliation(s)
- M-C Labarthe
- Department of Oncology, Cellular and Molecular Medicine, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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