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Hartup SM, Morgan JL, Cheng VWT, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O’Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: protocol for a prospective, multicentre cohort study. Int J Surg Protoc 2024; 28:20-26. [PMID: 38433867 PMCID: PMC10905491 DOI: 10.1097/sp9.0000000000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 03/05/2024] Open
Abstract
Background Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome. Methods The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors. Discussion This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies.
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Affiliation(s)
- Sue M. Hartup
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Jenna L. Morgan
- Division of Clinical Medicine, University of Sheffield School of Medicine and Population Health, Beech Hill Road, Sheffield
| | - Vinton WT Cheng
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Peter A. Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, Surrey
- The Institute of Cancer Research
| | - Ellen Copson
- Somers Cancer Research Building, University of Southampton and University Hospital Southampton, Southampton
| | - Ramsey I. Cutress
- Somers Cancer Research Building, University of Southampton and University Hospital Southampton, Southampton
| | - Rajiv Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital
| | - Beatrix Elsberger
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen
| | | | - Brian Hogan
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Kieran Horgan
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Cliona C. Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Manchester
| | - Stuart A. McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast
| | - Rachel L. O’Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, Surrey
- The Institute of Cancer Research
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Learning and Research Building, Southmead Hospital
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary
- Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester
| | - Lisa Sheehan
- Wessex Deanery, Southern House, Otterbourne, Winchester, UK
| | - Lynda Wyld
- Division of Clinical Medicine, University of Sheffield School of Medicine and Population Health, Beech Hill Road, Sheffield
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
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Sheu A, O’Connell RL, Jenkins AJ, Tran T, Drury PL, Sullivan DR, Li L, Colman P, O’Brien R, Kesäniemi YA, Center JR, White CP, Keech AC. Factors associated with fragility fractures in type 2 diabetes: An analysis of the randomised controlled Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Metab Res Rev 2023; 39:e3631. [PMID: 36893361 PMCID: PMC10909535 DOI: 10.1002/dmrr.3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/23/2022] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
AIMS Fracture risk is elevated in some type 2 diabetes patients. Bone fragility may be associated with more clinically severe type 2 diabetes, although prospective studies are lacking. It is unknown which diabetes-related characteristics are independently associated with fracture risk. In this post-hoc analysis of fracture data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial (ISRCTN#64783481), we hypothesised that diabetic microvascular complications are associated with bone fragility. MATERIALS AND METHODS The FIELD trial randomly assigned 9795 type 2 diabetes participants (aged 50-75 years) to receive oral co-micronised fenofibrate 200 mg (n = 4895) or placebo (n = 4900) daily for a median of 5 years. We used Cox proportional hazards models to identify baseline sex-specific diabetes-related parameters independently associated with incident fractures. RESULTS Over 49,470 person-years, 137/6138 men experienced 141 fractures and 143/3657 women experienced 145 fractures; incidence rates for the first fracture of 4∙4 (95% CI 3∙8-5∙2) and 7∙7 per 1000 person-years (95% CI 6∙5-9∙1), respectively. Fenofibrate had no effect on fracture outcomes. In men, baseline macrovascular disease (HR 1∙52, 95% CI 1∙05-2∙21, p = 0∙03), insulin use (HR 1∙62, HR 1∙03-2∙55, p = 0∙03), and HDL-cholesterol (HR 2∙20, 95% CI 1∙11-4∙36, p = 0∙02) were independently associated with fracture. In women, independent risk factors included baseline peripheral neuropathy (HR 2∙04, 95% CI 1∙16-3∙59, p = 0∙01) and insulin use (HR 1∙55, 95% CI 1∙02-2∙33, p = 0∙04). CONCLUSIONS Insulin use and sex-specific complications (in men, macrovascular disease; in women, neuropathy) are independently associated with fragility fractures in adults with type 2 diabetes.
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Affiliation(s)
- Angela Sheu
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and DiabetesSt Vincent's HospitalSydneyAustralia
| | | | | | - Thach Tran
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
| | - Paul L. Drury
- Auckland Diabetes CentreAuckland District Health BoardAucklandNew Zealand
| | - David R. Sullivan
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
- Royal Prince Alfred HospitalSydneyAustralia
| | - LiPing Li
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
| | - Peter Colman
- Department of Diabetes and EndocrinologyRoyal Melbourne HospitalMelbourneAustralia
- Walter and Eliza Hall Institute of Medical ResearchMelbourneAustralia
- University of MelbourneMelbourneAustralia
| | - Richard O’Brien
- University of MelbourneMelbourneAustralia
- Austin HospitalMelbourneAustralia
| | - Y. Antero Kesäniemi
- Internal Medicine Research UnitMedical Research CenterOulu University HospitalOuluFinland
- University of OuluOuluFinland
| | - Jacqueline R. Center
- Bone Biology DivisionGarvan Institute of Medical ResearchSydneyAustralia
- Clinical SchoolSt Vincent's HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and DiabetesSt Vincent's HospitalSydneyAustralia
| | - Christopher P. White
- Clinical SchoolPrince of Wales HospitalFaculty of MedicineUniversity of New South Wales SydneySydneyAustralia
- Department of Endocrinology and MetabolismPrince of Wales HospitalSydneyAustralia
| | - Anthony C. Keech
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
- Royal Prince Alfred HospitalSydneyAustralia
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Wakam GK, Biesterveld BE, Pai MP, Kemp MT, O’Connell RL, Rajanayake KK, Chtraklin K, Vercruysse CA, Alam HB. A single dose of valproic acid improves neurologic recovery and decreases brain lesion size in swine subjected to an isolated traumatic brain injury. J Trauma Acute Care Surg 2021; 91:867-871. [PMID: 34695064 PMCID: PMC8715863 DOI: 10.1097/ta.0000000000003136] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We lack specific treatments for traumatic brain injury (TBI), which remains the leading cause of trauma-related morbidity and mortality. Treatment with valproic acid (VPA) improves outcomes in models of severe TBI with concurrent hemorrhage. However, it is unknown if VPA will have similar benefits after isolated nonlethal TBI, which is the more common clinical scenario. The goal of this study was to evaluate the effect of VPA treatment in a preclinical isolated TBI swine model on neurologic outcomes and brain lesion size and to perform detailed pharmacokinetic analyses for a future clinical trial. METHODS Yorkshire swine (n = 10; 5/cohort) were subjected to TBI (8-mm controlled cortical impact). An hour later, we randomized them to receive VPA (150 mg/kg) or saline placebo (control). Neuroseverity scores were assessed daily (0 [normal] to 36 [comatose]), brain lesion size was measured on postinjury 3, and serial blood samples were collected for pharmacokinetic studies. RESULTS Physiologic parameters and laboratory values were similar in both groups. Valproic acid-treated animals demonstrated significantly better neuroseverity scores on postinjury 1 (control, 9.2 ± 4.4; VPA, 0 ± 0; p = 0.001). Valproic acid-treated animals had significantly smaller brain lesion sizes (mean volume in microliter: control, 3,130 ± 2,166; VPA, 764 ± 208; p = 0.02). Pharmacokinetic data confirmed adequate plasma and tissue levels of VPA. CONCLUSION In this clinically relevant model of isolated TBI, a single dose of VPA attenuates neurological impairment and decreases brain lesion size.
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Affiliation(s)
- Glenn K. Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Ben E. Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Manjunath P. Pai
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Michael T. Kemp
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | | | | | - Kiril Chtraklin
- Department of Surgery, Northwestern University, Chicago, IL, 60611; USA
| | | | - Hasan B. Alam
- Department of Surgery, Northwestern University, Chicago, IL, 60611; USA
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Murphy NJ, Eyles J, Bennell KL, Bohensky M, Burns A, Callaghan FM, Dickenson E, Fary C, Grieve SM, Griffin DR, Hall M, Hobson R, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O’Connell RL, O’Donnell J, O’Sullivan M, Randhawa S, Reichenbach S, Saxby DJ, Singh P, Spiers L, Tran P, Wrigley TV, Hunter DJ. Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial. BMC Musculoskelet Disord 2017; 18:406. [PMID: 28950859 PMCID: PMC5615805 DOI: 10.1186/s12891-017-1767-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/21/2017] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management. METHODS This is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and 12 months. Secondary outcomes include patient-reported outcomes and several structural and biomechanical measures relevant to the pathogenesis of FAI and development of hip OA. Interventions will be compared by intention-to-treat analysis. DISCUSSION The findings will help determine whether hip arthroscopy or an individualised physiotherapy program is superior for the management of FAI, including for the prevention of hip OA. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . Trial registered 2/11/2015 (retrospectively registered).
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Affiliation(s)
- Nicholas J. Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Megan Bohensky
- Melbourne EpiCentre, University of Melbourne, Melbourne, Australia
| | | | - Fraser M. Callaghan
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Camperdown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC Australia
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Camperdown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Damian R. Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - James M. Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, NSW Australia
| | - David G. Lloyd
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, NSW Australia
| | - Rachel L. O’Connell
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O’Donnell
- Hip Arthroscopy Australia, 21 Erin St, Richmond, VIC Australia
- St Vincent’s Private Hospital, 159 Grey St, East Melbourne, VIC Australia
| | - Michael O’Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, NSW Australia
| | - Sunny Randhawa
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, Sydney, NSW 2109 Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - David J. Saxby
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin St, Richmond, VIC Australia
- Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, VIC 3135 Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC Australia
| | - Tim V. Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - David J. Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
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