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Fleming S, Sennhauser S, May L, Simone N, Beuningen A, Bhatt K. A Case of Acute Mitoxantrone Mediated Myocarditis in Refractory Acute Myeloid Leukemia (AML). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.443] [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: 04/05/2023] Open
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Fleming S. Is it time to properly examine
NHS
reform? Trends Urol & Men's Health 2023. [DOI: 10.1002/tre.909] [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] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Gill CE, Mitchell PJ, Clark J, Cornish J, Fergusson P, Gilchrist N, Hayman L, Hornblow S, Kim D, Mackenzie D, Milsom S, von Tunzelmann A, Binns E, Fergusson K, Fleming S, Hurring S, Lilley R, Miller C, Navarre P, Pettett A, Sankaran S, Seow MY, Sincock J, Ward N, Wright M, Close JCT, Harris IA, Armstrong E, Hallen J, Hikaka J, Kerse N, Vujnovich A, Ganda K, Seibel MJ, Jackson T, Kennedy P, Malpas K, Dann L, Shuker C, Dunne C, Wood P, Magaziner J, Marsh D, Tabu I, Cooper C, Halbout P, Javaid MK, Åkesson K, Mlotek AS, Brûlé-Champagne E, Harris R. Experience of a systematic approach to care and prevention of fragility fractures in New Zealand. Arch Osteoporos 2022; 17:108. [PMID: 35917039 PMCID: PMC9344235 DOI: 10.1007/s11657-022-01138-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/09/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. PURPOSE This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. METHODS In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. RESULTS In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. CONCLUSION Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.
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Affiliation(s)
- Christine Ellen Gill
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
| | - Paul James Mitchell
- Osteoporosis New Zealand, Wellington, New Zealand.
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand.
- School of Medicine, University of Notre Dame Australia, Sydney Campus, 128-140 Broadway, Chippendale, Sydney, NSW, 2007, Australia.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland.
| | - Jan Clark
- Osteoporosis New Zealand, Wellington, New Zealand
| | - Jillian Cornish
- Osteoporosis New Zealand, Wellington, New Zealand
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
- Australian and New Zealand Bone and Mineral Society, Sydney, Australia
| | | | - Nigel Gilchrist
- Osteoporosis New Zealand, Wellington, New Zealand
- CGM Research Trust, 40 Stewart Street, Christchurch, New Zealand
| | - Lynne Hayman
- Osteoporosis New Zealand, Wellington, New Zealand
| | - Sue Hornblow
- Osteoporosis New Zealand, Wellington, New Zealand
| | - David Kim
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Australian and New Zealand Bone and Mineral Society, Sydney, Australia
- Waitemata District Health Board, Auckland, New Zealand
| | - Denise Mackenzie
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
| | - Stella Milsom
- Osteoporosis New Zealand, Wellington, New Zealand
- Fertility Associates, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Elizabeth Binns
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Physiotherapy New Zealand, Wellington, New Zealand
| | - Kim Fergusson
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Fracture Liaison Network New Zealand, Wellington, New Zealand
- Fracture Liaison Service, Marlborough District Health Board, Nelson, Nelson, New Zealand
| | - Stewart Fleming
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- OperaIT Data Services, Logan, Queensland, Australia
| | - Sarah Hurring
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Older Persons' Health Specialist Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Rebbecca Lilley
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Caroline Miller
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
| | - Pierre Navarre
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Southland Hospital, Invercargill, New Zealand
- University of Otago, Dunedin, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
| | - Andrea Pettett
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
| | - Shankar Sankaran
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
| | - Min Yee Seow
- Waitemata District Health Board, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Australian and New Zealand Society for Geriatric Medicine, Sydney, NSW, Australia
| | - Jenny Sincock
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Canterbury District Heath Board, Christchurch, New Zealand
| | - Nicola Ward
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Mark Wright
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- New Zealand Orthopaedic Association, Wellington, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacqueline Clare Therese Close
- Australian and New Zealand Hip Fracture Registry Steering Group, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ian Andrew Harris
- Australian and New Zealand Hip Fracture Registry Steering Group, Sydney, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW, Australia
| | - Elizabeth Armstrong
- Australian Hip Fracture Registry, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Jamie Hallen
- Australian Hip Fracture Registry, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Joanna Hikaka
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrea Vujnovich
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Kirtan Ganda
- Australian and New Zealand Fragility Fracture Registry Steering Group, Sydney, Australia
- Department of Endocrinology, Concord Hospital, Concord, NSW, Australia
- Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Markus Joachim Seibel
- Australian and New Zealand Fragility Fracture Registry Steering Group, Sydney, Australia
- Bone Research Program, ANZAC Research Institute, Concord, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School at Concord Campus, The University of Sydney, Sydney, NSW, Australia
| | - Thomas Jackson
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Paul Kennedy
- Accident Compensation Corporation, Wellington, New Zealand
| | - Kirsten Malpas
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Leona Dann
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- Health Quality & Safety Commission New Zealand, Wellington, New Zealand
| | - Carl Shuker
- Health Quality & Safety Commission New Zealand, Wellington, New Zealand
| | | | - Philip Wood
- Waitemata District Health Board, Auckland, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
- Ministry of Health, Wellington, New Zealand
| | - Jay Magaziner
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Marsh
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
| | - Irewin Tabu
- Fragility Fracture Network, c/o MCI Schweiz AG, Zürich, Switzerland
- Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines
- Institute on Aging-National Institutes of Health, UP Manila, Manila, Philippines
| | - Cyrus Cooper
- International Osteoporosis Foundation, Nyons, Switzerland
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- International Osteoporosis Foundation, Nyons, Switzerland
| | - Kristina Åkesson
- International Osteoporosis Foundation, Nyons, Switzerland
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | | | | | - Roger Harris
- Osteoporosis New Zealand, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Fragility Fracture Registry, Wellington, New Zealand
- New Zealand Implementation and Management Committee, Australian and New Zealand Hip Fracture Registry, Wellington, New Zealand
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O'Reilly D, Fleming S, Sweeney P, MayerPower NG. An index case of Birt Hogg Dube Syndrome. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100150] [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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Wheen P, O'Callaghan D, Murray P, Minelli C, Byrne L, Armstrong R, Maher V, Shiels P, Fleming S, Daly C. Persisting Symptomatic Severe Secondary Mitral Regurgitation in Heart Failure Patients. Ir Med J 2022; 115:514. [PMID: 35279048] [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: 06/14/2023]
Abstract
Aims We aimed to assess the rate of persisting severe symptomatic secondary mitral regurgitation (MR) in a newly diagnosed heart failure (HF) population following optimisation of guideline directed medical therapy (GDMT), cardiac resynchronisation therapy (CRT) and revascularisation. Methods We assessed all new patients referred to our hospital group’s HF clinics. We retrospectively reviewed these patients at HF clinic enrolment, HF programme completion, as well as most recent follow up. Results Of the 242 new patients referred to our HF clinics, there were 10 patients (4.1%) who had either persisting symptomatic severe secondary MR at HF programme completion, or had undergone mitral valve surgery. There were no percutaneous mitral valve repairs at the time of these patients’ referrals. The rates of ACE/ARB/ARNI, BB and MRA use were 87.8%, 94.1%, and 49.8% in those with mid ranged, or reduced ejection fraction. The rates of ICD and CRT therapy were 15.1% and 4.4% at follow up. Patients with severe MR had higher time adjusted rates of death or hospitalization for heart failure. Conclusion In a well-treated newly diagnosed HF population, repeat assessment at HF programme completion suggests 4.1% of patients have a persisting indication for percutaneous mitral valve repair based on persisting severe symptomatic secondary MR.
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Affiliation(s)
- P Wheen
- School of Medicine, Trinity College, Dublin, Ireland
- St. James Hospital, James Street, Dublin 8, Ireland
- Tallaght University Hospital, Dublin 24, Ireland
| | | | - P Murray
- Tallaght University Hospital, Dublin 24, Ireland
| | - C Minelli
- Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
| | - L Byrne
- Midlands Regional Hospital, Portlaoise, Co. Laois, Ireland
| | - R Armstrong
- St. James Hospital, James Street, Dublin 8, Ireland
| | - V Maher
- Tallaght University Hospital, Dublin 24, Ireland
| | - P Shiels
- Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
| | - S Fleming
- Midlands Regional Hospital, Portlaoise, Co. Laois, Ireland
| | - C Daly
- St. James Hospital, James Street, Dublin 8, Ireland
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Au S, Bellato V, Carvas JM, Córdoba CD, Daudu D, Dziakova J, Eltarhoni K, El Feituri N, Fung ACH, Fysaraki C, Gallo G, Gultekin FA, Harbjerg JL, Hatem F, Ioannidis A, Jakobsen L, Clinch D, Kristensen HØ, Kuiper SZ, Kwok AMF, Kwok W, Millan M, Milto KM, Ng HJ, Pellino G, Picciariello A, Pronin S, van Ramshorst GH, Ramser M, Jiménez-Rodríguez RM, Sainz Hernandez JC, Samadov E, Sohrabi S, Uchiyama M, Wang JHS, Younis MU, Fleming S, Alhomoud S, Mayol J, Moeslein G, Smart NJ, Soreide K, Teh C, Verran D, Maeda Y. Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages. Br J Surg 2021; 108:1315-1322. [PMID: 34467970 DOI: 10.1093/bjs/znab275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/24/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally. METHODS A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. RESULTS Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance. CONCLUSION Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.
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Affiliation(s)
- S Au
- NHS Education for Scotland, Edinburgh, UK
| | | | | | - C D Córdoba
- University of Lausanne, Lausanne, Switzerland
| | - D Daudu
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | - J Dziakova
- Hospital Clinico San Carlos, IDISSC, Madrid, Spain
| | | | | | - A C H Fung
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - C Fysaraki
- Urology Department, Mid Yorkshire Hospitals NHS Trust, UK
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ayca Gultekin
- General Surgery Department, Zonguldak Bulent, Ecevit University School of Medicine, Zonguldak, Turkey
| | - J L Harbjerg
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - F Hatem
- Glasgow Royal Infirmary, Glasgow, UK
| | | | - L Jakobsen
- UiT, The Arctic University of Norway, University Hospital of North Norway, Tromso, Norway
| | - D Clinch
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - H Ø Kristensen
- Department of Surgery, Research Unit C119, Aarhus University Hospital, Palle Juul-Jensens, Aarhus N, Denmark
| | - S Z Kuiper
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | | | - W Kwok
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Millan
- Coloproctology Unit, Department of Surgery, La Fe University Hospital, Valencia, Spain
| | - K M Milto
- NHS Education for Scotland, Edinburgh, UK
| | - H J Ng
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, UK
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Italy
| | - S Pronin
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Ramser
- Department of Surgery, Solothurner Spitäler SoH, Bürgerspital Solothurn, Solothurn, Switzerland
| | | | - J C Sainz Hernandez
- Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - E Samadov
- Surgical Department, LEYLA Medical Centre, Baku, Azerbaijan
| | | | - M Uchiyama
- Showa University School of Medicine, Tokyo, Japan
| | - J H-S Wang
- Australasian Students' Surgical Association, New Zealand
| | - M U Younis
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | - S Fleming
- Barts and the London School of Medicine and Dentistry, London, UK
| | - S Alhomoud
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - J Mayol
- Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain
| | - G Moeslein
- Ev. Bethesda Khs Duisburg, University of Witten, Herdecke, Germany
| | - N J Smart
- Royal Devon & Exeter Hospital & University of Exeter Medical School, Exeter, UK
| | - K Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Teh
- Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney & Transplant Institute, Quezon City, Philippines
| | - D Verran
- Ramsey Health Care, Sydney, Australia
| | - Y Maeda
- Department of Colorectal Surgery, Western General Hospital and University of Edinburgh, Edinburgh, UK
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Nijs M, Morroll D, Lynch C, Levett S, Fleming S, Chin R, Razina O, Ketterson K, Erreb. Agerholm I. P–786 Virtual continual professional education programs in ART in time of SARS-CoV–2: do they deliver? Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.785] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Can virtual training deliver effective professional education to ART professionals?
Summary answer
Virtual continual professional education programs are an excellent learning platform for ART professionals. The web-based Educational Library is a very useful global scientific resource.
What is known already
Retention levels are the highest when theoretical knowledge sharing is combined with practical hands-on training in a face-to-face training center set up. This is especially the case for training in Assisted Reproductive Techniques, where success depends in part on the ART professional’s skills. Due to the global SARS-CoV–2 pandemic in 2020, hands-on training programs were forced to close, and new educational web-based activities tools like streaming of webinars and journal clubs were developed.
Study design, size, duration
The effectiveness of the Global Education and Webinar Series organised by CooperSurgical (including webinars and journal clubs) streamed in 2020, was evaluated retrospectively by analysing the following: 1) the live attendance rates; 2) viewing rates in the Webinar Series Library; 3) outcomes of the feedback questionnaire focusing on the level of the webinar content, relevance to day-to-day clinical and laboratory work, gaining new knowledge, and pace of the webinar.
Participants/materials, setting, methods
In 2020, 65 webinars and 8 journal clubs were streamed at different timepoints to accommodate a global professional ART audience. The target audience included embryologists, lab technicians, IVF clinicians, counsellors, and scientists. Topics were IVF lab and clinic-based, theoretical but also practical. Lectures were prepared with an evidence-based approach and submitted for scientific review. Post live attendance, viewers were invited to fill in a questionnaire; they obtained a certificate of attendance.
Main results and the role of chance
In 2020, 16,839 viewers attended the 65 live webinars and 8 journal clubs. Live attendance rates dropped by 75% in May, when IVF clinics were re-opening after the first wave of SARS-CoV–2.
On 08.01.2021, a total of 23,258 library viewings were recorded. Library viewings increased significantly after the re-opening of the clinics.
Viewers were located in 129 countries; India, Thailand, and Spain had the highest viewing of all the countries (> 1500 viewings per country). Multiple viewers attended between 10 to 26 of the virtual activities.
The feedback analysis showed that 96% of the viewers found the webinars to be relevant to their day-to-day work; 92% gained knowledge as a result of the webinar; 94% of the viewers found the level appropriate and 91% felt that the pace of the presentations was just right.
These outcomes demonstrate that the need for continual professional education programs in ART in time of SARS-CoV–2 is clearly present globally. Our virtual Global Education and Webinar Series could deliver evidence-based knowledge to viewers globally and assist them in gaining knowledge – even in a distance learning setting. The Library is an excellent resource tool for ART professionals to gain knowledge at their own pace.
Limitations, reasons for caution
Not all ART professionals have access to high-quality internet facilities. Not all the viewers completed the questionnaire
Wider implications of the findings: Web-based virtual activities can be an excellent tool for knowledge sharing. These outcomes will be used to further develop our virtual educational training program.
Trial registration number
Not applicable
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Affiliation(s)
- M Nijs
- CooperSurgical, Medical Affairs, Måløv, Denmark
| | - D Morroll
- CooperSurgical, Medical Affairs, Måløv, Denmark
| | - C Lynch
- CooperSurgical, Medical Affairs, Måløv, Denmark
| | - S Levett
- CooperSurgical, Medical Affairs, Måløv, Denmark
| | - S Fleming
- CooperSurgical, Medical Affairs, Måløv, Denmark
| | - R Chin
- CooperSurgical, Asia Pacific Countries, Singapore, Singapore Rep. of
| | - O Razina
- CooperSurgical, Russia- the Nordic and the Baltic areas, StPetersburg, Russia C.I.S
| | - K Ketterson
- CooperSurgical, Medical Affairs, Livingston, USA
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Hardie J, Page P, Fleming S. 889 A Window to Individual Surgical Training Plans. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.173] [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: 11/12/2022]
Abstract
Abstract
Introduction
A recent publication in the Plastic and Reconstructive Surgery journal (Rohrich et al., 2020) has attracted controversy for its generalised approach to “millennial” plastic surgeons. We suggest that surgeons in training, trainers and colleagues need to adjust their focus from the group to the individual in order to maximise clinical performance, quality of working life and quality of care delivered to patients.
Method
We outline a simple model, adapted from the Johari window tool, with the aim of delivering a job and training plan with which all parties are content. It considers individual ability to process scenarios and perform tasks (bandwidth), and the resources available to the individual trainee, to assess each aspect of the role.
Results
No two clinicians have the same strengths and weaknesses, and no two posts are identical. The Johari-like matrix allows trainers and trainees to identify which activities are firmly within the bandwidth and resources of the trainee, those which are clearly not, and those which may cause some concern and require further discussion or modification.
Conclusions
In this model, we suggest a framework which may help surgeons in training and trainers alike and provide a means of recording this longitudinally as individuals or roles evolve.
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Affiliation(s)
- J Hardie
- Frimley Park Hospital NHS Trust, Camberley, United Kingdom
| | - P Page
- Frimley Park Hospital NHS Trust, Camberley, United Kingdom
| | - S Fleming
- Barts & The London School of Medicine and Dentistry, London, United Kingdom
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Batchelor R, Thomas C, Gardiner BJ, Lee SJ, Fleming S, Wei A, Coutsouvelis J, Ananda-Rajah M. When Azoles Cannot Be Used: The Clinical Effectiveness of Intermittent Liposomal Amphotericin Prophylaxis in Hematology Patients. Open Forum Infect Dis 2021; 8:ofab113. [PMID: 34337090 PMCID: PMC8318248 DOI: 10.1093/ofid/ofab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin B (L-AMB) prophylaxis in a heterogenous group of hematology patients. Methods A retrospective cohort of all hematology patients who received a course of intravenous L-AMB, defined as 1 mg/kg thrice weekly from July 1, 2013 to June 30, 2018, were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation, and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n = 19 of 198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven BIFD occurred in 13 patients (6.6%, 13 of 198), including molds in 54% (n = 7) and non-albicans Candidemia in 46% (n = 6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukemia (6.8%) followed by acute lymphoblastic leukemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy, or anticancer drug-azole interactions (75% of courses) dominated by vincristine, or acute myeloid leukemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury, using a modified international definition, complicated 27% of courses but was not clinically significant, accounting for only 3.3% (9 of 273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help researchers find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios in which azoles are unsuitable, especially as targeted anticancer drugs increase in use.
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Affiliation(s)
- R Batchelor
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - C Thomas
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - B J Gardiner
- Department of Infectious Diseases Alfred Health Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - S J Lee
- Department of Infectious Diseases Alfred Health Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - S Fleming
- Australian Centre for Blood Diseases, Alfred Health Melbourne, Victoria, Australia.,Department of Haematology, Alfred Health Melbourne, Victoria, Australia
| | - A Wei
- Australian Centre for Blood Diseases, Alfred Health Melbourne, Victoria, Australia.,Department of Haematology, Alfred Health Melbourne, Victoria, Australia
| | - J Coutsouvelis
- Pharmacy Department, Alfred Health Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Monash University Parkville, Victoria, Australia
| | - M Ananda-Rajah
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Infectious Diseases Alfred Health Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
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10
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O'Connell JE, Schache AG, Fleming S, Shaw RJ. Virtual surgical planning in mandibular reconstruction using scapular free flaps: a technical note. Br J Oral Maxillofac Surg 2020; 59:724-725. [PMID: 34090733 DOI: 10.1016/j.bjoms.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- J E O'Connell
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, UK.
| | - A G Schache
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, UK; Department of Molecular and Clinical Cancer Medicine, Northwest Cancer Research Centre, University of Liverpool, Liverpool, UK
| | - S Fleming
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, UK
| | - R J Shaw
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, UK; Department of Molecular and Clinical Cancer Medicine, Northwest Cancer Research Centre, University of Liverpool, Liverpool, UK
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11
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Lindberg KG, Lindberg KG, Kinneberg KM, Lindberg KG, Batterson D, Bobb R, Boleszczuk P, Brudvig S, Bryant D, Bryce J, Buckner K, Bulthaus M, DeJesus J, Ellis K, Finkenbiner D, Fleming S, Follni-Lieder E, Harper C, Ihrke P, Johnson K, King J, Langridge M, Maycock L, McAteer L, McCann T, Otten N, Robbins R, Sass A, Saunders L, Schop R, Strand S, Tebay D, VanWinkle J, Wolowski C. Dry Rehydratable Film Method for Rapid Enumeration of Coliforms in Foods (3M™ Petrifilm™ Rapid Coliform Count Plate): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.1.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A rehydratable dry-film plating method for coliforms in foods, the 3M™ Petrifilm™ Rapid Coliform Count plate method, was compared with the U.S. Food and Drug Administration's Bacteriological Analytical Manual method for nondairy foods and the American Public Health Association's Standard Methods for the Examination of Dairy Products (SMEDP) method for dairy foods. Six food types, vanilla ice cream, cheddar cheese, fresh refrigerated uncooked pasta, wheat flour, prepared frozen macaroni and cheese, and frozen hash browns, were analyzed for coliforms by 11 collaborating laboratories. For each food product tested, the collaborators received 8 blind samples consisting of a control sample and 3 levels of inoculated sample, each in duplicate. The mean log counts for the methods were comparable. The repeatability and reproducibility variances of the Petrifilm Rapid Coliform Count method at 14 and 24 h were not significantly different from those of the standard methods.
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12
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Frazer JS, Barnes GE, Woodcock V, Flanagan E, Littlewood T, Stevens RJ, Fleming S, Ashdown HF. Variability in body temperature in healthy adults and in patients receiving chemotherapy: prospective observational cohort study. J Med Eng Technol 2019; 43:323-333. [PMID: 31578101 DOI: 10.1080/03091902.2019.1667446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Between-individual variability of body temperature has been little investigated, but is of clinical importance: for example, in detection of neutropenic sepsis during chemotherapy. We studied within-person and between-person variability in temperature in healthy adults and those receiving chemotherapy using a prospective observational design involving 29 healthy participants and 23 patients undergoing chemotherapy. Primary outcome was oral temperature. We calculated each patient's mean temperature, standard deviation within each patient (within-person variability), and between patients (between-person variability). Secondary analysis explored temperature changes in the three days before admission for neutropenic sepsis. 1,755 temperature readings were returned by healthy participants and 1,765 by chemotherapy patients. Mean participant temperature was 36.16 C (95% CI 36.07-36.26) in healthy participants and 36.32 C (95% CI 36.18-36.46) in chemotherapy patients. Healthy participant within-person variability was 0.40 C (95% CI 0.36-0.44) and between-person variability was 0.26 C (95% CI 0.16-0.35). Chemotherapy patient within-person variability was 0.39 C (95% CI 0.34-0.44) and between-person variability was 0.34 C (95% CI 0.26-0.48). Thus, use of a population mean rather than personalised baselines is probably sufficient for most clinical purposes as between-person variability is not large compared to within-person variability. Standardised guidance and provision of thermometers to patients might help to improve recording and guide management.
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Affiliation(s)
- J S Frazer
- Medical School, University of Oxford , Oxford , UK
| | - G E Barnes
- Medical School, University of Oxford , Oxford , UK
| | - V Woodcock
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust , Oxford , UK
| | - E Flanagan
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust , Oxford , UK
| | - T Littlewood
- Medical School, University of Oxford , Oxford , UK.,Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust , Oxford , UK
| | - R J Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford , UK
| | - S Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford , UK
| | - H F Ashdown
- Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford , UK
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13
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Loriot Y, Van Sanden S, Diels J, Rahhali N, Seshagiri D, Kowalski B, Fleming S, De Porre P, Siefker-Radtke AO. Erdafitinib (erda) versus available therapies in advanced urothelial cancer: A matching adjusted indirect comparison. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.025] [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: 11/14/2022] Open
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14
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Delahunt B, Srigley JR, Judge M, Amin M, Billis A, Camparo P, Fleming S, Griffiths D, Lopez-Beltran A, Martignoni G, Moch H, Nacey JN, Zhou M, Evans AJ. Dataset for the reporting of renal biopsy for tumour: recommendations from the International Collaboration on Cancer Reporting (ICCR). J Clin Pathol 2019; 72:573-578. [PMID: 31300532 DOI: 10.1136/jclinpath-2019-205959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/07/2019] [Revised: 06/06/2019] [Accepted: 06/19/2019] [Indexed: 11/04/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) has developed a suite of detailed datasets for international implementation. These datasets are based on the reporting protocols developed by the Royal College of Pathologists (UK), The Royal College of Pathologists of Australasia and the College of American Pathologists, with modifications undertaken by international expert groups appointed according to ICCR protocols. The dataset for the reporting of renal biopsy for tumour is designed to provide a structured reporting template containing minimum data recording key elements suitable for international use. In formulating the dataset, the ICCR panel incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the 2016 edition of the WHO Bluebook on tumours of the urinary and male genital systems. Reporting elements were divided into Required (Core) and Recommended (Non-core) components of the report. Required elements are as follows: specimen laterality, histological tumour type, WHO/ISUP histological tumour grade, sarcomatoid morphology, rhabdoid morphology, necrosis, lymphovascular invasion and coexisting pathology in non-neoplastic kidney. Recommended reporting elements are as follows: operative procedure, tumour site(s), histological tumour subtype and details of ancillary studies. In particular, it is noted that fluorescence in situ hybridisation studies may assist in diagnosing translocation renal cell carcinoma (RCC) and in distinguishing oncocytoma and eosinophilic chromophobe RCC. It is anticipated that the implementation of this dataset into routine clinical practice will facilitate uniformity of pathology reporting worldwide. This, in turn, should have a positive impact on patient treatment and the quality of demographic information held by cancer registries.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington Sch Med, Wellington, New Zealand
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Meagan Judge
- Royal College of Pathologists of Australasia, Surry Hills, New South Wales, Australia
| | - Mahul Amin
- Department of Pathology and Laboratory medicine, University of Tennessee Health Sciences, Memphis, Tennessee, USA
| | - Athanase Billis
- Department of Anatomic Pathology, Universidade Estadual de Campinas, Campinas, Brazil
| | - Philippe Camparo
- Service d'anatomie et cytologie pathologiques, Hopital Foch, Paris, France
| | - Stewart Fleming
- Department of Cellular and Molecular Pathology, University of Dundee, Dundee, UK
| | - David Griffiths
- Department of Pathology, University Hospital of Wales, Cardiff, UK
| | - Antonio Lopez-Beltran
- Department of Pathology and Surgery, Cordoba University Medical School, /Cordoba, Spain
| | - Guido Martignoni
- Anatomia Patologica, Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Holger Moch
- Department of Pathology, Institute for Surgical Pathology, University Hospital, Zurich, Switzerland
| | - John N Nacey
- Department of Surgery and Anaesthesia, Wellington Sch Med, Wellington, New Zealand
| | - Ming Zhou
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Andrew John Evans
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
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15
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Delahunt B, Srigley JR, Judge MJ, Amin MB, Billis A, Camparo P, Evans AJ, Fleming S, Griffiths DF, Lopez-Beltran A, Martignoni G, Moch H, Nacey JN, Zhou M. Data set for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2019; 74:377-390. [PMID: 30325065 DOI: 10.1111/his.13754] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
Abstract
AIMS The International Collaboration on Cancer Reporting (ICCR) has provided detailed data sets based upon the published reporting protocols of the Royal College of Pathologists, the Royal College of Pathologists of Australasia and the College of American Pathologists. METHODS AND RESULTS The data set for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use, and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the fourth edition of the World Health Organisation Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are required and recommended components of the report. Required elements are: specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co-existing pathology. Recommended reporting elements are: pre-operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). CONCLUSIONS It is anticipated that the implementation of this data set in routine clinical practice will inform patient treatment as well as provide standardised information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Meagan J Judge
- Royal College of Pathologists of Australasia, Sydney, Australia
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences, Memphis - Department of Urology, University of Tennessee Health Sciences, Memphis, TN, USA
| | - Athanase Billis
- Department of Anatomical Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Philippe Camparo
- Department of Pathology, Centre de Pathologie Amiens, Amiens, France
| | - Andrew J Evans
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Stewart Fleming
- Department of Cellular and Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee
| | - David F Griffiths
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | | | - Guido Martignoni
- Department of Pathology and Diagnostics, University of Verona, Verona - Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Holger Moch
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - John N Nacey
- Department of Surgery and Anaesthesia, Wellington School of Medicine and Health Sciences, Wellington, New Zealand
| | - Ming Zhou
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
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16
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Dahran N, Szewczyk-Bieda M, Vinnicombe S, Fleming S, Nabi G. Periprostatic fat adipokine expression is correlated with prostate cancer aggressiveness in men undergoing radical prostatectomy for clinically localized disease. BJU Int 2019; 123:985-994. [PMID: 29969844 DOI: 10.1111/bju.14469] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the relationship between periprostatic adipose tissue (PPAT) adipokine expression and prostate cancer (PCa) aggressiveness using both pathological features of radical prostatectomy (RP) and multiparametric magnetic resonance imaging ( MRI) variables. PATIENTS AND METHODS Sixty-nine men were recruited to assess immunohistochemical expression of tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) of periprostatic fat of RP specimens. Per cent immunopositivity was quantified on scanned slides using the Aperio Positive Pixel Count algorithm for PPAT TNFα, VEGF and androgen receptors. Periprostatic fat volume (PFV) was segmented on contiguous T1 -weighted axial MRI slices from the level of the prostate base to apex. PFV was normalized to prostate volume (PV) to account for variations in PV (normalized PFV = PFV/PV). MRI quantitative values (Kep , Ktrans and apparent diffusion coefficient) were measured from the PCa primary lesion using Olea Sphere software. Patients were stratified into three groups according to RP Gleason score (GS): ≤6, 7(3 + 4) and ≥7(4 + 3). RESULTS The mean rank of VEGF and TNFα was significantly different between the groups [H(2) = 11.038, P = 0.004] and [H(2) = 13.086, P = 0.001], respectively. Patients with stage pT3 had higher TNFα (18.2 ± 8.95) positivity than patients with stage pT2 (13.27 ± 10.66; t [67] = -2.03, P = 0.047). TNFα expression significantly correlated with Ktrans (ρ = 0.327, P = 0.023). TNFα (P = 0.043), and VEGF (P = 0.02) correlated with high grade PCa (GS ≥ 7) in RP specimens and also correlated significantly with upgrading of GS from biopsy to RP histology. CONCLUSIONS The expression levels of TNFα and VEGF on immunostaining significantly correlated with aggressivity of PCa. As biomarkers, these indicate the risk of having high grade PCa in men undergoing RP.
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Affiliation(s)
- Naief Dahran
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK.,Department of Anatomy, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Sarah Vinnicombe
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
| | - Stewart Fleming
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
| | - Ghulam Nabi
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
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17
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Kelly BD, Murphy R, Curley A, Duffy RM, Fleming S. Mental Incapacity for Treatment Decisions: Where do Doctors Stand? Ir Med J 2018; 111:833. [PMID: 30558406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- B D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland
| | - R Murphy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland
| | - A Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland
| | - R M Duffy
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, D07 YH5R, Ireland
| | - S Fleming
- Department of Medicine, Midland Regional Hospital, Dublin Road, Portlaoise, County Laois, R32 RW61, Ireland
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18
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Murphy R, Fleming S, Curley A, Duffy RM, Kelly BD. Who can decide? Prevalence of mental incapacity for treatment decisions in medical and surgical hospital inpatients in Ireland. QJM 2018; 111:881-885. [PMID: 30295869 DOI: 10.1093/qjmed/hcy219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of mental incapacity for treatment decisions among medical and surgical hospital inpatients is poorly understood or not known in many countries, including Ireland. AIM To assess the prevalence of mental incapacity in hospital inpatients in Ireland. DESIGN Cross-sectional observational study of mental incapacity for treatment decisions. METHODS We assessed mental capacity in 300 randomly selected hospital inpatients in 2 general hospitals in Dublin (urban) and Portlaoise (rural), in Ireland, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). RESULTS Mean MacCAT-T score was 14.80 (SD: 8.40) out of a possible maximum of 20 (with a higher score indicating greater mental capacity). Over one quarter of participants (27.7%; n = 83) lacked the mental capacity for treatment decisions; 1.7% (n = 5) had partial capacity and 70.7% (n = 212) had full capacity. Scores for each of the four sub-scales of the MacCAT-T were generally consistent across the four key areas of understanding, appreciation, reasoning and expressing a choice. CONCLUSIONS Mental incapacity for treatment decisions is common in medical and surgical hospital inpatients in Ireland. This issue both merits and requires greater attention in clinical practice, research and legislation.
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Affiliation(s)
- R Murphy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - S Fleming
- Department of Medicine, Midland Regional Hospital, Portlaoise, County Laois, Ireland
| | - A Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
- Department of Psychiatry, Crosslanes, Drogheda, County Louth, Ireland
| | - R M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - B D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
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19
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El-Mokadem I, Kidd T, Pratt N, Fleming S, Nabi G. Tumour suppressor gene (CDKNA2) status on chromosome 9p in resected renal tissue improves prognosis of localised kidney cancer. Oncotarget 2018; 7:73045-73054. [PMID: 27682877 PMCID: PMC5341962 DOI: 10.18632/oncotarget.12196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023] Open
Abstract
Background Genetic alterations on chromosome 9p, including inactivation of the tumour suppressor gene, CDKN2A, result in cellular proliferation and growth of tumours. Our aim was to use microsatellite analysis and fluorescence in situ hybridization (FISH) to characterise the architecture of this region. Results Seventy-five out of 77 clear cell renal cell cancers (tumour/normal pairs) were interpretable for LOH analysis on chromosome 9p (two tumours were excluded, as all five primers were uninformative). Twenty out of 75 (26.6%) tumours showed LOH in at least one of the five primers employed. Most allelic deletions were detected, telomeric to the CDKN2A region at D9S916, with 11 out of 52 informative tumours (21%) displaying LOH. The LOH in the coding region of CDKN2A, at D9S974 and D9S942, was associated with a higher pT-stage (p = 0.004) and metastasis (p = 0.006, both markers). The rate of chromosome 9p deletion in ccRCC was 44% (35/80 cases) according to FISH. Somatic copy number loss of chromosome 9p was associated with a larger tumour size (p = 0.002), higher pathological tumour stage (p = 0.021), presence of tumour necrosis (p = 0.019) and microvascular invasion (p = 0.032). The cases with copy number loss, loss of heterozygosity and copy number neutral (n = 42) were at a higher risk of cancer-specific death when compared to tumours in category D (n = 32) (Log-rank: p = 0.001). Seventeen patients with localised ccRCC developed recurrence, and fourteen of those showed either LOH or somatic copy number loss at CDKN2A (Log-rank: p = 0.005). Multivariate analysis showed that LOH or copy number loss at CDKN2A retained its independent prognostic effect, improving the predictive accuracy of stage and SSIGN score by concordance Index C from 0.823 to 0.878 (p = 0.001). Materials and Methods Cytogenetics data, microsatellite analysis and FISH were acquired for a cohort of patients undergoing resection for clinically localised renal cancer between January 2001 and December 2005. Five microsatellite markers (D9S916, D9S1814, D9S974, D9S942 and D9S171) assessed loss of heterogeneity (LOH) using DNA samples and in the same cohort FISH analysis was accomplished on tissue microarray slides. The FISH data were scored by two observers blinded to the histological data of the patients. Cytogenetic aberrations were correlated with histological and clinical outcomes by univariate and multivariate analyses using different prognostic models. Disease specific and recurrence free survival based on cytogenetic changes were assessed by Kaplan Meier methods. Conclusions A comprehensive cytogenetic analysis using microsatellite analysis and FISH of the CDKN2A region on chromosome 9p improves the predictive accuracy of known prognostic factors in clinically localised renal cell carcinoma undergoing surgical resection.
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Affiliation(s)
- Ismail El-Mokadem
- Academic Section of Urology, Division of Cancer Research, University of Dundee, Ninewells Hospital, DD1 9SY, Dundee, Scotland
| | - Thomas Kidd
- Department of Pathology, University of Dundee, Ninewells Hospital, DD1 9SY, Dundee, Scotland
| | - Norman Pratt
- Department of Cytogenetic, University of Dundee, Ninewells Hospital, DD1 9SY, Dundee, Scotland
| | - Stewart Fleming
- Department of Pathology, University of Dundee, Ninewells Hospital, DD1 9SY, Dundee, Scotland
| | - Ghulam Nabi
- Academic Section of Urology, Division of Cancer Research, University of Dundee, Ninewells Hospital, DD1 9SY, Dundee, Scotland
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20
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Buckley C, Nelson RJ, Mullins LJ, Sharp MGF, Fleming S, Kenyon CJ, Semprini S, Steppan D, Peti-Peterdi J, Kurtz A, Christian H, Mullins JJ. Phenotypic dissection of the mouse Ren1d knockout by complementation with human renin. J Biol Chem 2017; 293:1151-1162. [PMID: 29123029 PMCID: PMC5787795 DOI: 10.1074/jbc.ra117.000160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/03/2017] [Indexed: 11/08/2022] Open
Abstract
Normal renin synthesis and secretion is important for the maintenance of juxtaglomerular apparatus architecture. Mice lacking a functional Ren1d gene are devoid of renal juxtaglomerular cell granules and exhibit an altered macula densa morphology. Due to the species-specificity of renin activity, transgenic mice are ideal models for experimentally investigating and manipulating expression patterns of the human renin gene in a native cellular environment without confounding renin–angiotensin system interactions. A 55-kb transgene encompassing the human renin locus was crossed onto the mouse Ren1d-null background, restoring granulation in juxtaglomerular cells. Correct processing of human renin in dense core granules was confirmed by immunogold labeling. After stimulation of the renin–angiotensin system, juxtaglomerular cells contained rhomboid protogranules with paracrystalline contents, dilated rough endoplasmic reticulum, and electron-lucent granular structures. However, complementation of Ren1d−/− mice with human renin was unable to rescue the abnormality seen in macula densa structure. The juxtaglomerular apparatus was still able to respond to tubuloglomerular feedback in isolated perfused juxtaglomerular apparatus preparations, although minor differences in glomerular tuft contractility and macula densa cell calcium handling were observed. This study reveals that the human renin protein is able to complement the mouse Ren1d−/− non-granulated defect and suggests that granulopoiesis requires a structural motif that is conserved between the mouse Ren1d and human renin proteins. It also suggests that the altered macula densa phenotype is related to the activity of the renin-1d enzyme in a local juxtaglomerular renin–angiotensin system.
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Affiliation(s)
- Charlotte Buckley
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom,
| | - Robert J Nelson
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Linda J Mullins
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Matthew G F Sharp
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Stewart Fleming
- the University of Dundee, Ninewells Hospital Medical School, Dundee DD1 9SY, Scotland
| | - Christopher J Kenyon
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Sabrina Semprini
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Dominik Steppan
- the Physiologisches Institut der Universität Regensburg, Regensburg D-93053, Germany
| | - Janos Peti-Peterdi
- the Department of Physiology and Biophysics and Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, and
| | - Armin Kurtz
- the Physiologisches Institut der Universität Regensburg, Regensburg D-93053, Germany
| | - Helen Christian
- the Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3QX, United Kingdom
| | - John J Mullins
- From the University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom,
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Abdi AH, Luong C, Tsang T, Allan G, Nouranian S, Jue J, Hawley D, Fleming S, Gin K, Swift J, Rohling R, Abolmaesumi P. Correction to "Automatic Quality Assessment of Echocardiograms Using Convolutional Neural Networks: Feasibility on the Apical Four-Chamber View". IEEE Trans Med Imaging 2017; 36:1992. [PMID: 28866478 DOI: 10.1109/tmi.2017.2741762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the above paper [1], the first footnote should have indicated the following information: A. H. Abdi and C. Luong are joint first authors.
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Tenorio-Pearl JO, Herbschleb ED, Fleming S, Creatore C, Oda S, Milne WI, Chin AW. Corrigendum: Observation and coherent control of interface-induced electronic resonances in a field-effect transistor. Nat Mater 2017; 16:874. [PMID: 28748965 DOI: 10.1038/nmat4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Aird JJ, Nic An Riogh AU, Fleming S, Hislop RG, Sweeney P, Mayer N. Papillary Renal Cell Carcinoma With Osteosarcomatous Heterologous Differentiation: A Case Report With Molecular Genetic Analysis and Review of the Literature. Int J Surg Pathol 2017; 25:745-750. [PMID: 28669254 DOI: 10.1177/1066896917716772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcomatoid differentiation can occur in all subtypes of renal cell carcinoma (RCC). In rare cases, heterologous differentiation has been described. We present a case of heterologous osteosarcomatous differentiation in association with sarcomatoid papillary RCC including an analysis of chromosomal copy number alteration. This is the first case to identify heterologous differentiation in association with papillary RCC. The patient was a 70-year-old man who had a mass in the right kidney. Speckled calcification was seen on computed tomography scan. Histological assessment demonstrated papillary RCC merging with areas of sarcomatoid change and malignant bone formation simulating osteosarcoma. Cytogenetic evaluation demonstrated additional copies of chromosome 7 in both epithelial and osteosarcomatous components. A literature review identified 33 previous cases of heterologous differentiation in association with RCC. Of the 14 cases that reported an epithelial subtype, 13 cases were reported to be chromophobe RCC and 1 case was reported to be clear cell RCC.
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Affiliation(s)
| | | | | | | | | | - Nick Mayer
- 1 Cork University Hospital, Wilton, Cork, Ireland
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Rossi SH, Hsu R, Blick C, Goh V, Nathan P, Nicol D, Fleming S, Sweeting M, Wilson ECF, Stewart GD. Meta-analysis of the prevalence of renal cancer detected by abdominal ultrasonography. Br J Surg 2017; 104:648-659. [PMID: 28407225 DOI: 10.1002/bjs.10523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The potential for an ultrasound-based screening programme for renal cell carcinoma (RCC) to improve survival through early detection has been the subject of much debate. The prevalence of ultrasound-detected asymptomatic RCC is an important first step to establishing whether a screening programme may be feasible. METHODS A systematic search of MEDLINE and Embase was performed up to March 2016 to identify studies reporting the prevalence of renal masses and RCC. Two populations of patients were chosen: asymptomatic individuals undergoing screening ultrasonography and patients undergoing ultrasonography for abdominal symptoms not related to RCC. A random-effects meta-analysis was performed. Study quality was evaluated using a validated eight-point checklist. RESULTS Sixteen studies (413 551 patients) were included in the final analysis. The pooled prevalence of renal mass was 0·36 (95 per cent c.i. 0·23 to 0·52) per cent and the prevalence of histologically proven RCC was 0·10 (0·06 to 0·15) per cent. The prevalence of RCC was more than double in studies from Europe and North America than in those from Asia: 0·17 (0·09 to 0·27) versus 0·06 (0·03 to 0·09) per cent respectively. Data on 205 screen-detected RCCs showed that 84·4 per cent of tumours were stage T1-T2 N0, 13·7 per cent were T3-T4 N0, and only 2·0 per cent had positive nodes or metastases at diagnosis. CONCLUSION At least one RCC would be detected per 1000 individuals screened. The majority of tumours identified are early stage (T1-T2).
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Affiliation(s)
- S H Rossi
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - R Hsu
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - C Blick
- Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK
| | - V Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, and Department of Radiology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - P Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - D Nicol
- Department of Urology, Royal Marsden Hospital, and Institute of Cancer Research, London, UK
| | - S Fleming
- Centre for Forensic and Legal Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - M Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - E C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, and Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - G D Stewart
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
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Tenorio-Pearl JO, Herbschleb ED, Fleming S, Creatore C, Oda S, Milne WI, Chin AW. Observation and coherent control of interface-induced electronic resonances in a field-effect transistor. Nat Mater 2017; 16:208-213. [PMID: 27643731 DOI: 10.1038/nmat4754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/15/2016] [Indexed: 06/06/2023]
Abstract
Electronic defect states at material interfaces provide highly deleterious sources of noise in solid-state nanostructures, and even a single trapped charge can qualitatively alter the properties of short one-dimensional nanowire field-effect transistors (FET) and quantum bit (qubit) devices. Understanding the dynamics of trapped charge is thus essential for future nanotechnologies, but their direct detection and manipulation is rather challenging. Here, a transistor-based set-up is used to create and probe individual electronic defect states that can be coherently driven with microwave (MW) pulses. Strikingly, we resolve a large number of very high quality (Q ∼ 1 × 105) resonances in the transistor current as a function of MW frequency and demonstrate both long decoherence times (∼1 μs-40 μs) and coherent control of the defect-induced dynamics. Efficiently characterizing over 800 individually addressable resonances across two separate defect-hosting materials, we propose that their properties are consistent with weakly driven two-level systems.
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Affiliation(s)
- J O Tenorio-Pearl
- Quantum Nanoelectronics Research Center, Tokyo Institute of Technology, Tokyo 152-8552, Japan
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge CB3 0FA, UK
| | - E D Herbschleb
- Quantum Nanoelectronics Research Center, Tokyo Institute of Technology, Tokyo 152-8552, Japan
| | - S Fleming
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge CB3 0FA, UK
| | - C Creatore
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK
| | - S Oda
- Quantum Nanoelectronics Research Center, Tokyo Institute of Technology, Tokyo 152-8552, Japan
| | - W I Milne
- Quantum Nanoelectronics Research Center, Tokyo Institute of Technology, Tokyo 152-8552, Japan
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge CB3 0FA, UK
| | - A W Chin
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK
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McQuarrie EP, Mackinnon B, Bell S, Fleming S, McNeice V, Stewart G, Fox JG, Geddes CC. Multiple socioeconomic deprivation and impact on survival in patients with primary glomerulonephritis. Clin Kidney J 2017. [PMID: 28639628 PMCID: PMC5469556 DOI: 10.1093/ckj/sfw127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 12/19/2022] Open
Abstract
Background: The impact of multiple socio-economic deprivation on patient outcomes in primary renal diseases is unknown. We aimed to assess whether risk of death or requiring renal replacement therapy (RRT) in patients with primary glomerulonephritis (GN) was higher in patients living in an area of multiple socio-economic deprivation. Methods: Patients undergoing native renal biopsy between 2000 and 2014 were identified. Baseline demographics, postcode at time of biopsy, follow-up blood pressure, proteinuria and time to death or RRT were recorded. The Scottish Index of Multiple Deprivation (SIMD) is a multidimensional model used to measure deprivation based on postcode. Using SIMD, patients were separated into tertiles of deprivation. Results: A total of 797 patients were included, 64.2% were male with mean age of 54.1 (standard deviation 17.0) years. Median follow-up was 6.3 (interquartile range 3.7–9.4) years during which 174 patients required RRT and 185 patients died. Patients in the most deprived tertile of deprivation were significantly more likely to die than those in the least deprived tertile [hazard ratio (HR) 2.2, P < 0.001], independent of age, baseline serum creatinine and blood pressure. They were not more likely to require RRT (P = 0.22). The increased mortality risk in the most deprived tertile was not uniform across primary renal diseases, with the association being most marked in focal segmental glomerulosclerosis (HR 7.4) and IgA nephropathy (HR 2.7) and absent in membranous nephropathy. Conclusion: We have demonstrated a significant independent 2-fold increased risk of death in patients with primary GN who live in an area of multiple socio-economic deprivation at the time of diagnosis as compared with those living in less deprived areas.
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Affiliation(s)
- Emily P McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Mackinnon
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | | | | | - Jonathan G Fox
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin C Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Kidder D, Bray SE, Fleming S. Differences in the frequency of macrophage and T cell markers between focal and crescentic classes of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. J Nephropathol 2016; 6:97-102. [PMID: 28491860 PMCID: PMC5418077 DOI: 10.15171/jnp.2017.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/07/2016] [Accepted: 11/20/2016] [Indexed: 11/11/2022] Open
Abstract
Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) can be classified into; focal, crescentic, mixed and sclerotic classes. Macrophages and T lymphocytes are key players in mediating renal injury. The frequency of macrophage and T lymphocytes in different histological classes is unclear. Objectives We examined the frequency of macrophage and T lymphocyte markers in AAGN and assessed their correlation with renal function at presentation. Patients and Methods Renal biopsies from 38 patients were included in immunohistochemistry analysis of macrophages (CD68, sialoadhesin [Sn] and mannose receptor [MR]) and T cells (CD4 and CD8) markers. The frequency of these markers in glomerular, periglomerular and interstitial compartments were measured in a blinded fashion. Biopsies were allocated a histological class of focal, crescentic, mixed or sclerotic. Scores were then matched to histological class and assessed for correlation with renal function. Results The biopsies were crescentic 19 (50%), focal 10 (26.3%), mixed 6 (15.7%) and sclerotic 3 (8%). Interstitial CD68+ macrophages and CD8+ T lymphocytes showed best correlation with renal function at the time of presentation. CD68+ macrophages were significantly increased in crescentic compared to focal AAGN. MR+ macrophages, CD4 and CD8 T cells were also elevated in the interstitium of crescentic compared to focal group. Conclusions In this study interstitial CD68 and CD8 showed the highest association with the renal function at presentation. Differences in the cellular infiltrate between focal and crescentic AAGN were related to CD68+ macrophages and to interstitial MR+ macrophages and T lymphocytes. Further studies are needed to assess these differences across all four histological categories.
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Affiliation(s)
- Dana Kidder
- Renal Unit, Aberdeen, Royal Infirmary, Aberdeen, Scotland, AB25 2ZN
| | - Susan E Bray
- Tayside Tissue Bank, University of Dundee Medical School, Ninewells Hospital, Dundee, Scotland, DD1 9SY
| | - Stewart Fleming
- Department of Pathology, University of Dundee Medical School, Ninewells Hospital, Dundee, Scotland, DD1 9SY
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Jakes A, Jani P, Menon M, Adams K, Edey M, Fleming S, Bhandari S. Renal Squamous Cell Carcinoma of a Native Kidney After Renal Transplant: A Case Report. Transplant Proc 2016; 48:259-61. [PMID: 26915879 DOI: 10.1016/j.transproceed.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 12/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Renal squamous cell carcinoma is a rare primary tumor of the kidney that rapidly invades local structures and has a poor prognosis. Presentation is usually nonspecific and is associated with renal stone disease and chronic infection. Immunosuppressed renal transplant recipients are more likely to develop a malignancy than the general population. Squamous cell carcinoma of the kidney in the context of a renal transplant and long-term immunosuppression has not previously been described in the literature. CASE REPORT A 46-year-old white man with previous renal stones and recurrent urinary infections underwent a right nephrectomy and subsequent renal transplantation owing to failure of the remaining kidney. Five years posttransplant, an abdominal ultrasound scan was performed owing to recurrent urinary infections and ongoing pyuria. This was reported as normal, but he later developed a discharging sinus in his left flank. A computed tomography (CT) scan revealed a tracking perinephric abscess with an associated cystic lesion of the left kidney. A left nephrectomy was performed and histologic examination suggested an invasive squamous cell carcinoma of the renal pelvis. The patient later required major surgery for chronic infection, and further imaging revealed metastatic disease, resulting in the decision to manage palliatively. CONCLUSION Given the nonspecific nature of the symptoms and the poor prognosis, health care professionals should have a lower threshold for diagnostic imaging in these patients. Abdominal ultrasonography was unhelpful and only a later CT scan revealed the underlying malignancy. This should be expedited if there is a persistent abnormality on urinalysis. Once diagnosed, a change in immunosuppressant regime to include sirolimus should be considered.
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Affiliation(s)
- A Jakes
- Renal Unit, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - P Jani
- Hull-York Medical School, University of Hull, Hull, UK
| | - M Menon
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Adams
- Department of Infection & Tropical Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, UK
| | - M Edey
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK
| | - S Fleming
- Cellular and Molecular Pathology, Ninewells Hospital, University of Dundee, Dundee, UK
| | - S Bhandari
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK.
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Lee MJ, Bhangu A, Blencowe NS, Nepogodiev D, Gokani VJ, Harries RL, Akinfala M, Ali O, Allum W, Bosanquet D, Boyce K, Bradburn M, Chapman S, Christopher E, Coulter I, Dean B, Dickfos M, El Boghdady M, Elmasry M, Fleming S, Glasbey J, Healy C, Kasivisvanathan V, Khan K, Kolias A, Lee S, Morton D, O'Beirne J, Sinclair P, Sutton P. Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group. Int J Surg 2016; 36 Suppl 1:S24-S30. [DOI: 10.1016/j.ijsu.2016.08.236] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/20/2016] [Indexed: 10/21/2022]
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Ramaswamy L, Velraja S, Escalante G, Harvey P, Alencar M, Haddock B, Harvey P, Escalante G, Alencar M, Haddock B, Durkalec-Michalski K, Jeszka J, Zawieja B, Podgórski T, Trussardi Fayh AP, Okano AH, de Jesus Ferreira AM, Jäger R, Purpura M, Harris RC, Krause MM, Lavanger KA, Allen NO, Lieb AE, Mullen KA, Eckerson JM, Lavanger KA, Krause MM, Allen NO, Lieb AE, Mullen KA, Eckerson JM, Morales E, Forsse J, Andre T, McKinley S, Hwang P, Tinsley G, Spillane M, Grandjean P, Willoughby D, Jagim A, Wright G, Kisiolek J, Meinking M, Ochsenwald J, Andre M, Jones MT, Oliver JM, Ferreira VA, de Souza DC, dos Santos VOA, Browne RAV, Costa EC, Fayh APT, Mathews ST, Bishop HD, Bowen CR, Liang Y, West EA, Rogers RR, Marshall MR, Petrella JK, Holland AM, Kephart WC, Mumford PW, Mobley CB, Lowery RP, Wilson JM, Roberts MD, Trexler ET, Hirsch KR, Campbell BI, Mock MG, Smith-Ryan AE, Zemek K, Johnston C, Mobley CB, Mumford PW, Pascoe DD, Lockwood CM, Miller ME, Roberts MD, Sanders GJ, Peveler W, Warning B, Peacock CA, Kephart WC, Mumford PW, Lowery RP, Roberts MD, Wilson JM, Sandler D, Ojalvo SP, Komorowski J, Campbell BI, Aguilar D, Vargas A, Conlin L, Sanders A, Fink-Irizarry P, Norton L, Perry R, McCallum R, Wynn MR, Lenton J, Campbell BI, Gai C, Donelson S, Best S, Bove D, Couvillion K, Dolan J, Xing D, Chernesky K, Pawela M, Toledo AD, Jimenez R, Rabideau M, Walker A, Pellegrino J, Hofacker M, McFadden B, Conway S, Ordway C, Sanders D, Monaco R, Fragala MS, Arent SM, Stone JD, Kreutzer A, Oliver JM, Kisiolek J, Jagim AR, Hofacker M, Walker A, Pellegrino J, Rabideau M, McFadden B, Conway S, Sanders D, Ordway C, Monaco R, Fragala MS, Arent SM, Tok O, Pellegrino JK, Walker AJ, Sanders DJ, McFadden BA, Rabideau MM, Conway SP, Ordway CE, Bello M, Hofacker ML, Mackowski NS, Poyssick AJ, Capone E, Monaco RM, Fragala MS, Arent SM, Mumford PW, Holland AM, Kephart WC, Lowery RP, Mobley CB, Patel RK, Newton A, Beck DT, Roberts MD, Wilson JM, Young KC, Silver T, Ellerbroek A, Buehn R, Vargas L, Tamayo A, Peacock C, Antonio J, Ellerbroek A, Silver T, Buehn R, Vargas L, Tamayo A, Peacock C, Antonio J, Pollock A, Ellerbroek A, Silver T, Peacock C, Antonio J, Kreutzer A, Zavala P, Fleming S, Jones M, Oliver JM, Jagim A, Haun CT, Mumford PW, Hyde PN, Fairman CM, Kephart WC, Beck DT, Moon JR, Roberts MD, Kendall KL, Young KC, Hudson GM, Hannings T, Sprow K, DiPietro L, Kalman D, Ojalvo SP, Komorowski J, Zavala P, Fleming S, Jones M, Oliver J, Jagim A, Wallace B, Bergstrom H, Wallace K, Monsalves-Alvarez M, Oyharçabal S, Espinoza V, VanDusseldorp TA, Escobar KA, Johnson KE, Cole N, Moriarty T, Stratton M, Endito MR, Mermier CM, Kerksick CM, Romero MA, Mobley CB, Linden M, Meers GME, Rector RS, Roberts MD, Gills JL, Lu H, Parker K, Dobbins C, Guillory JN, Romer B, Szymanski D, Glenn J, Newmire DE, Rivas E, Deemer SE, Wildman R, Ben-Ezra V, Kerksick C, Gieske B, Stecker R, Smith C, Witherbee K, Lane MT, Byrd MT, Bell Z, Frith E, Lane LMC, Lane MT, Byrd MT, Bell Z, Frith E, Lane LMC, Peacock CA, Silver TA, Colas M, Mena M, Rodriguez W, Sanders GJ, Antonio J, Vansickle A, DiFiore B, Stepp S, Slack G, Smith B, Ruffner K, Mendel R, Lowery L, Hirsch KR, Mock MG, Blue MMN, Trexler ET, Roelofs EJ, Smith-Ryan AE, Conlin L, Aguilar D, Campbell BI, Norton L, Coles K, Trexler ET, Martinez N, Joy JM, Vogel RM, Hoover TH, Broughton KS, Dalton R, Sowinski R, Grubic T, Collins PB, Colletta A, Reyes A, Sanchez B, Kozehchain M, Jung YP, Rasmussen C, Murano P, Earnest CP, Greenwood M, Kreider RB, Grubic T, Dalton R, Sowinski R, Collins PB, Colletta A, Reyes A, Sanchez B, Kozehchain M, Jung YP, Rasmussen C, Murano P, Earnest CP, Greenwood M, Kreider RB, Sowinski R, Dalton R, Grubic T, Collins PB, Colletta A, Reyes A, Sanchez B, Kozehchain M, Jung YP, Rasmussen C, Murano P, Earnest CP, Greenwood M, Kreider RB, Durkalec-Michalski K, Jeszka J, Podgórski T, Kerksick C, Gieske B, Stecker R, Smith C, Witherbee K, Urbina S, Santos E, Villa K, Olivencia A, Bennett H, Lara M, Foster C, Wilborn C, Taylor L, Cholewa JM, Hewins A, Gallo S, Micensky A, de Angelis C, Carney C, Campbell B, Conlin L, Norton L, Rossi F, Koozehchian MS, Collins PB, Sowinski R, Grubic T, Dalton R, O’Connor A, Shin SY, Jung YP, Sanchez BK, Coletta A, Cho M, Reyes A, Rasmussen C, Earnest CP, Murano PS, Greenwood M, Kreider RB. Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo. J Int Soc Sports Nutr 2016. [PMCID: PMC5025820 DOI: 10.1186/s12970-016-0144-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
P1 Impact of antioxidant-enriched nutrient bar supplementation on the serum antioxidant markers and physical fitness components of track and field athletes Lalitha Ramaswamy, Supriya Velraja P2 The effects of phosphatidic acid supplementation on fitness levels in resistance trained women Guillermo Escalante, Phil Harvey, Michelle Alencar, Bryan Haddock P3 The effects of phosphatidic acid supplementation on cardiovascular risk factors in resistance trained men Phil Harvey, Guillermo Escalante, Michelle Alencar, Bryan Haddock P4 The efficacy of sodium bicarbonate supplementation on physical capacity and selected biochemical markers in elite wrestlers Krzysztof Durkalec-Michalski, Jan Jeszka, Bogna Zawieja, Tomasz Podgórski P5 Effects of different nutritional strategies in hydration and physical performance in healthy well-trained males Ana Paula Trussardi Fayh, Alexandre Hideki Okano, Amanda Maria de Jesus Ferreira P6 Reduction of plasma creatine concentrations as an indicator of improved bioavailability Ralf Jäger, Martin Purpura, Roger C Harris P7 Effect of three different breakfast meals on energy intake and nutritional status in college-age women Molly M. Krause, Kiley A. Lavanger, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson P8 Accuracy of the ASA24® Dietary Recall system for assessing actual dietary intake in normal weight college-age women. Kiley A. Lavanger, Molly M. Krause, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson P9 β-aminoisobutyric acid does not regulate exercise induced UCP-3 expression in skeletal muscle Elisa Morales, Jeffrey Forsse, Thomas Andre, Sarah McKinley, Paul Hwang, Grant Tinsley, Mike Spillane, Peter Grandjean, Darryn Willoughby P10 The ability of collegiate football athletes to adhere to sport-specific nutritional recommendations A. Jagim, G. Wright, J. Kisiolek, M. Meinking, J. Ochsenwald, M. Andre, M.T. Jones, J. M. Oliver P11 A single session of low-volume high intensity interval exercise improves appetite regulation in overweight men Victor Araújo Ferreira, Daniel Costa de Souza, Victor Oliveira Albuquerque dos Santos, Rodrigo Alberto Vieira Browne, Eduardo Caldas Costa, Ana Paula Trussardi Fayh P12 Acute effects of oral peppermint oil ingestion on exercise performance in moderately-active college students Suresh T. Mathews, Haley D. Bishop, Clara R. Bowen, Yishan Liang, Emily A. West, Rebecca R. Rogers, Mallory R. Marshall, John K. Petrella P13 Associations in body fat and liver triglyceride content with serum health markers in sedentary and exercised rats fed a ketogenic diet, Western diet or standard chow over a 6-week period A. Maleah Holland, Wesley C. Kephart, Petey W. Mumford, C. Brooks Mobley, Ryan P. Lowery, Jacob M. Wilson, Michael D. Roberts P14 Physiological changes following competition in male and female physique athletes: A pilot study Eric T. Trexler, Katie R. Hirsch, Bill I. Campbell, Meredith G. Mock, Abbie E. Smith-Ryan P15 Relationship between cognition and hydration status in college students at a large Southwestern university Kate Zemek, Carol Johnston P16 Whey protein-derived exosomes increase protein synthesis in C2C12 myotubes C. Brooks Mobley, Petey W. Mumford, David D. Pascoe, Christopher M. Lockwood, Michael E. Miller, Michael D. Roberts P17 The effect of three different energy drinks on 1.5-mile running performance, oxygen consumption, and perceived exertion Gabriel J. Sanders, Willard Peveler, Brooke Warning, Corey A. Peacock P18 The Ketogenic diet improves rotarod performance in young and older rats Wesley C. Kephart, Petey W. Mumford, Ryan P. Lowery, Michael D. Roberts, Jacob M. Wilson P19 Absorption of bonded arginine silicate compared to individual arginine and silicon components David Sandler, Sara Perez Ojalvo, James Komorowski P20 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on body composition in aspiring female physique athletes engaging in an 8-week resistance training program Bill I. Campbell, Danielle Aguilar, Andres Vargas, Laurin Conlin, Amey Sanders, Paola Fink-Irizarry, Layne Norton, Ross Perry, Ryley McCallum, Matthew R. Wynn, Jack Lenton P21 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on maximal strength in aspiring female physique athletes engaging in an 8-week resistance training program Bill I. Campbell, Chris Gai, Seth Donelson, Shiva Best, Daniel Bove, Kaylee Couvillion, Jeff Dolan, Dante Xing, Kyshia Chernesky, Michael Pawela, Andres D. Toledo, Rachel Jimenez P22 Monitoring of female collegiate athletes over a competitive season reveals changes in nutritional biomarkers M. Rabideau, A. Walker, J. Pellegrino, M. Hofacker, B. McFadden, S. Conway, C. Ordway, D. Sanders, R. Monaco, M. S. Fragala, S. M. Arent P23 Comparison of prediction equations to indirect calorimetry in men and women athletes Jason D. Stone, Andreas Kreutzer, Jonathan M. Oliver, Jacob Kisiolek, Andrew R. Jagim P24 Regional variations in sweat-based electrolyte loss and changes in plasma electrolyte content in Division I female athletes over the course of a competitive season M. Hofacker, A. Walker, J. Pellegrino, M. Rabideau, B. McFadden, S. Conway, D. Sanders, C. Ordway, R. Monaco, M. S. Fragala, S. M. Arent P25 In-season changes in plasma amino acid levels in Division I NCAA female athletes Ozlem Tok, Joseph K. Pellegrino, Alan J. Walker, David J. Sanders, Bridget A. McFadden, Meaghan M. Rabideau, Sean P. Conway, Chris E. Ordway, Marissa Bello, Morgan L. Hofacker, Nick S. Mackowski, Anthony J. Poyssick, Eddie Capone, Robert M. Monaco, Maren S. Fragala, Shawn M. Arent P26 Effects of a ketogenic diet with exercise on serum markers of bone metabolism, IGF-1 and femoral bone mass in rats Petey W. Mumford, A. Maleah Holland, Wesley C. Kephart, Ryan P. Lowery, C. Brooks Mobley, Romil K. Patel, Annie Newton, Darren T. Beck, Michael D. Roberts, Jacob M. Wilson, Kaelin C. Young P27 Casein supplementation in trained men and women: morning versus evening Tobin Silver, Anya Ellerbroek, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio P28 A high protein diet has no harmful effects: a one-year crossover study in resistance-trained males Anya Ellerbroek, Tobin Silver, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio P29 SUP (Stand-up Paddling) athletes: nutritional intake and body composition Adam Pollock, Anya Ellerbroek, Tobin Silver, Corey Peacock, Jose Antonio P30 The effects of 8 weeks of colostrum and bio-active peptide supplementation on body composition in recreational male weight lifters A. Kreutzer, P. Zavala, S. Fleming, M. Jones, J. M. Oliver, A. Jagim P31 Effects of a Popular Women’s Thermogenic Supplement During an Energy-Restricted High Protein Diet on Changes in Body Composition and Clinical Safety Markers Cody T. Haun, Petey W. Mumford, Parker N. Hyde, Ciaran M. Fairman, Wesley C. Kephart, Darren T. Beck, Jordan R. Moon, Michael D. Roberts, Kristina L. Kendall, Kaelin C. Young P32 Three days of caffeine consumption following caffeine withdrawal yields small strength increase in knee flexors Geoffrey M Hudson, Tara Hannings, Kyle Sprow, Loretta DiPietro P33 Comparison of cellular nitric oxide production from various sports nutrition ingredients Doug Kalman, Sara Perez Ojalvo, James Komorowski P34 The effects of 8 weeks of bio-active peptide supplementation on training adaptations in recreational male weight lifters P. Zavala, S. Fleming, M. Jones, J. Oliver, A. Jagim P35 Effects of MusclePharm Assault BlackTM on lower extremity spinal excitability and postactivation potentiation: A pilot study Brian Wallace, Haley Bergstrom, Kelly Wallace P36 Effects of four weeks of Ketogenic Diet alone and combined with High intensity Interval Training or Continuous-Moderate intensity on body composition, lipid profile and physical performance on healthy males Matias Monsalves-Alvarez, Sebastian Oyharçabal, Victoria Espinoza P37 Effect of branched-chain amino acid supplementation on creatine kinase, muscular performance, and perceived muscle soreness following acute eccentric exercise Trisha A. VanDusseldorp, Kurt A. Escobar, Kelly E. Johnson, Nathan Cole, Terence Moriarty, Matthew Stratton, Marvin R. Endito, Christine M. Mermier, Chad M. Kerksick P38 Effects of endurance training on markers of ribosome biogenesis in rodents fed a high fat diet Matthew A. Romero, C. Brooks Mobley, Melissa Linden, Grace Margaret-Eleanor Meers, R. Scott Rector, Michael D. Roberts P39 The effects of acute citrulline-malate on lower-body isokinetic performance in recreationally active individuals Joshua L Gills, Hocheng Lu, Kimberly Parker, Chris Dobbins, Joshua N Guillory, Braden Romer, David Szymanski, Jordan Glenn P40 The effect pre-ingested L-isoleucine and L-leucine on blood glucose responses and glycemic hormones in healthy inactive adults: Preliminary data. Daniel E. Newmire, Eric Rivas, Sarah E. Deemer, Robert Wildman, Victor Ben-Ezra P41 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise? C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee P42 Effects of a pre-workout supplement on peak power and power maintenance during lower and upper body testing Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane P43 Effects of a pre-workout supplement on peak power production during lower and upper body testing in college-age females Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane P44 A comparison of whey versus casein protein supplementation on resting metabolic rate and body composition: a pilot study Corey A. Peacock, Tobin A. Silver, Megan Colas, Mauricio Mena, Winter Rodriguez, Gabriel J. Sanders, Jose Antonio P45 A novel mixed-tocotrienol intervention enhances recovery after eccentric exercise: preliminary findings Andrea Vansickle, Brittany DiFiore, Stephanie Stepp, Grant Slack, Bridget Smith, Kayla Ruffner, Ronald Mendel, Lonnie Lowery P46 The effects of post-exercise ingestion of a high molecular weight glucose on cycle performance in female cyclists Katie R. Hirsch, Meredith G. Mock, Malia M.N. Blue, Eric T. Trexler, Erica J. Roelofs, Abbie E. Smith-Ryan P47 Inclusive vs. exclusive dieting and the effects on body composition in resistance trained individuals Laurin Conlin, Danielle Aguilar, Bill I. Campbell, Layne Norton, Katie Coles, Eric T. Trexler, Nic Martinez P48 A whey protein hydrolysate may positively augment resting metabolism compared to intact whey protein Jordan M. Joy, Roxanne M. Vogel, Thomas H. Hoover, K. Shane Broughton P49 Seven days of high and low dose creatine nitrate supplementation I: hepatorenal, glucose and muscle enzyme function R Dalton, R Sowinski, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider P50 Seven days of high and low dose creatine nitrate supplementation II: performance T Grubic, R Dalton, R Sowinski, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider P51 Seven days of high and low dose creatine nitrate supplementation III: hemodynamics R Sowinski, R Dalton, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider P52 The efficacy of a β-hydroxy-β-methylbutyrate supplementation on physical capacity, body composition and biochemical markers in highly-trained combat sports athletes Krzysztof Durkalec-Michalski, Jan Jeszka, Tomasz Podgórski P53 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise? C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee P54 Effects of 30 days of Cleanse™ supplementation on measure of body composition, waist circumference, and markers of gastrointestinal distress in females Stacie Urbina, Emily Santos, Katelyn Villa, Alyssa Olivencia, Haley Bennett, Marissa Lara, Cliffa Foster, Colin Wilborn, Lem Taylor P55 The effects of moderate- versus high-load training on body composition, muscle growth, and performance in college aged females Jason M Cholewa, Amy Hewins, Samantha Gallo, Ashley Micensky, Christian De Angelis, Christopher Carney, Bill Campbell, Laurin Conlin, Layne Norton, Fabricio Rossi P56 Effect of a multi-ingredient preworkout supplement on cognitive function and perceptions of readiness to perform MS Koozehchian, PB Collins, R Sowinski, T Grubic, R Dalton, A O’Connor, SY Shin, Y Peter Jung, BK Sanchez, A Coletta, M Cho, A Reyes, C Rasmussen, CP Earnest, PS Murano, M Greenwood, RB Kreider
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Yorke J, Fleming S, Shuldham C, Rao H, Smith HE. Nonpharmacological interventions aimed at modifying health and behavioural outcomes for adults with asthma: a critical review. Clin Exp Allergy 2016; 45:1750-64. [PMID: 25675860 DOI: 10.1111/cea.12511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence suggests that living with asthma is linked with psychological and behavioural factors including self-management and treatment adherence, and therefore, there is a reasonable hypothesis that nonpharmacological treatments may improve health outcomes in people living with this condition. A systematic review of randomized controlled trials (RCTs) of nonpharmacological interventions for adults with asthma was designed. Databases searched included The Cochrane Airways Group Register of trials, CENTRAL and Psychinfo. The literature search was conducted until May 2014. Twenty-three studies met the inclusion criteria and were organized into four groups: relaxation-based therapies (n = 9); mindfulness (n = 1), biofeedback techniques (n = 3); cognitive behavioural therapies (CBT) (n = 5); and multicomponent interventions (n = 5). A variety of outcome measures were used, even when trials belonged to the same grouping, which limited the ability to conduct meaningful meta-analyses. Deficiencies in the current evidence base, notably trial heterogeneity, means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited. Relaxation and CBT, however, appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes, and lung function (relaxation only). Future trials should be informed by previous work to harmonize the interventions under study and outcome measures used to determine their effectiveness; only then will meaningful meta-analyses inform clinical practice.
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Affiliation(s)
- J Yorke
- Nursing, University of Manchester, Manchester, UK
| | - S Fleming
- Nursing Research, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - C Shuldham
- Nursing and Quality, Royal Brompton and Harefield Foundation Trust, London, UK
| | - H Rao
- Public Health and Primary Care, University of Brighton, Brighton, UK
| | - H E Smith
- Public Health and Primary Care, University of Brighton, Brighton, UK
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El-Mokadem I, Lim A, Kidd T, Garret K, Pratt N, Batty D, Fleming S, Nabi G. Microsatellite alteration and immunohistochemical expression profile of chromosome 9p21 in patients with sporadic renal cell carcinoma following surgical resection. BMC Cancer 2016; 16:546. [PMID: 27465101 PMCID: PMC4963937 DOI: 10.1186/s12885-016-2514-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/27/2016] [Indexed: 11/20/2022] Open
Abstract
Background Long-term prognostic significance of loss of heterozygosity on chromosome 9p21 for localized renal cell carcinoma following surgery remains unreported. The study assessed the frequency of deletions of different loci of chromosome 9p along with immunohistochemical profile of proteins in surgically resected renal cancer tissue and correlated this with long-term outcomes. Methods DNA was extracted from renal tumours and corresponding normal kidney tissues in prospectively collected samples of 108 patients who underwent surgical resection for clinically localized disease between January 2001 and December 2005, providing a minimum of 9 years follow-up for each participant. After checking quality of DNA, amplified by PCR, loss of heterozygosity (LOH) on chromosome 9p was assessed using 6 microsatellite markers in 77 clear cell carcinoma. Only 5 of the markers showed LOH (D9S1814, D9S916, D9S974, D9S942, and D9S171). Protein expression of p15(INK4b), p16(INK4a), p14(ARF), CAIX, and adipose related protein (ADFP) were demonstrated by immunostaining in normal and cancer tissues. Loss of heterozygosity for microsatellite analysis was correlated with tumour characteristics, recurrence free, cancer specific, and overall survival, including significance of immunohistochemical profile of protein expressions. Results The main deletion was found at loci telomeric to CDKN2A region at D9S916. There was a significant correlation between frequency of LOH stage (p = 0.005) and metastases (p = 0.006) suggesting a higher LOH for advanced and aggressive renal cell carcinoma. Most commonly observed LOH in the 3 markers: D9S916, D9S974, and D9S942 were associated with poor survival, and were statistically significant on multivariate analysis. Immunohistochemical expression of p14, p15, and p16 proteins were either low or absent in cancer tissue compared to normal. Conclusions Loss of heterozygosity of p921 chromosome is associated with aggressive tumours, and predicts cancer specific or recurrence free survival on long-term follow-up. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2514-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ismail El-Mokadem
- Academic Section of Urology, Division of Cancer Research, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Alison Lim
- Academic Section of Urology, Division of Cancer Research, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Thomas Kidd
- Department of Pathology, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Katherine Garret
- Department of Pathology, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Norman Pratt
- Department of Cytogenetic, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - David Batty
- Department of Cytogenetic, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Stewart Fleming
- Department of Pathology, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Ghulam Nabi
- Academic Section of Urology, Division of Cancer Research, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK.
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Domanski K, Kleinschmidt K, Schulte JM, Fleming S, Frazee C, Menendez A, Tavakoli K. Two cases of intoxication with new synthetic opioid, U-47700. Clin Toxicol (Phila) 2016; 55:46-50. [DOI: 10.1080/15563650.2016.1209763] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. Domanski
- North Texas Poison Control Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - K.C. Kleinschmidt
- North Texas Poison Control Center, Parkland Health and Hospital System, Dallas, TX, USA
- UT Southwestern Medical Center, Dallas, TX, USA
| | - J. M. Schulte
- North Texas Poison Control Center, Parkland Health and Hospital System, Dallas, TX, USA
| | | | - C. Frazee
- Children’s Mercy Hospital, Kansas City, MO, USA
| | - A. Menendez
- North Texas Poison Control Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - K. Tavakoli
- North Texas Poison Control Center, Parkland Health and Hospital System, Dallas, TX, USA
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Ward CD, Turpin G, Dewey ME, Fleming S, Hurwitz B, Ratib S, von Fragstein M, Lymbery M. Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial. Clin Rehabil 2016; 18:717-25. [PMID: 15573827 DOI: 10.1191/0269215504cr792oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions. Design: Randomized controlled trial with 12 months follow-up. Setting: Participants’ homes in the City of Nottingham. Participants: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis. Interventions: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home. Main measures: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months. Results: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p=0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002). Conclusions: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.
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Palmer S, Litvinova K, Dunaev A, Fleming S, McGloin D, Nabi G. Changes in autofluorescence based organoid model of muscle invasive urinary bladder cancer. Biomed Opt Express 2016; 7:1193-200. [PMID: 27446646 PMCID: PMC4929632 DOI: 10.1364/boe.7.001193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/04/2016] [Accepted: 02/13/2016] [Indexed: 05/04/2023]
Abstract
Muscle invasive urinary bladder cancer is one of the most lethal cancers and its detection at the time of transurethral resection remains limited and diagnostic methods are urgently needed. We have developed a muscle invasive transitional cell carcinoma (TCC) model of the bladder using porcine bladder scaffold and the human bladder cancer cell line 5637. The progression of implanted cancer cells to muscle invasion can be monitored by measuring changes in the spectrum of endogenous fluorophores such as reduced nicotinamide dinucleotide (NADH) and flavins. We believe this could act as a useful tool for the study of fluorescence dynamics of developing muscle invasive bladder cancer in patients. Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.
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Affiliation(s)
- Scott Palmer
- Division of Imaging and Technology, University of Dundee, Ninewells Hospital and Medical School, James Arrott Drive, Dundee, DD1 9SY, UK
| | - Karina Litvinova
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Andrey Dunaev
- Biomedical Photonics Instrumentation Group, Scientific-Educational Centre of “Biomedical Engineering,” State University – Education-Science-Production Complex, Oryol, 302020, Russia
| | - Stewart Fleming
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, James Arrott Drive, Dundee, DD1 9SY, UK
| | - David McGloin
- Division of Electronic Engineering and Physics, Ewing Building, University of Dundee, Nethergate, Dundee, DD14HN, UK
| | - Ghulam Nabi
- Division of Imaging and Technology, University of Dundee, Ninewells Hospital and Medical School, James Arrott Drive, Dundee, DD1 9SY, UK
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Russell AM, Doyle AM, Ross D, Burdett C, Gane J, Fleming S, Aden Z, Maher TM, Cullinan P. P4 Patient and Carer Co-investigators: Shared experiences of a Research Steering Group from the Idiopathic Pulmonary Fibrosis Patient Reported Outcome Measure (IPF-PRoM) study: Abstract P4 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.141] [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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Walker T, Thomas J, Pring A, Thomas S, Verne J, Fleming S. Factors influencing place of death from head & neck cancer in England 2003–2012. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wilson M, Walker T, Fleming S, Pring A, Hughes C, Thomas S, Verne J. Quality of end of life care in thyroid cancer in England 2003–2012. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cardaci S, Zheng L, MacKay G, van den Broek NJ, MacKenzie ED, Nixon C, Stevenson D, Tumanov S, Bulusu V, Kamphorst JJ, Vazquez A, Fleming S, Schiavi F, Kalna G, Blyth K, Strathdee D, Gottlieb E. Pyruvate carboxylation enables growth of SDH-deficient cells by supporting aspartate biosynthesis. Nat Cell Biol 2015; 17:1317-26. [PMID: 26302408 PMCID: PMC4591470 DOI: 10.1038/ncb3233] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
Succinate dehydrogenase (SDH) is a heterotetrameric nuclear-encoded complex responsible for the oxidation of succinate to fumarate in the tricarboxylic acid cycle. Loss-of-function mutations in any of the SDH genes are associated with cancer formation. However, the impact of SDH loss on cell metabolism and the mechanisms enabling growth of SDH-defective cells are largely unknown. Here, we generated Sdhb-ablated kidney mouse cells and used comparative metabolomics and stable-isotope-labelling approaches to identify nutritional requirements and metabolic adaptations to SDH loss. We found that lack of SDH activity commits cells to consume extracellular pyruvate, which sustains Warburg-like bioenergetic features. We further demonstrated that pyruvate carboxylation diverts glucose-derived carbons into aspartate biosynthesis, thus sustaining cell growth. By identifying pyruvate carboxylase as essential for the proliferation and tumorigenic capacity of SDH-deficient cells, this study revealed a metabolic vulnerability for potential future treatment of SDH-associated malignancies.
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MESH Headings
- Animals
- Aspartic Acid/biosynthesis
- Carboxylic Acids/metabolism
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/metabolism
- Cell Line, Transformed
- Cell Proliferation
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Cells, Cultured
- Humans
- Immunoblotting
- Kidney/cytology
- Kidney/metabolism
- Kidney Neoplasms/genetics
- Kidney Neoplasms/metabolism
- Male
- Metabolomics/methods
- Mice, 129 Strain
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Nude
- Pyruvate Carboxylase/metabolism
- Pyruvic Acid/metabolism
- RNA Interference
- Succinate Dehydrogenase/genetics
- Succinate Dehydrogenase/metabolism
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Affiliation(s)
- Simone Cardaci
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Liang Zheng
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Gillian MacKay
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | | | | | - Colin Nixon
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - David Stevenson
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Sergey Tumanov
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1BD, UK
| | - Vinay Bulusu
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1BD, UK
| | - Jurre J. Kamphorst
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1BD, UK
| | - Alexei Vazquez
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Stewart Fleming
- Department of Pathology, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Francesca Schiavi
- Veneto Institute of Oncology IRCCS, Familial cancer clinic and oncoendocrinology, Via Gattamelata 64, 35128 Padova, Italy
| | - Gabriela Kalna
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Karen Blyth
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Douglas Strathdee
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
| | - Eyal Gottlieb
- Cancer Research UK, Beatson Institute, Switchback Rd, Glasgow, G61 1BD, UK
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Valluri A, Hetherington L, Mcquarrie E, Fleming S, Kipgen D, Geddes CC, Mackinnon B, Bell S. Acute tubulointerstitial nephritis in Scotland. QJM 2015; 108:527-32. [PMID: 25434050 DOI: 10.1093/qjmed/hcu236] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIMS Acute tubulointerstitial nephritis (ATIN) is a potentially reversible cause of acute kidney injury with the majority of cases drug related. Our aims were to examine the incidence profile of patients with ATIN in Scotland and to assess the impact of corticosteroid treatment. DESIGN AND METHODS All adult patients with biopsy-proven ATIN, diagnosed between 2000 and 2012, presenting to renal units serving 1.9 of Scotland's 5 million population were included. Patient demographics, presenting, aetiologic and pathologic features, treatment given and outcome were extracted from patient records. RESULTS In total, 171 cases representing 4.7% of native renal biopsies were identified. Median serum creatinine (sCr) was 327 μmol/l at biopsy (106 μmol/l at baseline). Eosinophilia, fever or rash was present in 57% with all 3 in only 1.1%. Active urinary sediment was found in 68%. Aetiology appeared drug induced in 73%. Proton pump inhibitors (PPIs) were likely causative in almost as many cases as antibiotics (35% each) and were more frequently implicated than non-steroidal anti-inflammatory drugs (20%). Number of PPI-related cases paralleled the rising prescription of these drugs. Corticosteroids were prescribed in 59% of drug-induced ATIN (median sCr at biopsy: 356 μmol/l vs. 280 μmol/l in those managed conservatively). There was no difference in sCr at 1, 6 and 12 months, with similar proportions of both groups experiencing complete renal recovery (48% vs. 41%) and becoming dialysis dependent (10% in both). CONCLUSIONS Incidence of biopsy-proven ATIN in Scotland has been rising over the past decade with the majority of cases drug induced. Evidence supporting corticosteroid treatment is lacking.
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Affiliation(s)
- A Valluri
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - L Hetherington
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - E Mcquarrie
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - S Fleming
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - D Kipgen
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - C C Geddes
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - B Mackinnon
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
| | - S Bell
- From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK
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Ogden NH, Koffi JK, Lindsay LR, Fleming S, Mombourquette DC, Sanford C, Badcock J, Gad RR, Jain-Sheehan N, Moore S, Russell C, Hobbs L, Baydack R, Graham-Derham S, Lachance L, Simmonds K, Scott AN. Surveillance for Lyme disease in Canada, 2009 to 2012. Can Commun Dis Rep 2015; 41:132-145. [PMID: 29769945 PMCID: PMC5933887 DOI: 10.14745/ccdr.v41i06a03] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To summarize the first four years of national surveillance for Lyme disease in Canada from 2009 to 2012 and to conduct a preliminary comparison of presenting clinical manifestations in Canada and the United States. METHODS The numbers and incidence of reported cases by province, month, year, age and sex were calculated. Logistic regression was used to examine trends over time. Acquisition locations were mapped and presenting clinical manifestations reported for jurisdictions where data was available. Variations by province, year, age and sex as well as presenting clinical symptoms were explored by logistic regression. An initial comparative analysis was made of presenting symptoms in Canada and the United States. RESULTS The numbers of reported cases rose significantly from 144 in 2009 to 338 in 2012 (coefficient = 0.34, standard error = 0.07, P <0.05), mostly due to an increased incidence of infections acquired in Canada. More cases were classified as 'confirmed' (71.5%) than 'probable' (28.5%). Most cases occurred in locations where vector tick populations were known to be present. More men than women were affected (53.4% versus 46.6%), incidence was highest in adults aged 55 to 74 years and in children aged five to 14 years. Most cases (95%) were acquired from April to November. Of cases acquired in endemic areas, 39.7% presented with manifestations of early Lyme disease, while 60.3% had manifestations of disseminated Lyme disease. There were significant differences among age groups, sexes and provinces in the frequencies of reported clinical manifestations. The proportion of cases acquired in endemic areas presenting with early Lyme disease was lower than that reported in the US. CONCLUSION Lyme disease incidence is increasing in Canada. Most cases are acquired where vector tick populations are spreading and this varies geographically within and among provinces. There is also variation in the frequency of age, season and presenting manifestations. The lower proportion of cases presenting with early Lyme disease in Canada compared with the US suggests lower awareness of early Lyme disease in Canada, but this requires further study.
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Affiliation(s)
- NH Ogden
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - JK Koffi
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - LR Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - S Fleming
- Public Health Branch, Nova Scotia Department of Health and Wellness, Halifax, NS
| | - DC Mombourquette
- Public Health Branch, Nova Scotia Department of Health and Wellness, Halifax, NS
| | - C Sanford
- Population Health Assessment and Surveillance, Prince Edward Island Department of Health and Wellness, Charlottetown, PE
| | - J Badcock
- Office of the Chief Medical Officer of Health, New Brunswick Department of Health, NB
| | - RR Gad
- Office of the Chief Medical Officer of Health, New Brunswick Department of Health, NB
| | - N Jain-Sheehan
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - S Moore
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - C Russell
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - L Hobbs
- Enteric, Zoonotic and Vector-Borne Diseases, Public Health Ontario, Toronto, ON
| | - R Baydack
- Communicable Disease Control Branch, Manitoba Health Healthy Living and Seniors, Winnipeg, MB
| | - S Graham-Derham
- Communicable Disease Control Branch, Manitoba Health Healthy Living and Seniors, Winnipeg, MB
| | - L Lachance
- Surveillance and Assessment Branch, Alberta Health, Calgary, AB
| | - K Simmonds
- Surveillance and Assessment Branch, Alberta Health, Calgary, AB
| | - AN Scott
- Surveillance and Assessment Branch, Alberta Health, Calgary, AB
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Kidder D, Rutherford E, Kipgen D, Fleming S, Geddes C, Stewart GA. Kidney biopsy findings in primary Sjögren syndrome. Nephrol Dial Transplant 2015; 30:1363-9. [PMID: 25817222 DOI: 10.1093/ndt/gfv042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Renal involvement is rare in primary Sjögren syndrome (PSS). In this study, we examined renal biopsy findings in patients with PSS and correlated them with their clinical and renal findings. METHODS Twenty-five patients with PSS who underwent renal biopsies from two renal units in Scotland between 1978 and 2013 were identified from renal biopsy database. We examined the renal morphologic, clinical and renal findings at the time of renal biopsy, renal and patient outcomes. RESULTS The diagnosis of PSS preceded renal biopsy in 18/25 patients. In this group, the median duration of the disease was 5.5 years. Significant proteinuria, combined microscopic haematuria and proteinuria and reduced renal excretory function were found in 76, 56 and 84% of patients, respectively. The 3-year actuarial patient survival was significantly lower in patients with glomerulonephritis as compared with tubulointerstitial nephritis (66 versus 100%, P = 0.02). There was no difference in 3-year actuarial renal survival between these two groups (92 versus 92%, P = 1.0). CONCLUSIONS Renal biopsy is rare in PSS and often reveals diverse pathological findings. Glomerulonephritis, as compared with tubulointerstitial nephritis, is associated with higher early mortality. Further studies are needed to evaluate the utility of renal biopsy and its impact on disease management.
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Affiliation(s)
- Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - David Kipgen
- Pathology Department, Southern General Hospital, Glasgow, UK
| | - Stewart Fleming
- Department of Pathology, Ninewells Medical School, Dundee, UK
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow, UK
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Kovac M, Navas C, Horswell S, Salm M, Bardella C, Rowan A, Stares M, Castro-Giner F, Fisher R, de Bruin EC, Kovacova M, Gorman M, Makino S, Williams J, Jaeger E, Jones A, Howarth K, Larkin J, Pickering L, Gore M, Nicol DL, Hazell S, Stamp G, O’Brien T, Challacombe B, Matthews N, Phillimore B, Begum S, Rabinowitz A, Varela I, Chandra A, Horsfield C, Polson A, Tran M, Bhatt R, Terracciano L, Eppenberger-Castori S, Protheroe A, Maher E, El Bahrawy M, Fleming S, Ratcliffe P, Heinimann K, Swanton C, Tomlinson I. Recurrent chromosomal gains and heterogeneous driver mutations characterise papillary renal cancer evolution. Nat Commun 2015; 6:6336. [PMID: 25790038 PMCID: PMC4383019 DOI: 10.1038/ncomms7336] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
Papillary renal cell carcinoma (pRCC) is an important subtype of kidney cancer with a problematic pathological classification and highly variable clinical behaviour. Here we sequence the genomes or exomes of 31 pRCCs, and in four tumours, multi-region sequencing is undertaken. We identify BAP1, SETD2, ARID2 and Nrf2 pathway genes (KEAP1, NHE2L2 and CUL3) as probable drivers, together with at least eight other possible drivers. However, only ~10% of tumours harbour detectable pathogenic changes in any one driver gene, and where present, the mutations are often predicted to be present within cancer sub-clones. We specifically detect parallel evolution of multiple SETD2 mutations within different sub-regions of the same tumour. By contrast, large copy number gains of chromosomes 7, 12, 16 and 17 are usually early, monoclonal changes in pRCC evolution. The predominance of large copy number variants as the major drivers for pRCC highlights an unusual mode of tumorigenesis that may challenge precision medicine approaches.
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Affiliation(s)
- Michal Kovac
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
- Department of Biomedicine, Research Group Human Genomics, University of Basel, Mattenstrasse 28, 4058 Basel, Switzerland
| | - Carolina Navas
- Translational Cancer Therapeutics Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Stuart Horswell
- Bioinformatics and Biostatistics, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Max Salm
- Bioinformatics and Biostatistics, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Chiara Bardella
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Andrew Rowan
- Translational Cancer Therapeutics Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Mark Stares
- Translational Cancer Therapeutics Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Francesc Castro-Giner
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Rosalie Fisher
- Translational Cancer Therapeutics Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Elza C. de Bruin
- University College London Cancer Institute and Hospitals, Huntley Street, London WC1E 6DD, UK
| | - Monika Kovacova
- Faculty of Mechanical Engineering, Institute of Mathematics and Physics, Slovak University of Technology, Namestie slobody 17, 812 31 Bratislava, Slovakia
| | - Maggie Gorman
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Seiko Makino
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Jennet Williams
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Emma Jaeger
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Angela Jones
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Kimberley Howarth
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - James Larkin
- Department of Medicine, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Lisa Pickering
- Department of Medicine, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Martin Gore
- Department of Medicine, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - David L. Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Steven Hazell
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Gordon Stamp
- Experimental Histopathology, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Tim O’Brien
- Urology Centre, Guy’s and St Thomas’s Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Ben Challacombe
- Urology Centre, Guy’s and St Thomas’s Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Nik Matthews
- Advanced Sequencing Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Benjamin Phillimore
- Advanced Sequencing Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Sharmin Begum
- Advanced Sequencing Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Adam Rabinowitz
- Advanced Sequencing Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - Ignacio Varela
- Genomic analysis of tumour development, Instituto de Biomedicina y Biotecnología de Cantabria (CSIC-UC-Sodercan), Departamento de Biología Molecular, Universidad de Cantabria, 39011 Santander, Spain
| | - Ashish Chandra
- Department of Histopathology, Guy’s and St Thomas’s Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Catherine Horsfield
- Department of Histopathology, Guy’s and St Thomas’s Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Alexander Polson
- Department of Histopathology, Guy’s and St Thomas’s Hospital NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Maxine Tran
- Department of Oncology, Uro-Oncology Research Group, University of Cambridge, Cambridge CB2 0RE, UK
| | - Rupesh Bhatt
- Department of Urology, University Hospitals, Birmingham B15 2TH, UK
| | - Luigi Terracciano
- Institute for Pathology, University Hospital Basel, Schönbeinstrasse 40, 4003 Basel, Switzerland
| | | | - Andrew Protheroe
- Department of Oncology, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals, Oxford OX3 7LJ, UK
| | - Eamonn Maher
- Department of Medical Genetics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Mona El Bahrawy
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
| | - Stewart Fleming
- Department of Histopathology, Medical Research Institute, University of Dundee Medical School, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Peter Ratcliffe
- Hypoxia Biology Laboratory, Henry Wellcome Building for Molecular Physiology, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Karl Heinimann
- Department of Biomedicine, Research Group Human Genomics, University of Basel, Mattenstrasse 28, 4058 Basel, Switzerland
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, London Research Institute, Cancer Research UK, 44, Lincoln’s Inn Fields, London WC2A 3LY, UK
- University College London Cancer Institute and Hospitals, Huntley Street, London WC1E 6DD, UK
| | - Ian Tomlinson
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Clinical Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
- NIHR Comprehensive Biomedical Research Centre, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
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Abstract
Tumours of the distal nephron are uncommon but can create diagnostic difficulties. They may be divided into three groups-tumours of intercalated cell phenotype, those of principal cell phenotype and others with an unconfirmed distal nephron origin. Oncocytomas, chromophobe carcinoma and hybrid oncocytoma chromophobe carcinoma, all show features of intercalated cells and the distinction amongst these is one of the most common areas of diagnostic dilemma. Collecting duct carcinoma and renal medullary carcinoma are the most aggressive forms of renal cancer but recent evidence suggests they may respond to targeted therapy so their recognition becomes crucial to the management of these patients. There remains debate over the precise phenotype of both tubulocystic carcinoma and mucinous tubular and spindle cell carcinoma.
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Affiliation(s)
- Stewart Fleming
- Department of Cellular and Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.
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Macesic N, Langsford D, Nicholls K, Hughes P, Gottlieb DJ, Clancy L, Blyth E, Micklethwaite K, Withers B, Majumdar S, Fleming S, Sasadeusz J. Adoptive T cell immunotherapy for treatment of ganciclovir-resistant cytomegalovirus disease in a renal transplant recipient. Am J Transplant 2015; 15:827-32. [PMID: 25648555 DOI: 10.1111/ajt.13023] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 01/25/2023]
Abstract
Cytomegalovirus (CMV) is a significant cause of morbidity, mortality and graft loss in solid organ transplantation (SOT). Treatment options for ganciclovir-resistant CMV are limited. We describe a case of ganciclovir-resistant CMV disease in a renal transplant recipient manifested by thrombotic microangiopathy-associated glomerulopathy. Adoptive T cell immunotherapy using CMV-specific T cells from a donor bank was used as salvage therapy. This report is a proof-of-concept of the clinical and logistical feasibility of this therapy in SOT recipients.
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Affiliation(s)
- N Macesic
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
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Kidder D, Stewart GA, Furrie E, Fleming S. The case. Idiopathic hypocomplementemic interstitial nephritis. Diagnosis: Idiopathic hypocomplementemic tubulointerstitial nephritis. Kidney Int 2015; 87:485-6. [PMID: 25635726 DOI: 10.1038/ki.2013.507] [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: 11/09/2022]
Affiliation(s)
- Dana Kidder
- Renal Unit, Ninewells Hospital, Dundee, Scotland, UK
| | | | - Elizabeth Furrie
- Immunology Department, Ninewells Hospital Medical School, Dundee, Scotland, UK
| | - Stewart Fleming
- Pathology Department, Ninewells Hospital Medical School, Dundee, Scotland, UK
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Gill AJ, Hes O, Papathomas T, Šedivcová M, Tan PH, Agaimy A, Andresen PA, Kedziora A, Clarkson A, Toon CW, Sioson L, Watson N, Chou A, Paik J, Clifton-Bligh RJ, Robinson BG, Benn DE, Hills K, Maclean F, Niemeijer ND, Vlatkovic L, Hartmann A, Corssmit EPM, van Leenders GJLH, Przybycin C, McKenney JK, Magi-Galluzzi C, Yilmaz A, Yu D, Nicoll KD, Yong JL, Sibony M, Yakirevich E, Fleming S, Chow CW, Miettinen M, Michal M, Trpkov K. Succinate dehydrogenase (SDH)-deficient renal carcinoma: a morphologically distinct entity: a clinicopathologic series of 36 tumors from 27 patients. Am J Surg Pathol 2015; 38:1588-602. [PMID: 25025441 PMCID: PMC4229399 DOI: 10.1097/pas.0000000000000292] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Succinate dehydrogenase (SDH)-deficient renal carcinoma has been accepted as a provisional entity in the 2013 International Society of Urological Pathology Vancouver Classification. To further define its morphologic and clinical features, we studied a multi-institutional cohort of 36 SDH-deficient renal carcinomas from 27 patients, including 21 previously unreported cases. We estimate that 0.05% to 0.2% of all renal carcinomas are SDH deficient. Mean patient age at presentation was 37 years (range, 14 to 76 y), with a slight male predominance (M:F=1.7:1). Bilateral tumors were observed in 26% of patients. Thirty-four (94%) tumors demonstrated the previously reported morphology at least focally, which included: solid or focally cystic growth, uniform cytology with eosinophilic flocculent cytoplasm, intracytoplasmic vacuolations and inclusions, and round to oval low-grade nuclei. All 17 patients who underwent genetic testing for mutation in the SDH subunits demonstrated germline mutations (16 in SDHB and 1 in SDHC). Nine of 27 (33%) patients developed metastatic disease, 2 of them after prolonged follow-up (5.5 and 30 y). Seven of 10 patients (70%) with high-grade nuclei metastasized as did all 4 patients with coagulative necrosis. Two of 17 (12%) patients with low-grade nuclei metastasized, and both had unbiopsied contralateral tumors, which may have been the origin of the metastatic disease. In conclusion, SDH-deficient renal carcinoma is a rare and unique type of renal carcinoma, exhibiting stereotypical morphologic features in the great majority of cases and showing a strong relationship with SDH germline mutation. Although this tumor may undergo dedifferentiation and metastasize, sometimes after a prolonged delay, metastatic disease is rare in the absence of high-grade nuclear atypia or coagulative necrosis.
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Affiliation(s)
- Anthony J Gill
- *Department of Anatomical Pathology †Cancer Diagnosis and Pathology Research Group §§Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital ‡University of Sydney, Sydney ††Histopath Pathology ¶¶Douglass Hanly Moir Pathology, North Ryde ‡‡Department of Anatomical Pathology, St Vincents Hospital, Darlinghurst §§§Department of Anatomical Pathology, South Western Area Pathology Service, Liverpool, NSW ∥∥Pathology Queensland, Gold Coast University Hospital, Qld ****Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Vic., Australia §Department of Pathology, Medical Faculty and Charles University, Pilsen, Czech Republic ∥Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Centre, Rotterdam ##Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands ¶Department of Pathology, Singapore General Hospital, Singapore, Singapore #Institute of Pathology, Friedrich-Alexander-University, Erlangen, Germany **Department of Pathology, Oslo University Hospital ***Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway †††Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH ¶¶¶Department of Pathology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI ††††Laboratory of Surgical Pathology, National Cancer Institute, Bethesda, MD ‡‡‡Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada ∥∥∥Department of Pathology, Hopital Cochin Université Paris Descartes, Paris, France ###Department of Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee, UK
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Fleming S, Yannakou CK, Haeusler GM, Clark J, Grigg A, Heath CH, Bajel A, van Hal SJ, Chen SC, Milliken ST, Morrissey CO, Tam CS, Szer J, Weinkove R, Slavin MA. Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2014; 44:1283-97. [DOI: 10.1111/imj.12595] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Fleming
- Malignant Haematology and Stem Cell Transplantation Service; Alfred Health; Prahran Victoria
| | - C. K. Yannakou
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - G. M. Haeusler
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- Department of Paediatric Infectious Diseases; Monash Children's Hospital; Monash Health; Clayton Victoria
- Paediatric Integrated Cancer Service; Parkville Victoria
| | - J. Clark
- Infection Management and Prevention Service; The Royal Children's Hospital Brisbane; Queensland Health; Herston Queensland
| | - A. Grigg
- Department of Clinical Haematology; Austin Health; Heidelberg Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - C. H. Heath
- Department of Microbiology and Infectious Diseases; Royal Perth Hospital; Perth Western Australia
- School of Medicine and Pharmacology (RPH Unit); University of Western Australia; Perth Western Australia
| | - A. Bajel
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - S. J. van Hal
- Department of Microbiology and Infectious Diseases; Royal Prince Alfred Hospital; Camperdown New South Wales
| | - S. C. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services; ICPMR - Pathology West; Westmead New South Wales
- Department of Infectious Diseases; Westmead Hospital; Westmead New South Wales
- Sydney Medical School; The University of Sydney; Sydney New South Wales
| | - S. T. Milliken
- Department of Haematology; St Vincent's Hospital; Darlinghurst New South Wales
- Faculties of Medicine and Pathology; The University of NSW; Kensington New South Wales
| | - C. O. Morrissey
- Department of Infectious Diseases; Alfred Health and Monash University; Prahran Victoria
- Department of Clinical Haematology; Alfred Health; Prahran Victoria
| | - C. S. Tam
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Victoria
| | - J. Szer
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - R. Weinkove
- Wellington Blood and Cancer Centre; Capital and Coast District Health Board; Wellington New Zealand
- Vaccine Research Group; Malaghan Institute of Medical Research; Wellington New Zealand
| | - M. A. Slavin
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Victorian Infectious Diseases Service; The Doherty Institute for Infection and Immunity; Parkville Victoria
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Russell A, Sanderson T, Fleming S, Wells A, Maher T, Cullinan T. M266 Development Of An Idiopathic Pulmonary Fibrosis (ipf) Patient Reported Outcome Measure (prom): An Iterative Approach To Item Generation. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.447] [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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Eremenco S, Fleming S, Riordan D, Stringer S, Gleeson S, Sanga P, Kelly K. Usability Testing of A Novel Pain Medication Diary Administered Electronically. Value Health 2014; 17:A386. [PMID: 27200876 DOI: 10.1016/j.jval.2014.08.2647] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - S Fleming
- Janssen Global Services, Titusville, NJ, USA
| | - D Riordan
- Janssen Research and Development, Raritan, NJ, USA
| | | | | | - P Sanga
- Janssen Research and Development, Titusville, NJ, USA
| | - K Kelly
- Janssen Research and Development L. L. C., Titusville, NJ, USA
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