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Armstrong S, Makris A, Belessiotis-Richards K, Abdul-Latif M, Ostler P, Shah N, Miles D, Tsang YM. Treatment Outcomes of Stereotactic Ablative Body Radiotherapy on Extra-cranial Oligometastatic and Oligoprogressive Breast Cancer: Mature Results from a Single Institution Experience. Clin Oncol (R Coll Radiol) 2024; 36:362-369. [PMID: 38575431 DOI: 10.1016/j.clon.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
AIMS Evidence shows stereotactic ablative body radiotherapy (SABR) is used as a non-invasive ablative therapy in the treatment of multisite oligometastatic (OM) and oligoprogressive (OP) diseases originating from metastatic breast cancer. This study aims to report the treatment outcomes and to investigate what factors that are prognostic in terms of local control, progression-free survival (PFS) and overall survival (OS) in patients receiving SABR for extracranial OM and OP diseases originating from metastatic breast cancer. MATERIALS AND METHODS A retrospective review on treatment records of patients with OM and OP from metastatic breast cancer who underwent SABR at a single was carried out. SABR was performed with daily image-guided radiotherapy (IGRT) using a dedicated robotic SABR machine. Local control, PFS and OS were calculated using Kaplan-Meier statistics and the post-treatment toxicity data was scored following the CTCAE v4.0 protocol. Univariate and multivariate Cox regression tests were used in the subgroup analysis of prognostic factors on PFS and OS including patients' age, types of follow-up imaging (staging CT only vs whole-body MR/PET), metastases status (OM vs OP), primary breast cancer tumour grade, hormone receptors (ER/PR/HER2) status, change of systemic treatments at SABR, number of metastases, SABR treatment sites and doses. RESULTS 56 metastatic breast cancer patients (38 patients with OM and 18 patients with OP) were involved in this retrospective review. The median follow-up was 35.6 months (range 4.0-132.9 months). The estimated local control at 1 , 2 and 5 years were 90.9%, 88.7% and 88.7%, respectively. The estimated median PFS was 19.2 months (95%CI 10.3-28.1 months); the PFS at 1, 2 and 5 years were 63.3%, 44.4% and 33.2%. The estimated OS at 1, 2 and 5 years were 98.0%, 91.9% and 74.3%, respectively with the estimated median OS of 105.1 months (95%CI 51.5-158.7 months). The vast majority of patients tolerated the treatment well with the commonest acute side effects as grade 1 fatigue. There were no statistically significant factors found in OS regression analysis. The types of follow-up imaging, metastases status, oestrogen receptor status, and number of metastases for SABR were statistically significant factors (p < 0.05) in the multivariate Cox regression analysis on PFS. CONCLUSION There are limited studies published on the efficacy and post-treatment toxicities of metastatic breast cancer OM and OP SABR with adequate length of follow-up. This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer in terms of the acceptable post-treatment toxicities.
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Affiliation(s)
- S Armstrong
- Lismore Base Hospital, North Coast Cancer Institute, New South Wales, Australia
| | - A Makris
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | - M Abdul-Latif
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - N Shah
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - D Miles
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Y M Tsang
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Thaitirarot C, Sze S, Armstrong S, Somani R. Ultrasound-guided explantation technique for implantable loop recorder in patients with high body mass index: a practical approach. Heart Rhythm O2 2024; 5:198-199. [PMID: 38560376 PMCID: PMC10980916 DOI: 10.1016/j.hroo.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Chokanan Thaitirarot
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Shirley Sze
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Suzanne Armstrong
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Riyaz Somani
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
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Barrett K, Oxenford C, Canfield P, Armstrong S, Malik R. Vale Dave McGavin. Aust Vet J 2024; 102:48. [PMID: 38302107 DOI: 10.1111/avj.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Affiliation(s)
- K Barrett
- Launceston Veterinary Hospital, South Launceston, 7249, Tasmania, Australia
| | - C Oxenford
- WHO Lyon, 24 Rue Jean Baldassini, Lyon, F-69007, France
| | - P Canfield
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - S Armstrong
- Zoetis, Springfield Drive, Surrey, KT22 7LP, United Kingdom of Great Britain and Northern Ireland
| | - R Malik
- Centre for Veterinary Education, University of Sydney, Camperdown, New South Wales, 2006, Australia
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S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, 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H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Kotb A, Armstrong S, Antoun I, Koev I, Mavilakandy A, Barker J, Vali Z, Panchal G, Li X, Lazdam M, Ibrahim M, Sandilands A, Chin S, Somani R, Andre Ng G. Atrial fibrillation virtual ward: reshaping the future of AF care. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management.
Methods
An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR <140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT).
Results
Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients.
Conclusion
This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kotb
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - S Armstrong
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - I Antoun
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - I Koev
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - A Mavilakandy
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - J Barker
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - Z Vali
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - G Panchal
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - X Li
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - M Lazdam
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - M Ibrahim
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - A Sandilands
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - S Chin
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - R Somani
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - G Andre Ng
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
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Armstrong S, Pacey A, Farquhar C, Lensen S. O-227 Has time-lapse technology finally proven its clinical benefit? Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.005] [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
Background
Time-lapse technology for the observation of embryos is not new, having been first described in 1930 by Dr WH Lewis using rabbit embryos. However, the use of software (using artificial intelligence and deep learning) linked to known clinical outcomes theoretically helps the embryologist select the ‘best’ embryo for embryo transfer. Time-lapse also reduces the need to manually handle embryos and is hypothesised would reduce biases due to interobserver variation and improve clinical outcomes. Whilst the technology may help improve laboratory workflow, the quantitative evidence is less clear. This raises the ethical question about charging extra for a technology which does not improve patient outcome. In offering time-lapse, professionals have argued that it responds to patient demand and the need to be seen as ‘cutting edge’. However, the patient perspective for using time-lapse has, until recently, been largely unexplored.
Methods
This presentation relies on three sources of evidence: (i) Systematic reviews of randomised controlled trials (RCTs) and newly published RCTs not yet incorporated into systematic reviews; (ii) Qualitative studies concerning the consideration or use of time-lapse in those undergoing IVF; and (iii) A qualitative study (VALUE) of patient professional views regarding time-lapse, amongst other add-ons.
Results
The latest Cochrane systematic review undertook three comparisons to best establish where the potential advantage of time-lapse may lie: (i) undisturbed culture; (ii) the use of software to select the embryo to replace; or (iii) a combination of both stable culture and software. For all outcomes assessed, including crucially livebirth and miscarriage, there was no good evidence to show that time-lapse was any more or less effective than conventional methods of embryo incubation. These findings are supported by another systematic review by Chen et al (2017). A large RCT (TILT) is currently underway and will be the largest RCT to examine the clinical effectiveness and safety of time-lapse. TILT is expected to complete recruitment soon.
The VALUE study is an international qualitative semi-structured interview study of patients, embryologists, and clinicians to explore the reasons behind the decisions to use non-evidence-based treatment ‘add-ons’ alongside an IVF cycle. Over half of patient participants interviewed opted to use time-lapse. Inductive thematic analysis revealed five key themes for patients: (i) ‘vulnerability’; (ii) ‘power of the trusted professional opinion’; (iii) ‘role of previous experience’; (iv) ‘acceptability of add-on’; and (v) ‘the evidence doesn’t apply to me’. The analysis of the professional participants’ interviews revealed five themes, some of which mirror the patient themes: (i) ‘treating desperation’; (ii) ‘the patient shopper’; (iii) ‘success not profits’; (iv) ‘potential for harm’; and (v) ‘tensions within evidence-based practice’.
Discussion
Time-lapse has been adopted widely across fertility clinics globally, and with good reason. It brings efficiencies and convenience for embryologists by allowing them to observe embryos remotely. However, the highest quality evidence does not support the notion that it improves livebirth or reduces miscarriage rates. Qualitative research shows that patients can make choices about add-ons that can leave them in debt due to desperation and the desire to look for hope in an otherwise uncontrollable situation. Professionals acknowledge this, and in their desire to achieve a pregnancy, they sometimes look to add-ons such as time-lapse as a ‘why not’ when previous cycles have failed. Patients describe how they do not want to be denied time-lapse but want it in the context of informed consent. This must include being open about the paucity of evidence to support its effectiveness at this stage.
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Affiliation(s)
- S Armstrong
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - A Pacey
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - C Farquhar
- University of Auckland, Obstetrics and Gynaecology , Auckland, New Zealand
| | - S Lensen
- University of Melbourne, Obstetrics and Gynaecology , Melbourne, Australia
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Armstrong S, Vaughan E, Lensen S, Caughey L, Farquhar C, Pacey A, Balen A, Peate M, Wainwright E. O-078 The VALUE study: a qualitative semi-structured interview study of add-on use by patients, clinicians, and embryologists in the UK and Australia. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.092] [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] Open
Abstract
Abstract
Study question
Why do patients, clinicians and embryologists opt to use IVF add-ons in fertility treatment?
Summary answer
Add-ons offer options, hope and control in a desperate situation. The perceived drivers differ between patients and professionals; however, both feel add-ons offer bespoke care.
What is known already
Evidence that add-ons offer clinical advantages for the outcomes of IVF is lacking or insufficient. However, they remain popular in the UK and Australia, with over three-quarters of couples opting to use them. Professionals, clinical societies, and the media have latched onto the ethical aspects of offering non-evidence-based add-ons, often provided at an additional cost to vulnerable patients. Conversely, it has also been suggested that patients are driving add-on use. The VALUE study is the first large qualitative study to include both patients and professionals that explores the drivers behind their use, and how the existing evidence is weighed up.
Study design, size, duration
VALUE was a multinational semi-structured interview study in the UK and Australia. The interview schedule was reached through extensive patient and public involvement. Between January and May 2021, recruitment took place via social media advertisement, email invitation from professional societies, and snowballing. A purposive sampling strategy was planned; all eligible participants (25 patients, 25 embryologists, and 24 clinicians) were interviewed via recorded teleconference. Anonymised verbatim transcripts were analysed iteratively, and themes developed inductively.
Participants/materials, setting, methods
Patient and professional transcripts were coded separately using the software DedooseTM Two separate thematic analyses followed. An inductive approach to analysis was adopted, whereby themes emerged from the data, opposed to constructing a pre-conceived coding scheme. Codes were combined into broader themes, and sub-themes, which were discussed, debated, and named. The wider research team then commented upon and debated the themes and sub-themes, which were settled upon by consensus.
Main results and the role of chance
Thematic analysis of patient interviews identified five themes: ‘vulnerability’; ‘power of the trusted professional opinion’; ‘role of previous experience’; ‘acceptability of add-on’; and ‘the evidence doesn’t apply to me’. The professional interviews identified five themes: ‘Treating desperation’; ‘tensions within evidence-based practice’; ‘success, not profits’; ‘the patient shopper’; and ‘potential for harm’.
Analysis identified that that people undergoing IVF are vulnerable and opting for non-evidence-based treatments at additional cost because of a sense of desperation following unsuccessful cycles. For patients, utilising add-ons lends hope and a sense of control, with considerations of safety and efficacy being ranked lower than hope. For professionals, add-ons are reasonable given the absence of anything else to add, and allows patients the opportunity to exhaust every avenue. At odds with one-another are the themes regarding who is driving add-on use. Patients describe the power of a professional recommendation, believing it to be in their best interest. For professionals, it’s the patients who research and request add-ons, and failing to offer them risks losing patients. The tension between evidence and bespoke care was evident across both analyses, with testimonies being particularly powerful for patients, and for professionals, a belief that add-ons are helpful in the right context.
Limitations, reasons for caution
The VALUE study has captured patients and professionals who have volunteered to talk about this particularly contentious area of medicine. Participants are likely to be a motivated group of individuals who may potentially represent those with strong views regarding add-ons.
Wider implications of the findings
The theme of desperation runs through VALUE’s analyses and whilst we did find that patients drive add-on use, professional opinion for or against add-ons was powerful. Patients want autonomy, but only in the context of informed consent.
Trial registration number
https://osf.io/he7tn/
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Affiliation(s)
- S Armstrong
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - E Vaughan
- University Hospitals Bristol, Academic Women's Health Unit , Bristol, United Kingdom
- University of Bristol, Bristol Medical School- Translational Health Sciences , Bristol, United Kingdom
| | - S Lensen
- University of Melbourne, Obstetrics and Gynaecology, Melbourne , Australia
| | - L Caughey
- University of Melbourne, Faculty of Medicine- Dentistry and Health Sciences, Melbourne , Australia
| | - C Farquhar
- University of Auckland, Faculty of Medical and Health Sciences , Auckland, New Zealand
| | - A Pacey
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - A Balen
- Leeds Teaching Hospitals NHS Trust, Obstetrics and Gynaecology , Leeds, United Kingdom
| | - M Peate
- University of Melbourne, Obstetrics and Gynaecology, Melbourne , Australia
| | - E Wainwright
- University of Aberdeen, Epidemiology Group- ACAMH , Aberdeen, United Kingdom
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Tsang Y, Tharmalingam H, Belessiotis-Richards K, Armstrong S, Ostler P, Hughes R, Alonzi R, Hoskin P. OC-0040 Ultrafractionated radiotherapy(RT) in localised prostate cancer:HDR brachytherapy vs stereotactic RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- A. Wheatley
- McGill University Library, McGill University, Montréal, QC, Canada
| | - S. Armstrong
- University of New Brunswick Libraries, University of New Brunswick, Fredericton, NB, Canada
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Chan J, Thakkar H, Comella A, Kim J, Armstrong S, Ihdayhid A, Dey D, Nerlekar N, Brown A. Coronary Perivascular Inflammation is Not Associated With Downstream Microcirculatory Dysfunction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Armstrong S, McHale G, Ledesma-Aguilar R, Wells GG. Evaporation and Electrowetting of Sessile Droplets on Slippery Liquid-Like Surfaces and Slippery Liquid-Infused Porous Surfaces (SLIPS). Langmuir 2020; 36:11332-11340. [PMID: 32882130 PMCID: PMC8011908 DOI: 10.1021/acs.langmuir.0c02020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Sessile droplet evaporation underpins a wide range of applications from inkjet printing to coating. However, drying times can be variable and contact-line pinning often leads to undesirable effects, such as ring stain formation. Here, we show voltage programmable control of contact angles during evaporation on two pinning-free surfaces. We use an electrowetting-on-dielectric approach and Slippery Liquid-Infused Porous (SLIP) and Slippery Omniphobic Covalently Attached Liquid-Like (SOCAL) surfaces to achieve a constant contact angle mode of evaporation. We report evaporation sequences and droplet lifetimes across a broad range of contact angles from 105°-67°. The values of the contact angles during evaporation are consistent with expectations from electrowetting and the Young-Lippman equation. The droplet contact areas reduce linearly in time, and this provides estimates of diffusion coefficients close to the expected literature value. We further find that the total time of evaporation over the broad contact angle range studied is only weakly dependent on the value of the contact angle. We conclude that on these types of slippery surfaces, droplet lifetimes can be predicted and controlled by the droplet's volume and physical properties (density, diffusion coefficient, and vapor concentration difference to the vapor phase) largely independent of the precise value of contact angle. These results are relevant to applications, such as printing, spraying, coating, and other processes, where controlling droplet evaporation and drying is important.
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Affiliation(s)
- S. Armstrong
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - G. McHale
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - R. Ledesma-Aguilar
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - G. G. Wells
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
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13
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Armstrong S, Arroyo M, Decker-Pulice K, Lane M, Mckinney M, Molesworth-Kenyon SJ. IL-1α Modulates IFN-γ-Induced Production of CXCL9/MIG during Herpes Simplex Virus Type-1 Corneal Infection. Curr Eye Res 2020; 46:309-317. [PMID: 32730721 DOI: 10.1080/02713683.2020.1803921] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Investigating the modulation of neutrophil production of MIG and IP-10 during the inflammatory response to HSV-1 infection. MATERIALS AND METHODS An ex vivo model of human corneal infection by HSV-1 was used for this study. This model permits the study of cytokine production by human corneal buttons in the presence, or absence, of gradient purified human neutrophils, under conditions of HSV-1 infection. All experimental samples were stimulated with a baseline concentration of recombinant human IFN-γ at 1 ng/mL. The relative levels of production for 12 pro-inflammatory mediators were screened using a multi-analyte ELISA assay. Neutrophil production of chemokines MIG and IP-10, under conditions of IFN-γ and/or HSV-1 stimulation were measured by quantitative ELISA. Lastly, antibody neutralization (goat IgG anti-human IL-1α, 2 µg/mL) of de novo production of IL-1α by corneal tissue was performed to investigated the effect on MIG and IP-10 production in the ex vivo model for HSV-1 infection. RESULTS Four of the 12 pro-inflammatory mediators screened (IL-8, IL-6, IL-1α and IL-1β) demonstrated elevated levels of production during corneal cell infection with HSV-1 and communication with neutrophils. Neutrophils were demonstrated to produce significant levels of both MIG and IP-10 under conditions of IFN-γ stimulation, and production of MIG was further upregulated by co-stimulation with IFN-γ and HSV-1. Neutralization of de novo IL-1α production in the model resulted in increased production of the chemokine production MIG but had no observable effect on IP-10 production. CONCLUSIONS Our data provide evidence demonstrating the potential for expression patterns of MIG and IP-10 to be modulated by IL-1α, during the inflammatory response to HSV-1 corneal infection. Both corneal cells and neutrophils contribute to the production of T cell recruiting chemokines. However, IL-1α has the potential to upregulate MIG production by corneal cells while down-regulating MIG production by neutrophils.
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Affiliation(s)
- S Armstrong
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Arroyo
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - K Decker-Pulice
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Lane
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Mckinney
- Department of Biology, University of West Georgia , Carrollton, GA, USA
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14
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Armstrong S, Hoskin P. Complex Clinical Decision-Making Process of Re-Irradiation. Clin Oncol (R Coll Radiol) 2020; 32:688-703. [PMID: 32893056 DOI: 10.1016/j.clon.2020.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022]
Abstract
As patients live longer with their cancer as a result of more effective treatment, recurrences and second malignancies in a previously irradiated field are an increasing challenge. The technical advances that enable high-dose radiation to limited volumes, excluding critical normal tissues, have increased the use of re-irradiation for many tumour sites. Minimising the volume, selecting patients with good performance status, negative metastatic screening and longer disease-free intervals are important principles. Despite this there is a narrow therapeutic window, and careful consideration with open discussion, including the patient, of the probable benefit and the implications of potential toxicities will always be essential. In this overview we evaluate the various radiobiological factors that need to be considered for re-irradiation, tissue recovery and dose tolerances in the setting of re-irradiation and summarise the available literature to guide clinicians in their decision-making for re-irradiation to primary and metastatic site/s of disease.
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Affiliation(s)
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
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15
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Thambar S, Kulkarni S, Armstrong S, Nikolarakos D. Botulinum toxin in the management of temporomandibular disorders: a systematic review. Br J Oral Maxillofac Surg 2020; 58:508-519. [PMID: 32143934 DOI: 10.1016/j.bjoms.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 06/29/2019] [Accepted: 02/10/2020] [Indexed: 01/01/2023]
Abstract
The aim of this review was to critically investigate and assess the evidence relating to the use and efficacy of botulinum toxin (BTX) in the management of temporomandibular joint disorders (TMD) and masticatory myofascial pain. A comprehensive search was conducted of PubMed, Scopus, Embase, and Cochrane CENTRAL, to find relevant studies from the last 30 years up to the end of July 2018. Seven were identified. Three showed a significant reduction in pain between the BTX and placebo groups and one showed a clinical, but not a significant, difference. In one that compared BTX with another novel treatment, myofascial pain reduced equally in both groups, and in the remaining two there was no significant difference in pain reduction between the BTX and control groups. Of the four studies that assessed mouth opening, two reported that BTX had resulted in a slight improvement; one reported no improvement, and the other a worsening of the condition. A meta-analysis was not possible because of the considerable variation in the studies' designs, the heterogeneity between the groups, and the different assessment tools used. Despite showing benefits, consensus on the therapeutic benefit of BTX in the management of myofascial TMD is lacking. Further randomised controlled trials with larger sample sizes, minimal bias, and longer follow-up periods are now needed.
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Affiliation(s)
- S Thambar
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia; Griffith University, School of Medicine, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215, Australia; Griffith University, School of Dentistry, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215.
| | - S Kulkarni
- Griffith University, School of Dentistry, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215
| | - S Armstrong
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - D Nikolarakos
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
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16
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Galipeau HJ, Turpin W, Caminero Fernandez A, Santiago A, Libertucci J, Bermudez-Brito M, Armstrong S, Bedrani L, Croitoru K, Verdu E. A35 MICROBIAL PROTEOLYTIC SIGNATURE IN ULCERATIVE COLITIS INDUCES AN INFLAMMATORY SIGNATURE IN MICROBIOTA-HUMANIZED MICE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Altered gut microbiota composition has been associated with inflammatory bowel diseases (IBD) including ulcerative colitis (UC), but causality and bacterially-driven mechanisms, are unclear. Proteases within the gastrointestinal tract play a critical role in maintaining homeostasis and are tightly regulated by anti-proteases. Host-derived proteolytic imbalances have been described in IBD, including UC, however, the role of intestinal microbiota as a source of proteases and anti-proteases has largely been ignored.
Aims
To study microbial proteolytic activity and intestinal microbiota profiles in a cohort of individuals at-risk for IBD, and in those individuals that develop UC at follow-up.
Methods
Fecal samples were collected from healthy individuals at-risk for IBD and who went on to develop UC (pre-UC; n=14) and again after UC diagnosis (post-UC, n=10). Fecal samples from matched at-risk individuals that did not develop UC were used as healthy controls (n=52). Overall fecal proteolytic and elastolytic activity was measured. We performed metagenomics sequencing in 4 UC subjects (pre and post) and 4 matched HC using Illumina Hi-Seq from stool DNA. To investigate bacterial origin and functional significance, pregnant germ-free (GF) mice were colonized with a fecal sample from a selected UC subject (pre and post) and a matched HC. Naturally colonized litters were followed for 12 weeks, after which proteolytic activities and signs of inflammation were measured.
Results
Fecal proteolytic and elastase activity was increased in pre- and post-UC samples compared to HCs. Metagenomics revealed over 20k genes were significantly different between HC and pre-UC samples, and of these, 440 related to proteases and peptidases. Increased fecal proteolytic activity, higher lipocalin levels, and increased colonic polymorphonuclear cells in colonic H&E sections was observed in pre- and post-UC colonized mice compared to HC colonized mice. Mice colonized with pre-UC microbiota showed increased mRNA expression of genes linked to immunological disease, antimicrobial and inflammatory responses (ie. Tlr2, Tlr5, Nod2, and Il1b) as compared to HC colonized mice.
Conclusions
These results suggest increased fecal proteolytic activity is observed prior to the onset and clinical diagnosis of UC in patients at-risk for IBD, and upon transfer to mice born from colonized GF dams, low-grade inflammation develops. These pathways could be developed as novel non-invasive biomarkers to monitor at-risk populations. Submitted on behalf of the CCC-GEM Project consortium. Supported by CCC GIA to EF Verdu
Funding Agencies
CCC
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Affiliation(s)
- H J Galipeau
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - W Turpin
- University of Toronto, Toronto, ON, Canada
| | - A Caminero Fernandez
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - A Santiago
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - J Libertucci
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - M Bermudez-Brito
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - S Armstrong
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - L Bedrani
- University of Toronto, Toronto, ON, Canada
| | - K Croitoru
- Mount Sinai Hospital, Toronto, ON, Canada
| | - E Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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17
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Kumar S, King EC, Christison AL, Kelly AS, Ariza AJ, Borzutzky C, Cuda S, Kirk S, Ali L, Armstrong S, Binns H, Brubaker J, Cristison A, Fox C, Gordon C, Hendrix S, Hes D, Jenkins L, Joseph M, Heyrman M, Liu L, McClure A, Hofley M, Negrete S, Novick M, O'Hara V, Rodrue J, Santos M, Stoll J, Stratbucker W, Sweeney B, Tester J, Walka S, deHeer H, Wallace S, Walsh S, Wittcopp C, Weedn A, Yee J, Grace B. Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER. J Pediatr 2019; 208:57-65.e4. [PMID: 30853195 DOI: 10.1016/j.jpeds.2018.12.049] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. STUDY DESIGN This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. RESULTS We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. CONCLUSIONS Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02121132.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Adolfo J Ariza
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Claudia Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA; Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, CA
| | - Suzanne Cuda
- Department of Pediatrics, Pediatric Weight Management, Children's Hospital of San Antonio, Baylor College of Medicine, Houston, TX
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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18
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Deng BH, Rouillard M, Feng P, Beall M, Armstrong S, Castellanos J, Kinley J, Leinweber HK, Ottaviano A, Settles G, Snitchler G, Wells J, Ziaei S, Thompson M. Development of a three-wave far-infrared laser interferometry and polarimetry diagnostic system for the C-2W field-reversed configuration plasmas. Rev Sci Instrum 2018; 89:10B109. [PMID: 30399682 DOI: 10.1063/1.5036977] [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] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
Great advancements in modern field-reversed configuration (FRC) experiments motivated the development of a 14-chord three-wave far infrared (FIR) laser interferometry and polarimetry diagnostic system, which can provide simultaneous high temporal resolution measurements of density and Faraday rotation profiles with high accuracy. The unique challenges facing FIR diagnostics in high beta FRC plasmas are the extremely small (<0.5°) Faraday rotation angles, and severe laser beam refraction effects due to high density gradient and choice of long wavelength. The diagnostic system design and development are described with methods to overcome the challenges, and initial experimental data are also presented.
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Affiliation(s)
- B H Deng
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - M Rouillard
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - P Feng
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - M Beall
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - S Armstrong
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - J Castellanos
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - J Kinley
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - H K Leinweber
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - A Ottaviano
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - G Settles
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - G Snitchler
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - J Wells
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - S Ziaei
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - M Thompson
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
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19
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Horne JC, Robinson K, Sims E, Stirling S, Sach T, Armstrong S, Logan PA. 24IMPROVING TRIAL RECRUITMENT IN CARE HOMES: THE FALLS IN CARE HOME (FINCH) EXPERIENCE. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - K Robinson
- Research and Innovation, Nottinghamshire Healthcare NHS Trust
| | - E Sims
- Norwich Clinical Trials Units, University of East Anglia, UK
| | - S Stirling
- Norwich Clinical Trials Units, University of East Anglia, UK
| | - T Sach
- Norwich Clinical Trials Units, University of East Anglia, UK
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20
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Shah R, Horner S, Armstrong S, Sanders S. 124DAY HOSPITAL ALCOHOL CONSUMPTION REVIEW. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Shah
- Templar Day Hospital, St John’s Hospital, Howden, Livingston
| | - S Horner
- Templar Day Hospital, St John’s Hospital, Howden, Livingston
| | - S Armstrong
- Templar Day Hospital, St John’s Hospital, Howden, Livingston
| | - S Sanders
- Templar Day Hospital, St John’s Hospital, Howden, Livingston
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21
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Campos-Pires R, Armstrong S, Sebastiani A, Luh C, Gruss M, Radyushkin K, Hirnet T, Werner C, Engelhard K, Franks N, Thal S, Dickinson R. Xenon treatment improves short-term and long-term outcomes in a rodent model of traumatic brain injury. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Robinson KR, Long AL, Leighton P, Armstrong S, Pulikottill-Jacob R, Gladman JRF, Gordon AL, Logan P, Anthony KA, Harwood RH, Blackshaw PE, Masud T. Chair based exercise in community settings: a cluster randomised feasibility study. BMC Geriatr 2018; 18:82. [PMID: 29614960 PMCID: PMC5883353 DOI: 10.1186/s12877-018-0769-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. Methods A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. Results 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. Conclusion There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible. Trial registration ISRCTN27271501. Date registered: 30/01/2018. Electronic supplementary material The online version of this article (10.1186/s12877-018-0769-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K R Robinson
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK. .,Duncan McMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - A L Long
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - P Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - S Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - J R F Gladman
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - P Logan
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - K A Anthony
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - R H Harwood
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P E Blackshaw
- Medical Physics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Masud
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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23
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Braga S, Oliveira L, Rodrigues RB, Bicalho AA, Novais VR, Armstrong S, Soares CJ. The Effects of Cavity Preparation and Composite Resin on Bond Strength and Stress Distribution Using the Microtensile Bond Test. Oper Dent 2017; 43:81-89. [PMID: 28976839 DOI: 10.2341/16-338-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the effect of flowable bulk-fill or conventional composite resin on bond strength and stress distribution in flat or mesio-occlusal-distal (MOD) cavity preparations using the microtensile bond strength (μTBS) test. METHODS Forty human molars were divided into two groups and received either standardized MOD or flat cavity preparations. Restorations were made using the conventional composite resin Z350 (Filtek Z350XT, 3M-ESPE, St Paul, MN, USA) or flowable bulk-fill (FBF) composite resin (Filtek Bulk Fill Flowable, 3M-ESPE). Postgel shrinkage was measured using the strain gauge technique (n=10). The Z350 buildup was made in two increments of 2.0 mm, and the FBF was made in a single increment of 4.0 mm. Six rectangular sticks were obtained for each tooth, and each section was used for μTBS testing at 1.0 mm/min. Polymerization shrinkage was modeled using postgel shrinkage data. The μTBS data were analyzed statistically using a two-way analysis of variance (ANOVA), and the postgel shrinkage data were analyzed using a one-way ANOVA with Tukey post hoc test. The failure modes were analyzed using a chi-square test (α=0.05). RESULTS Our results show that both the type of cavity preparation and the composite resin used affect the bond strength and stress distribution. The Z350 composite resin had a higher postgel shrinkage than the FBF composite resin. The μTBS of the MOD preparation was influenced by the type of composite resin used. Irrespective of composite resin, flat cavity preparations resulted in higher μTBS than MOD preparations ( p<0.001). Specifically, in flat-prepared cavities, FBF composite resin had a similar μTBS relative to Z350 composite resin. However, in MOD-prepared cavities, those with FBF composite resin had higher μTBS values than those with Z350 composite resin. Adhesive failure was prevalent for all tested groups. The MOD preparation resulted in higher shrinkage stress than the flat preparation, irrespective of composite resin. For MOD-prepared cavities, FBF composite resin resulted in lower stress than Z350 composite resin. However, no differences were found for flat-prepared cavities. CONCLUSIONS FBF composite resin had lower shrinkage stress than Z350 conventional composite resin. The μTBS of the MOD preparation was influenced by the composite resin type. Flat cavity preparations had no influence on stress and μTBS. However, for MOD preparation, composite resin with higher shrinkage stress resulted in lower μTBS values.
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Girach J, Armstrong S, Nath M, Somani R, Stafford P, Ng G, Sandilands A. 41Evolution of PROMS data and what it tells us about patients undergoing catheter ablation for atrial fibrillation. Europace 2017. [DOI: 10.1093/europace/eux283.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hardefeldt LY, Holloway S, Trott DJ, Shipstone M, Barrs VR, Malik R, Burrows M, Armstrong S, Browning GF, Stevenson M. Antimicrobial Prescribing in Dogs and Cats in Australia: Results of the Australasian Infectious Disease Advisory Panel Survey. J Vet Intern Med 2017; 31:1100-1107. [PMID: 28514013 PMCID: PMC5508328 DOI: 10.1111/jvim.14733] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 12/11/2016] [Revised: 03/15/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background Investigations of antimicrobial use in companion animals are limited. With the growing recognition of the need for improved antimicrobial stewardship, there is urgent need for more detailed understanding of the patterns of antimicrobial use in this sector. Objectives To investigate antimicrobial use for medical and surgical conditions in dogs and cats by Australian veterinarians. Methods A cross‐sectional study was performed over 4 months in 2011. Respondents were asked about their choices of antimicrobials for empirical therapy of diseases in dogs and cats, duration of therapy, and selection based on culture and susceptibility testing, for common conditions framed as case scenarios: 11 medical, 2 surgical, and 8 dermatological. Results A total of 892 of the 1,029 members of the Australian veterinary profession that completed the survey satisfied the selection criteria. Empirical antimicrobial therapy was more common for acute conditions (76%) than chronic conditions (24%). Overall, the most common antimicrobial classes were potentiated aminopenicillins (36%), fluoroquinolones (15%), first‐ and second‐generation cephalosporins (14%), and tetracyclines (11%). Third‐generation cephalosporins were more frequently used in cats (16%) compared to dogs (2%). Agreement with Australasian Infectious Disease Advisory Panel (AIDAP) guidelines (generated subsequently) was variable ranging from 0 to 69% between conditions. Conclusions and Clinical Importance Choice of antimicrobials by Australian veterinary practitioners was generally appropriate, with relatively low use of drugs of high importance, except for the empirical use of fluoroquinolones in dogs, particularly for otitis externa and 3rd‐generation cephalosporins in cats. Future surveys will determine whether introduction of the 2013 AIDAP therapeutic guidelines has influenced prescribing habits.
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Affiliation(s)
- L Y Hardefeldt
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - S Holloway
- Advanced Vetcare, Kensington, Vic., Australia
| | - D J Trott
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, SA, Australia
| | - M Shipstone
- School of Veterinary Sciences, University of Queensland, Gatton, Qld, Australia
| | - V R Barrs
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - R Malik
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - M Burrows
- Animal Dermatology, Perth, WA, Australia
| | - S Armstrong
- Zoetis Animal Health, Rhodes, NSW, Australia
| | - G F Browning
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - M Stevenson
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
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Walker GM, Logan P, Gordon AL, Conroy S, Armstrong S, Robertson K, Ward M, Frowd N, Darby J, Arnold G, Gladman JRF. 45 * ARE ACCELEROMETERS A USEFUL WAY TO MEASURE ACTIVITY IN CARE HOME RESIDENTS? Age Ageing 2015. [DOI: 10.1093/ageing/afv032.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Armstrong S, Fernando R, Tamilselvan P, Stewart A, Columb M. The effect of serial in vitro haemodilution with maternal cerebrospinal fluid and crystalloid on thromboelastographic (TEG®) blood coagulation parameters, and the implications for epidural blood patching. Anaesthesia 2014; 70:135-41. [DOI: 10.1111/anae.12911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. Armstrong
- Department of Anaesthesia; Frimley Health NHS Foundation Trust; Frimley UK
| | - R. Fernando
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - P. Tamilselvan
- Department of Anaesthesia; The Princess Alexandra Hospital; Harlow UK
| | - A. Stewart
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - M. Columb
- Department of Anaesthesia; South Manchester University Hospitals NHS Trust; Wythenshawe UK
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Armstrong S, Garfield S. Assessing Assessment: Does Health Technology Assessment Do Its Job of Controlling Costs Without Compromising Quality? Value Health 2014; 17:A420. [PMID: 27201065 DOI: 10.1016/j.jval.2014.08.1027] [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]
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Deng BH, Kinley JS, Knapp K, Feng P, Martinez R, Weixel C, Armstrong S, Hayashi R, Longman A, Mendoza R, Gota H, Tuszewski M. Far infrared laser polarimetry and far forward scattering diagnostics for the C-2 field reversed configuration plasmas. Rev Sci Instrum 2014; 85:11D401. [PMID: 25430164 DOI: 10.1063/1.4884903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A two-chord far infrared (FIR) laser polarimeter for high speed sub-degree Faraday rotation measurements in the C-2 field reversed configuration experiment is described. It is based on high power proprietary FIR lasers with line width of about 330 Hz. The exceptionally low intrinsic instrument phase error is characterized with figures of merit. Significant toroidal magnetic field with rich dynamics is observed. Simultaneously obtained density fluctuation spectra by far forward scattering are presented.
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Affiliation(s)
- B H Deng
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - J S Kinley
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - K Knapp
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - P Feng
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - R Martinez
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - C Weixel
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - S Armstrong
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - R Hayashi
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - A Longman
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - R Mendoza
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - H Gota
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
| | - M Tuszewski
- Tri Alpha Energy, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688, USA
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Roche T, Sun X, Armstrong S, Knapp K, Slepchenkov M. Langmuir probe diagnostic suite in the C-2 field-reversed configuration. Rev Sci Instrum 2014; 85:11D824. [PMID: 25430237 DOI: 10.1063/1.4890535] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Several in situ probes have been designed and implemented into the diagnostic array of the C-2 field-reversed configuration (FRC) at Tri Alpha Energy [M. Tuszewski et al. (the TAE Team), Phys. Rev. Lett. 108, 255008 (2012)]. The probes are all variations on the traditional Langmuir probe. They include linear arrays of triple probes, linear arrays of single-tipped swept probes, a multi-faced Gundestrup probe, and an ion-sensitive probe. The probes vary from 5 to 7 mm diameter in size to minimize plasma perturbations. They also have boron nitride outer casings that prevent unwanted electrical breakdown and reduce the introduction of impurities. The probes are mounted on motorized linear-actuators allowing for programmatic scans of the various plasma parameters over the course of several shots. Each probe has a custom set of electronics that allows for measurement of the desired signals. High frequency ( > 5MHz) analog optical-isolators ensure that plasma parameters can be measured at sub-microsecond time scales while providing electrical isolation between machine and data acquisition systems. With these probes time-resolved plasma parameters (temperature, density, spatial potential, flow, and electric field) can be directly/locally measured in the FRC jet and edge/scrape-off layer.
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Affiliation(s)
- T Roche
- Tri Alpha Energy Inc., PO Box 7010, Rancho Santa Margarita, California 92688, USA
| | - X Sun
- Department of Modern Physics, University of Science and Technology of China, Hefei Anhui 230026, China
| | - S Armstrong
- Tri Alpha Energy Inc., PO Box 7010, Rancho Santa Margarita, California 92688, USA
| | - K Knapp
- Tri Alpha Energy Inc., PO Box 7010, Rancho Santa Margarita, California 92688, USA
| | - M Slepchenkov
- Tri Alpha Energy Inc., PO Box 7010, Rancho Santa Margarita, California 92688, USA
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Hertz D, DiPaolo A, Armstrong S. Qualitative Research on the Impact Of European Hospital Procurement Practices on Market Access For Disposable Medical Devices. Value Health 2014; 17:A413. [PMID: 27201024 DOI: 10.1016/j.jval.2014.08.990] [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)
- D Hertz
- GfK Market Access, Wayland, MA, USA
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Doyle S, Armstrong S, Bowditch S. Budgetary Implications of Introducing Fluticasone Furoate/Vilanterol for Asthma in the UK. Value Health 2014; 17:A591. [PMID: 27202020 DOI: 10.1016/j.jval.2014.08.2026] [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]
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Mohammad H, Smitheman K, van Aller G, Cusan M, Kamat S, Liu Y, Johnson N, Hann C, Armstrong S, Kruger R. 212 Novel anti-tumor activity of targeted LSD1 inhibition by GSK2879552. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70338-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Doyle S, Armstrong S, Bowditch S. Budgetary Implications of Introducing Fluticasone Furoate/Vilanterol for COPD in the UK. Value Health 2014; 17:A591. [PMID: 27202021 DOI: 10.1016/j.jval.2014.08.2025] [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]
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35
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Garfield S, Armstrong S. Launching Novel Class Iii Implantable Cardiac Devices for Cardiology in Europe First, Is This Common Commercial Practice Improving Health Care Quality for Europeans. Value Health 2014; 17:A503. [PMID: 27201526 DOI: 10.1016/j.jval.2014.08.1521] [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]
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Abstract
Time-lapse imaging of embryos has been widely introduced to fertility laboratories worldwide with the aim of identifying the best quality embryos to transfer that will ultimately improve IVF success rates. In this opinion paper, we explore the lack of evidence of benefit of this novel intervention, analyse the methodological flaws of current studies, offer ideal study designs that assess the various features of time-lapse imaging, and discuss forthcoming studies. In particular, we emphasize the ethical aspects of hastily adopting a costly technology without current high level evidence of improved live birth rates, safety and cost effectiveness.
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Affiliation(s)
- S Armstrong
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - A Vail
- Manchester Academic Health Science Centre, Salford Royal Hospital, Centre for Biostatistics, University of Manchester, Manchester, UK
| | - S Mastenbroek
- Center for Reproductive Medicine, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Affiliation(s)
- P Harris
- WALTHAM; Melton Mowbray United Kingdom
| | - C Roberts
- University of Cambridge; Cambridge UK
| | | | - R Murray
- Animal Health Trust; Newmarket UK
| | - I Handel
- Edinburgh University; Edinburgh UK
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Spong J, Kennedy GA, Tseng J, Brown DJ, Armstrong S, Berlowitz DJ. Sleep disruption in tetraplegia: a randomised, double-blind, placebo-controlled crossover trial of 3 mg melatonin. Spinal Cord 2014; 52:629-34. [DOI: 10.1038/sc.2014.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/03/2014] [Accepted: 05/01/2014] [Indexed: 11/09/2022]
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Oliveira-Cunha M, Bowman V, di Benedetto G, Mitu-Pretorian MO, Armstrong S, Forgacs B, Tavakoli A, Augustine T, Pararajasingam R. Outcomes of methicillin-resistant Staphylococcus aureus infection after kidney and/or pancreas transplantation. Transplant Proc 2014; 45:2207-10. [PMID: 23953529 DOI: 10.1016/j.transproceed.2013.01.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The true extent of Methicillin-Resistant Staphylococcus aureus (MRSA) colonization and incidence of infection after solid organ transplantation in adults and children is not well-known. The aim of this study was to evaluate the incidence and the outcomes of MRSA infection following kidney and/or pancreas transplantation. MATERIAL AND METHODS We reviewed the case notes of all patients who developed MRSA colonization and infection within the first year of transplantation between September 2002 and December 2009. The primary endpoint of this study was mortality. The secondary endpoints included morbidity, graft failure, and length of hospital stay. RESULTS During the study period 1116 transplantations were performed. MRSA colonization was detected in 14 patients (1.25%) and infection occurred in 6 cases (0.53%) post-transplantation. Graft failure was not associated with MRSA colonization/infection in any of the cases. The mortality rate attributed to MRSA was 10% (n = 2). The overall median length of stay was 16 days (range, 6-243 days). CONCLUSIONS Our study demonstrates that the prevalence of MRSA colonization and infection in our unit is low in spite of immunosuppression. The incidence of MRSA infection was higher among patients who underwent pancreas transplantation. Patients who had MRSA colonization and then developed infection had higher morbidity and mortality rates.
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Affiliation(s)
- M Oliveira-Cunha
- Renal and Pancreas Transplant Unit, Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [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: 11/13/2022] Open
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Une D, Armstrong S, Ruel M, David TE. 068 * TWENTY-YEAR DURABILITY OF THE AORTIC HANCOCK II BIOPROSTHESIS IN YOUNG PATIENTS: IS IT DURABLE ENOUGH? Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.68] [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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Wesselmann D, Davidson M, Armstrong S, Schweitzer C, Bruckner D, Potter A. EMDR as a treatment for improving attachment status in adults and children. European Review of Applied Psychology 2012. [DOI: 10.1016/j.erap.2012.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Armstrong S, Fernando R, Columb M. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07284.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bessell EM, Bouliotis G, Armstrong S, Baddeley J, Haynes AP, O'Connor S, Nicholls-Elliott H, Bradley M. Long-term survival after treatment for Hodgkin's disease (1973-2002): improved survival with successive 10-year cohorts. Br J Cancer 2012; 107:531-6. [PMID: 22713660 PMCID: PMC3405204 DOI: 10.1038/bjc.2012.228] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The Nottinghamshire Lymphoma Registry contains the details of all the patients diagnosed with lymphoma (since 1 January 1973) within a defined geographical area with a population of 1.1 million. It was therefore possible to study the outcome of treatment for Hodgkin’s disease for three 10-year cohorts (1973–1982, 1983–1992 and 1993–2002). The aims of the study were to compare survival time among the three patient cohorts, to identify prognostic factors and to estimate relative survival. Methods: A total of 745 patients diagnosed between 1973 and 2002 were analysed for survival. Survivorship was estimated by the Kaplan-Meier method and parametric survival models. An accelerated failure-time regression was used for multivariate analysis. Results: Overall, patients were observed for 9.8 (0.3–34.82) years (median(range)), on average. One, five and fifteen-year disease-specific survival was found to be 87% (85–90%), 77% (74–80%) and 70% (67–74%), respectively. For those for diagnosed between 1973 and 1982, the 15-year survival was found to be 57% for 1983–1992, it was 74% and for 1993–2002, it was 83% (P<0.001). The difference remained significant after adjusting for prognostic factors. The actuarial risk of developing a second malignancy at 20 years was for the 1973–1982 cohort, 12.4%, and for the 1983–1992 cohort, 18.8%. Conclusion: Treatment advances and effective management of toxicities of treatment over time, have resulted in a significantly longer survival for patients with Hodgkin’s disease diagnosed within a defined population.
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Affiliation(s)
- E M Bessell
- Department of Clinical Oncology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Armstrong S, Brown E. 162 Outcomes following prophylactic cranial irradiation (PCI) in extensive small cell lung cancer (ESCLC) delivered in NHS Tayside. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry. Int J Obstet Anesth 2011; 20:293-8. [DOI: 10.1016/j.ijoa.2011.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 05/10/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022]
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Tyan C, Armstrong S, Khan R, Stirrat J, Al-Sherif O, Thompson T, Wisenberg G, Prato F, Drangova M, So A, Lee T, White J. 407 Tissue injury and stress hypo-perfusion in hypertrophic cardiomyopathy: Spatial correlation of T2-wieghted imaging, first-pass stress perfusion imaging and delayed enhancement imaging using cardiovascular magnetic resonance. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.344] [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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Wilmink JM, Veenman JN, van den Boom R, Rutten VPMG, Niewold TA, Broekhuisen-Davies JM, Lees R, Armstrong S, van Weeren PR, Barneveld A. Differences in polymorphonucleocyte function and local inflammatory response between horses and ponies. Equine Vet J 2010; 35:561-9. [PMID: 14515955 DOI: 10.2746/042516403775467234] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
REASONS FOR PERFORMING STUDY Wound healing proceeds faster in ponies than in horses and complications during healing, such as wound infection, occur less frequently in ponies. Earlier studies suggested that this difference might be related to differences in the initial post traumatic inflammatory response. HYPOTHESIS That polymorphonuclear leucocyte (PMN) function and profiles of humoral factors in local inflammatory processes are different in horses and ponies. METHODS PMNs were isolated from venous blood of horses and ponies. Chemotaxis and reactive oxygen species (ROS) production was determined. Tissue cages were implanted in limbs and necks of horses and ponies and injected with carrageenan and, 3 weeks later, with LPS. In sequential samples of inflammatory exudate, the numbers of macrophages and PMNs and the production of PGE2, TNFalpha, IL-1, IL-6 and chemoattractants were determined. RESULTS In vitro ROS production of PMNs was significantly higher in ponies than in horses, whereas in vitro PMN chemotaxis was significantly lower in ponies. In the tissue cages for both stimuli, the production of IL-1 and chemoattractants was significantly higher in ponies than in horses and remained so towards the end of the observation period in ponies. CONCLUSIONS This study demonstrated a higher production of various inflammatory mediators by pony leucocytes. Despite the lower in vitro chemotaxis of pony PMNs, this higher in vivo production resulted in a stronger initial inflammatory response in ponies, as has been reported in studies on wound healing, through the attraction of leucocytes and triggering of the production of other cytokines. A stronger initial inflammation may promote healing by more rapid elemination of contaminants and earlier transition to repair. POTENTIAL RELEVANCE Modulation of the initial inflammatory response might therefore be a valid option for therapeutic intervention in cases of problematic wound healing. Further, the intraspecies differences in leucocyte function may have an impact on many fields in equine medicine.
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Affiliation(s)
- J M Wilmink
- Department of Equine Sciences, Faculty of Veterinary Medicine, University of Utrecht, Yalelaan 12, 3584 CM Utrecht, The Netherlands
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Shroufi A, Copping J, Musonda P, Vivancos R, Langden V, Armstrong S, Slack R. Influenza vaccine uptake among staff in care homes in Nottinghamshire: a random cluster sample survey. Public Health 2009; 123:645-9. [PMID: 19875140 DOI: 10.1016/j.puhe.2009.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/13/2009] [Accepted: 09/22/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish uptake of influenza vaccine amongst care home clinical staff in Greater Nottingham, and to investigate what could be done to improve vaccine uptake in this group. STUDY DESIGN Postal questionnaire surveys were used. In the first instance, a total sample survey was used. In the second instance, a sample of care home staff was surveyed, randomized at the care home level. METHODS A postal questionnaire completed by care home matrons was used to obtain a preliminary estimate of staff vaccine uptake. Individual staff questionnaires were then used to validate this finding, and measure attitudes, beliefs and behaviours associated with vaccination. RESULTS Vaccine uptake among those working in care homes with nursing was found to be low. Vaccine uptake was higher in homes with a policy recommending vaccination of staff. Most respondents who had received vaccination reported that they had done so because of an existing medical condition, rather than because of being a healthcare worker. A statistically significant relationship (P=0.02) was found between individuals' reported beliefs on how well they could resist influenza and their vaccination status. CONCLUSIONS All care homes for the elderly should have a vaccination policy which recommends staff vaccination. Educational campaigns, vaccination in the workplace and free provision of the influenza vaccine may help to improve vaccine uptake in this group.
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Affiliation(s)
- A Shroufi
- NHS Mid Essex, Swift House, Chelmsford CM2 5PF, UK.
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Lin M, Armstrong S, Ronholm J, Dan H, Auclair ME, Zhang Z, Cao X. Screening and characterization of monoclonal antibodies to the surface antigens of Listeria monocytogenes serotype 4b. J Appl Microbiol 2009; 106:1705-14. [PMID: 19226395 DOI: 10.1111/j.1365-2672.2008.04140.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study aims to develop and characterize monoclonal antibodies (Mabs) with high specificity and affinity for surface antigens of an epidemiologically important serotype 4b of Listeria monocytogenes. METHODS AND RESULTS Hybridoma clones were derived from B lymphocytes of mice immunized with L. monocytogenes serotype 4b and screened against this strain by an enzyme-linked immunosorbent assay. Twenty-nine clones secreting Mabs reactive with formalin-killed bacteria were obtained; 15, 8, 5 and 1 Mabs were immunoglobulin subclasses IgG2a, IgG2b, IgM and IgG1, respectively. Immunofluorescence or immunogold labelling demonstrated all except five IgM and one IgG2a Mabs bound to the surface of a live L. monocytogenes serotype 4b. The majority of the 23 surface-binding Mabs recognized linear epitopes on a 77-kDa protein. These surface-binding Mabs exhibited little or no cross-reactivity with non-4b serotypes (1/2a, 1/2b, 3a, etc.) of L. monocytogenes, five other Listeria species, Escherichia coli O157:H7 and Salmonella enterica serovar Typhimurium. CONCLUSIONS The Mabs recognizing a 77-kDa surface protein are novel antibodies with specificity and affinity for L. monocytogenes serotype 4b. SIGNIFICANCE AND IMPACT OF THE STUDY These anti-77 kDa surface protein Mabs may be explored as reagents for the development of Mabs-based diagnostic immunoassays for L. monocytogenes serotype 4b strains.
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Affiliation(s)
- M Lin
- Canadian Food Inspection Agency, Ottawa Laboratory Fallowfield, 3851 Fallowfield Road, Ottawa, Ontario, Canada.
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