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Dubuisson N, de Maere d'Aertrijcke O, Marta M, Gnanapavan S, Turner B, Baker D, Schmierer K, Giovannoni G, Verma V, Docquier MA. Anaesthetic management of people with multiple sclerosis. Mult Scler Relat Disord 2023; 80:105045. [PMID: 37866022 DOI: 10.1016/j.msard.2023.105045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
There is a lack of published guidelines on the management of patients with multiple sclerosis (MS) undergoing procedures that require anaesthesia and respective advice is largely based on retrospective studies or case reports. The aim of this paper is to provide recommendations for anaesthetists and neurologists for the management of patients with MS requiring anaesthesia. This review covers issues related to the anaesthetic management of patients with MS, with a focus on preoperative assessment, choice of anaesthetic techniques and agents, side-effects of drugs used during anaesthesia and their potential impact on the disease evolution, drug interactions that may occur, and the need to use monitoring devices. A systematic PubMed research was performed to retrieve relevant articles.
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Affiliation(s)
- N Dubuisson
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Neuromuscular Reference Center, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
| | - O de Maere d'Aertrijcke
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - M Marta
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Gnanapavan
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B Turner
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK
| | - K Schmierer
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - G Giovannoni
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - V Verma
- Department of Anesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M-A Docquier
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
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Sayed S, Das A, Turner B, Wadhwa VS, Pathak KA. Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism. Ann R Coll Surg Engl 2023; 105:739-746. [PMID: 36748800 PMCID: PMC10618046 DOI: 10.1308/rcsann.2022.0126] [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] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). OBJECTIVE Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and 99mTc-MIBI-SPECT/CT). METHODS This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and 99mTc-MIBI-SPECT/CT (SpCT), or discordance between them, had 4D-CT performed in this study. RESULTS One hundred and two sporadic cases of pHPT with failed/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and 99mTc-MIBI-SPECT/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. CONCLUSION 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes.
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Affiliation(s)
- S Sayed
- CancerCare Manitoba, Winnipeg, Canada
| | - A Das
- Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - B Turner
- CancerCare Manitoba, Winnipeg, Canada
| | - V S Wadhwa
- Cedars Sinai Medical Center, Los Angeles, USA
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Sinclair AJ, Bellary S, Dashora U, Abdelhafiz AH, Rowles S, Reedman L, Turner B, Green M, Forbes A, Middleton A. Enhancing diabetes care for the most vulnerable in the 21st century: Interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD). Diabet Med 2023:e15088. [PMID: 36929728 DOI: 10.1111/dme.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 'quick-wins' were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People and King's College, London, UK
| | - S Bellary
- University of Aston and University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - U Dashora
- East Sussex Healthcare NHS Trust and Joint British Diabetes Societies-IP Care JBDS-IP and Association of British Clinical Diabetologists (ABCD), Malmesbury, UK
| | - A H Abdelhafiz
- Rotherham NHS Foundation Trust and Older Peoples Diabetes Network (OPDN), Rotherham, UK
| | - S Rowles
- Pennine Acute Hospitals NHS Trust and ABCD, Manchester, UK
| | | | | | | | | | - A Middleton
- Person Living with Diabetes (PLWD) and Diabetes, UK Diabetes Research Steering Group, London, UK
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Dhakal A, O’Regan R, Falkson C, Hicks D, Hawkins D, Turner B, Mohile N. Abstract OT1-10-02: Trial of Neratinib Plus Capecitabine in Subjects With HER2-Negative Metastatic Breast Cancer With Brain Metastases and Abnormally Active HER2 Signaling. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot1-10-02] [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: 03/06/2023]
Abstract
Abstract
Background: Development of brain metastasis (BM) portends poor prognosis in patients (pts) with metastatic breast cancer (MBC) mainly due to lack of systemic therapy with strong activity in CNS. While survival in HER2+ BC BMs has improved due to development of various HER2 therapies with activity against BM, outcome for HER2- BC BMs remains dismal. A novel assay (CELsignia) which measures underlying HER2 signal (HS) of live cancer cells in response to HER2 agonists & antagonists showed that about 25% of BC deemed HER2- by standard methods have underlying abnormal HS. Preclinical data showed various HER2 therapies inhibit tumor growth of such HER2- BC with abnormal HS. Among tested HER2 inhibitors with known CNS activity, neratinib had the lowest IC50. We propose a trial which identifies HER2- BC BM pts with abnormal HS & assesses activity of neratinib based therapy. Design: This is a phase II single arm study with 2 steps- step 0 (biopsy) & step 1 (treatment). Pts eligible for Step 0 will be registered as “Immediate Treatment (IT)” (intent to register to Step 1 immediately) or “Future Treatment” [registration can be delayed up to 28 weeks (wks)] & undergo biopsy of most accessible extra CNS (eCNS) tumor. Tumor will be sent for CELsignia testing (2 wks turn around). Additional biopsies may be obtained for standard of care (SOC). IT pts can be treated with a brief course of capecitabine 1gm/m2 BID for 1 wk followed by 1 wk off while waiting for CELsigia result. Pts with BC having abnormal HS will be screened & registered to step 1. Enrolled pts will receive neratinib 240mg daily (with SOC antidiarrheal prophylaxis) + capecitabine 750mg/m2 BID for 2 wks in every 3 wks cycle (C). Tumor assessments will be done prior to C3, 5 & 7 then every 12 wks with MRI brain, CT chest abdomen pelvis & bone scan using RECIST1.1 (eCNS disease) and a modified BM RANO criteria (>5mm, measurable disease, CNS). In isolated CNS progression, investigators have option of treatment beyond progression after SOC local treatment of progressing BMs. Key Eligibility Criteria: Step 0: Inclusion Criteria (IC): histologically confirmed HER2- BC (primary or metastatic); has radiological evidence of BM; prior treatment with CDK4/6 inhibitor + endocrine therapy required for hormone receptor+ BC, no prior specific treatment required for triple negative BC; radiological evidence of eCNS measurable disease (RECIST1.1) accessible for biopsy. Exclusion Criteria (EC): prior use of capecitabine in metastatic setting; known/suspected leptomeningeal disease. Step 1: IC: Abnormal HS; New or progressing BM that is measurable (>5mm); minimum washout periods in wks: last chemotherapy 2, hormonal therapy 1 except fulvestrant 4, targeted therapies 3, eCNS radiation 1, any investigational treatment 4. ECOG performance status 0-2; adequate end organ functions. EC: whole brain radiation in last 3 months (m). Endpoints: Co-primary: Overall survival (OS) and CNS progression free survival (CNS PFS). Key Secondary: Objective response rate, clinical benefit rate and duration of response (CNS using BM RANO, eCNS using RECIST1.1), eCNS PFS, various feasibility endpoints. Safety. Statistical methods: To detect 70% improvement in this trial in CNS PFS and OS compared to historical control (BEACON trial BM subset) 2.7m vs. 4.6m and 4.8m vs. 8.2 m with 80% power and 1-sided 5% significance level, a sample size of 22 is required. About 88 patients will undergo biopsy to enroll 22 pts in step 1. One futility assessment is planned when the first 12 pts have been treated for at least 6 wks or have failed (died or progressed) prior to 6 wks. If 9 or more in the first 12 have died or progressed by 6 wks of treatment, the study will close for futility. PFS and OS will be analyzed using Kaplan-Meier survival functions. Contact: Ajay Dhakal MBBS, ajay_dhakal@urmc.rochester.edu NCT#: NCT04965064 Funding: Celcuity, Puma Biotechnology Status: IRB approved. Anticipated activation Aug 2022, Accrual duration: 2 years. Seeking participating sites.
Citation Format: Ajay Dhakal, Ruth O’Regan, Carla Falkson, David Hicks, Douglas Hawkins, Bradley Turner, Nimish Mohile. Trial of Neratinib Plus Capecitabine in Subjects With HER2-Negative Metastatic Breast Cancer With Brain Metastases and Abnormally Active HER2 Signaling [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-10-02.
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Affiliation(s)
- Ajay Dhakal
- 1University of Rochester Medical Center, Rochester, New York
| | - Ruth O’Regan
- 2University of Rochester Medical Center, Rochester, New York
| | - Carla Falkson
- 3Wilmot Cancer Institute, University of Rochester Medical Center
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Khoury T, Rosa M, Nayak A, Karabakhtsian R, Fadare O, Li Z, Turner B, Fang Y, Kumarapeli A, Li X, Numbere N, Villatoro T, Wang JG, Sadeghi S, Attwood K, George A, Bhargava R. Clinicopathologic Predictors of Clinical Outcomes in Mammary Adenoid Cystic Carcinoma: A Multi-institutional Study. Mod Pathol 2023; 36:100006. [PMID: 36853781 PMCID: PMC10952059 DOI: 10.1016/j.modpat.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma (AdCC) is an uncommon type of invasive breast carcinoma with a favorable prognosis. However, some cases are aggressive. The study aims to define the clinicopathologic predictors of outcome. Clinical, radiological, and pathologic variables were recorded for 76 AdCC cases from 11 institutions. The following histologic characteristics were evaluated by the breast pathologist in each respective institution, including Nottingham grade (NG), percentages of various growth patterns (solid, cribriform, trabecular-tubular), percentage of basaloid component, tumor borders (pushing, infiltrative), perineural invasion, lymphovascular invasion, necrosis, and distance from the closest margin. Various grading systems were evaluated, including NG, salivary gland-type grading systems, and a new proposed grading system. The new grading system incorporated the growth pattern (percent solid, percent cribriform), percent basaloid morphology, and mitotic count using the Youden index criterion. All variables were correlated with recurrence-free survival. Nineteen (25%) women developed local and/or distant recurrence. Basaloid morphology (≥25% of the tumor) was identified in 20 (26.3%) cases and a solid growth pattern (using ≥60% cutoff) in 22 (28.9%) cases. In the univariate analysis, the following variables were significantly correlated with worse recurrence-free survival: solid growth pattern, basaloid morphology, lymphovascular invasion, necrosis, perineural invasion, and pN-stage. In the multivariate analysis including basaloid morphology, pN-stage, lymphovascular invasion, and perineural invasion, basaloid morphology was statistically significant, with a hazard ratio of 3.872 (95% CI, 1.077; 13.924; P =.038). The NG and the new grading system both correlated with recurrence-free survival. However, grade 2 had a similar risk as grade 3 in the NG system and a similar risk as grade 1 in the new grading system. For solid growth patterns and basaloid morphology, using a 2-tier system with 1 cutoff was better than a 3-tier system with 2 cutoffs. Basaloid morphology and solid growth pattern have prognostic values for AdCC, with a 2-tier grading system performing better than a 3-tier system.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
| | - Marilin Rosa
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Anupma Nayak
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rouzan Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego Health, La Jolla, California
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Turner
- Department of Pathology, University of Rochester, Rochester, New York
| | - Yisheng Fang
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Asangi Kumarapeli
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xiaoxian Li
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Numbereye Numbere
- Department of Pathology, University of Rochester, Rochester, New York
| | - Tatiana Villatoro
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
| | - Ji-Gang Wang
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Saed Sadeghi
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Anthony George
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
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Price G, Devaney S, French DP, Holley R, Holm S, Kontopantelis E, McWilliam A, Payne K, Proudlove N, Sanders C, Willans R, van Staa T, Hamrang L, Turner B, Parsons S, Faivre-Finn C. Can Real-world Data and Rapid Learning Drive Improvements in Lung Cancer Survival? The RAPID-RT Study. Clin Oncol (R Coll Radiol) 2022; 34:407-410. [PMID: 35000827 DOI: 10.1016/j.clon.2021.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- G Price
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
| | - S Devaney
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - D P French
- Manchester Centre of Health Psychology, The University of Manchester, Manchester, UK
| | - R Holley
- Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - S Holm
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - E Kontopantelis
- Centre for Health Services Research, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
| | - A McWilliam
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - K Payne
- Manchester Centre for Health Economics, Health Sciences Research Group, The University of Manchester, Manchester, UK
| | - N Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - C Sanders
- NIHR Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - R Willans
- Data Analytics Unit, National Institute for Health and Care Excellence, Manchester, UK
| | - T van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, UK
| | - L Hamrang
- RAPID-RT PPI Advisory Group, Manchester, UK
| | - B Turner
- RAPID-RT PPI Advisory Group, Manchester, UK
| | | | - C Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
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7
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Turner B, Jasionowska S, Bakko F, Huttman M, Hall R, Doshi A, Agarwal T. 349 Improving Surgical Teaching for Junior Trainees Internationally in Light of Covid-19. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.233] [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]
Abstract
Abstract
Aim
During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision.
Method
A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon.
Results
Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in >30 countries with >200 feedback responses and an average rating of 4.5/5.
Conclusions
Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.
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Affiliation(s)
- B. Turner
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Jasionowska
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - F. Bakko
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M. Huttman
- University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Hall
- Warwick University, Warwick, United Kingdom
| | - A. Doshi
- Barts Health NHS Trust, London, United Kingdom
| | - T. Agarwal
- London Northwest Healthcare Trust, London, United Kingdom
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Katerji H, Zhang H, Wang X, Schiffhauer L, Dhakal A, Huston A, Falkson C, Hicks D, Turner B. Abstract P3-09-19: The utility of using genomic testing on needle core biopsies during the COVID-19 pandemic: Molecular characterization, risk stratification, neoadjuvant outcome, and future implications. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-09-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The COVID-19 pandemic has caused an extraordinary challenge for global health. New guidelines were implemented, including postponing non-essential surgical procedures to conserve resources. In response, the COVID19 Pandemic Breast Cancer Consortium expert opinion suggested the use of core biopsies for genomic testing to help triage patients for surgical vs. systemic treatment. To better understand how expedited genomic results could impact peri-operative care, we performed a pre-operative quality project to assess testing Mammaprint (MP), a 70-gene risk of recurrence assay, and Blueprint (BP), an 80-gene molecular subtyping assay, on core biopsies. Here we report our experience with MP and BP testing on core biopsies, and the correlation between test results and response to neoadjuvant therapy.Design: From April to December 2020, all core biopsies with a breast carcinoma diagnosis from our clinic (300 patients) were routinely sent for MP and BP testing as part of a rapid result program that was initiated to see whether test results could be obtained in time and whether they would lead to more informed pre-operative treatment decisions. Unstained slides were sent for genomic and receptor testing concurrently. When genomic results differed from IHC/FISH results or suggested a different treatment plan vs. clinical factors alone, we referred to this as “reclassification.” For those patients who completed their neoadjuvant chemotherapy, we grouped them by their genomic results and by their conventional IHC/FISH/Clinical classification, and compared the outcome.Results: MP and BP results from core biopsy were available for 96.6% of patients (n=290/300). The average time from biopsy to test results was 10 days, and the average lab turnaround time was 5 days. Results were available for tumor conference discussions 100% of the time. MP and BP re-classified 84 of 300 patients (28%) from conventional IHC/FISH subtyping, and reclassified 42 of 195 patients (22%) of patients from their risk category based on traditional clinical factors (Table-1). Of the 38 patients with available post-neoadjuvant therapy outcome, 13 patients (34%) achieved pathologic complete response (pCR). 16 patients were classified as Her-2 enriched by IHC/FISH of which 9 (56%) achieved pCR. MP/BP aligned with the IHC/FISH Her-2 enriched classification in 11/16 patients, while 5 patients were reclassified to Luminal B by MP/BP. Of the 11 patients with concordant IHC/FISH and MP/BP results, 8 achieved pCR (73%), while one of the 5 cases reclassified to Luminal B achieved pCR (20%). Of the patients who were classified Luminal by IHC (9 patients), one patient achieved pCR (11%), and of the patients classified luminal (A or B) by MP/BP (12 patients) two achieved pCR (16%). Of the IHC-triple negative patients and genomic basal patients, three patients achieved pCR in each group (23% and 20%, respectively).Conclusion: Performing MP/BP tests on core needle biopsies hold a high success rate. Incorporating test results into peri-operative discussions may result in better-informed decisions about treatment planning and timing of surgery versus systemic therapy. A higher rate of pCR was seen in the MP/BP Her-2 enriched group compared to the IHC/FISH Her-2 enriched group. Although this workflow was designed to triage patients during the COVID pandemic, this approach has great potential beyond the pandemic.
Table-1: Reclassification Rate vs. path IHC/FISH or Clinical FactorsIHC/FISH/Clinical ◊ Genomic# of reclassified patients/total patients in the corresponding traditional category% of patientsLuminal A ◊ Luminal B25/16116%Luminal A ◊ Her-21/1610.6%Luminal B ◊ Luminal A35/7249%Luminal B ◊ Basal4/726%Her-2 ◊ Luminal A1/313%Her-2 ◊ Luminal B10/3132%Her-2 ◊ Basal1/313%Triple negative ◊ Luminal A4/3611%Triple negative ◊ Luminal B3/368%Clinical high risk ◊ Genomic low risk21/8425%Clinical low risk ◊ Genomic high risk21/11119%
Citation Format: Hani Katerji, Huina Zhang, Xi Wang, Linda Schiffhauer, Ajay Dhakal, Alissa Huston, Carla Falkson, David Hicks, Bradley Turner. The utility of using genomic testing on needle core biopsies during the COVID-19 pandemic: Molecular characterization, risk stratification, neoadjuvant outcome, and future implications [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-19.
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Affiliation(s)
| | | | - Xi Wang
- University of Rochester, Rochester, NY
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9
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Dixon L, Biggs S, Turner B, Embury-Young Y, Wood F, Leandro L, Lok P, Scroggie D. 1113 Surgical Innovators or Spin Doctors: Reporting of Expectations for Robotic Gastrointestinal Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
The use of robotics in gastrointestinal surgery is an increasingly popular area of surgical innovation. Despite uncertainty regarding clinical benefits, gastrointestinal surgery centres continue to introduce robotic services. This may be motivated by perceived benefits, in lieu of substantial empirical benefits. We aimed to summarise the expected advantages and disadvantages of robotic techniques in gastrointestinal surgery, as reported by study authors.
Method
A systematic review was undertaken by the trainee led RoboSurg Collaborative. Searches were conducted on of Embase, Medline, the Cochrane Library and Web of Science. Articles were double screened by abstract, then full text. All primary studies reporting outcomes following robotic cholecystectomy or oesophagectomy were included. Reports of expected benefits and disadvantages or robotic techniques were extracted verbatim, and summarised using descriptive statistics.
Results
We included 192 studies. An expected benefit was reported in 161 (84%). Of those, 127 (79%) expected robotics to have an intra-operative advantage, such as reduced operative time, improved dexterity and improved visualisation. Post-operative benefits, such as reduced recovery time and shorter length of hospital stay, were expected in 72 (45%). Expected disadvantages were reported in 96 (50%) of the included studies. Of those, 74 (77%) expected robotics to have intra-operative disadvantages such as increased operative times and lack of tactile feedback. Increased cost was another commonly expected limitation.
Conclusions
Study authors reported perceived benefits more frequently than disadvantages. Perceived benefits were more commonly advantageous to the surgeon rather than the patient. There were directly conflicting perceptions of how robotic techniques affect operative times.
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Affiliation(s)
- L Dixon
- University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - S Biggs
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - B Turner
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Y Embury-Young
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - F Wood
- University of Bristol, Bristol, United Kingdom
| | - L Leandro
- University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - P Lok
- University of East Anglia, Norwich, United Kingdom
| | - D Scroggie
- University of Bristol, Bristol, United Kingdom
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Turner B, Thomas R, Procassini R, Grange K. Neutron calorimeter design for pulsed neutron experiment diagnostics. Rev Sci Instrum 2021; 92:093304. [PMID: 34598510 DOI: 10.1063/5.0058349] [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: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
Neutron calorimeter for diagnostic support of both fission- and fusion-based pulsed neutron experiments is described. The calorimeter generates a voltage signal output via a pair of thermocouples contacting a sample material, which experiences a temperature increase due to interactions with an incident neutron fluence. Advantages of the calorimeter include the versatility derived from its small size, modularity, and the variety of employable neutron absorber materials and sizes. These characteristics permit use with neutron energies between the thermal and fast (up to 14 MeV) spectra. Design overview and requirements, Monte Carlo particle transport simulation results, test data, and possibilities for calorimeter development are provided and discussed.
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Affiliation(s)
- B Turner
- Lawrence Livermore National Laboratory, P. O. Box 808, L-125, Livermore, California 94550, USA
| | - R Thomas
- Lawrence Livermore National Laboratory, P. O. Box 808, L-125, Livermore, California 94550, USA
| | - R Procassini
- Lawrence Livermore National Laboratory, P. O. Box 808, L-125, Livermore, California 94550, USA
| | - K Grange
- Lawrence Livermore National Laboratory, P. O. Box 808, L-125, Livermore, California 94550, USA
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11
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Higginbotham G, Hollowood F, Lok P, Turner B, Gull E, Kirkham EN. P11 A systematic review of the reporting of robotic cholecystectomy. BJS Open 2021. [DOI: 10.1093/bjsopen/zrab032.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Robotic cholecystectomy (RC) is reported to be an innovative alternative to laparoscopic cholecystectomy for the surgical management of gallbladder disease. Perceived technical benefits of RC include enhanced ergonomic capabilities and visualisation. Whilst RC is becoming increasingly widespread, there is a paucity of high-quality data supporting its use, and conflicting evidence of outcomes in current literature. With accumulating reports citing complications associated with novel invasive procedures, experts have suggested that robust clinical evaluation is required. It is vital that techniques such as RC are evaluated consistently, in order for surgeons to fully educate patients about the treatment and obtain informed consent. This study aims to summarise and appraise the reporting of studies of RC.
Methods
Systematic searches identified all published studies reporting RC. Data collection was based on the IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework. This will be used to identify key areas of reporting including; general study characteristics, patient selection, regulatory and governance arrangements, operator and centre expertise, technique description, and outcome reporting. Because the study will not aim to draw conclusions about the effectiveness of robotic surgery, meta-analyses will not be not performed.
Results
Systematic searches identified 1425 abstracts; 90 full-text papers were included. Results will be summarised in a narrative synthesis and further data will be analysed prior to presentation.
Conclusion
This in-depth analysis of the published literature on RC will provide evidence to understand how this innovative procedure has been introduced and evaluated in relation to the IDEAL recommendations.
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Affiliation(s)
| | | | - P Lok
- North Bristol NHS Trust, Bristol, UK
| | - B Turner
- North Bristol NHS Trust, Bristol, UK
| | - E Gull
- North Bristol NHS Trust, Bristol, UK
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Zhang H, Ajabnoor R, Hicks D, Turner B. Abstract PS6-48: Clinicopathologic features and follow-up outcomes of breast cancers with HER2 FISH group 3 Results: A single institution experience. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: There is dearth information on the long-term outcome and role of HER2 targeted therapy in breast cancer patients in the HER2 FISH group 3 category, which is defined as breast cancer with a HER2/CEP17 ratio < 2 and HER2 copy number ≥ 6 signals/cell. In this study, we report the clinicopathologic features and outcomes of breast cancer patients in the HER2 FISH group 3 category at our institution. METHODS: We identified 52/2,874 (1.8%) breast cancer patients with HER2 FISH group 3 results between 1/2007 and 3/2020. 28 of these 52 patients had available detailed clinicopathologic and follow-up data, with an average follow-up of 38.5 months. RESULTS: Most of the cases with group 3 FISH results were high grade ductal carcinomas with positive hormonal receptor expressions and equivocal HER2 expression by immunohistochemistry. Among all the clinicopathologic variables, only tumor size (p=0.048) significantly contributed to the poor clinical outcomes. HER2 copy number failed to show any significant association with histologic grade, tumor size, clinical stage, hormonal receptor status or disease outcomes. There was no statistically significant difference in disease outcome between patients who were treated with HER2 targeted therapy and patients who did not receive HER2 targeted therapy, regardless of the HER2 copy number or clinical stage (Table 1). CONCLUSION: Our preliminary findings suggest that certain patients with HER2 FISH group 3 category breast cancer may not need HER-2 targeted therapy. Larger-scale studies are needed to further evaluate which HER2 FISH group 3 results are more likely to benefit from the HER-2 targeted therapy.
Table 1. Response to HER2 targeted therapy in HER2 FISH group 3 breast cancer patients based on HER2 copy numbers and clinical stageHER 2 targeted therapyp-valueGivenNot givenTotal populationGood outcome (n=21)1380.371Bad outcome (n=7)61HER2 copy number < 10Good outcome (n=16)1060.366Bad outcome (n=7)61HER2 copy number ≥ 10Good outcome (n=5)321.000Bad outcome (n=0)00Stage I-IIGood outcome (n=16)970.737Bad outcome (n=3)21Stage III-IVGood outcome (n=5)410.343Bad outcome (n=4)40*Good outcome = No evidence of disease**Bad outcome = Local recurrence, distant metastasis, and/or died of disease
Citation Format: Huina Zhang, Rana Ajabnoor, David Hicks, Bradley Turner. Clinicopathologic features and follow-up outcomes of breast cancers with HER2 FISH group 3 Results: A single institution experience [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-48.
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Affiliation(s)
- Huina Zhang
- 1University of Rochester Medical Center, Rochester, NY
| | - Rana Ajabnoor
- 2King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - David Hicks
- 1University of Rochester Medical Center, Rochester, NY
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Brown E, Desa D, Wu W, Hill R, Martens J, Strawderman R, Turner B. Abstract PS19-08: Intratumoral heterogeneity of second-harmonic generation scattering from tumor collagen and its effects on metastatic risk prediction. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps19-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Second harmonic generation (SHG) is an intrinsic optical signal that can be generated from fibrillar collagen. The directionality of SHG emission is influenced by the diameter and spacing of collagen fibrils, and the disorder in their packing within collagen fibers. One measure of SHG directionality is the ratio of forward- to backward-scattered SHG, or “F/B”. F/B has been used to assess healthy vs diseased tissue in breast, ovarian, and lung cancer, and is an independent prognostic indicator of metastasis free survival time in ER+, lymph node-negative (N0), invasive ductal carcinoma (IDC). Here we assess the heterogeneity in F/B within tumor sections from ER+ N0 IDC, and its effect on the use of F/B for metastatic risk prediction. We find that F/B of tumor collagen varies between the tumor/host interface and the more cellular tumor bulk (p<0.0001, Student’s t-test), and that F/B from the tumor/host interface, but not tumor bulk, is prognostic of metastasis free survival in 95 IDC ER+ N0 patients (p=0.0020 and 0.10, respectively, log rank test for trend). This result was repeated with two additional image analysis procedures to generate F/B with reduced user input and hence reduced possibility of bias. Using Random Survival Forests to generate a data-driven predictive model, we find that F/B from the tumor/host interface, but not bulk, as well as a 21-gene prognostic score inferred from Affymetrix data, both contribute to predicting metastasis-free survival in this cohort. Any tool to help predict metastasis and assist with treatment decisions is likely to be applied in combination with the now well-established genomic scores. To understand how F/B can support genomic methods for guiding treatment decisions we divided our patient samples into two cohorts based upon the value of their 21-gene score relative to the TAILORx cutoff of 26 (separating low-intermediate and high-risk groups). The F/B value from tumor-host interface identifies a subgroup of patients in the low-intermediate risk group with poor clinical outcome (p=0.045, log rank test for trend). Overall, this data reveals that intratumor heterogeneity can impact the ability of F/B to predict patient outcome, and that F/B specifically from the tumor-host interface may provide a tool to better identify patients in need of adjuvant treatment or enrollment in clinical trials.
Citation Format: Edward Brown, Danielle Desa, Wencheng Wu, Robert Hill, John Martens, Robert Strawderman, Bradley Turner. Intratumoral heterogeneity of second-harmonic generation scattering from tumor collagen and its effects on metastatic risk prediction [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS19-08.
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Affiliation(s)
| | | | | | | | - John Martens
- 3Erasmus University Medical Center, Rotterdam, Netherlands
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Chen C, Turner B, Applegate TJ, Litta G, Kim WK. Role of long-term supplementation of 25-hydroxyvitamin D 3 on egg production and egg quality of laying hen. Poult Sci 2020; 99:6899-6906. [PMID: 33248605 PMCID: PMC7704968 DOI: 10.1016/j.psj.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022] Open
Abstract
A study was conducted to evaluate the effect of dietary 25-hydroxyvitamin D3 (25OHD) on pullet and egg-laying hen growth performance, egg production, and egg quality. Three hundred and ninety 1-day-old Hy-Line W36 pullets were randomly allocated to 3 treatments with 10 replicated cages and 13 birds per cage. Dietary treatments were vitamin D3 at 2,760 IU/kg (D); vitamin D3 at 5,520 IU/kg (DD), and vitamin D3 at 2,760 IU/kg plus 25OHD at 2,760 IU (69 μg)/kg (25D). Body weight and feed intake were recorded at the end of each stage: starter 1 (0–3 wk), starter 2 (4–6 wk), grower (7–12 wk), developer (13–15 wk), prelay (15–17 wk), peaking (18–38 wk), layer 2 (39–48 wk), layer 3 (49–60 wk), layer 4 (61–75 wk), and layer 5 (76–95 wk). Egg production was recorded daily. Egg quality was evaluated every 8 wk starting from 25 wk. There was no difference in growth performance during the rearing period (0–17 wk). In the laying period (18–95 wk), DD showed lower feed intake at layer 2, but higher intake at layer 3 along with lower hen day production (HDP) from 22 to 48 wk compared to the other treatments. During the same period, the DD group laid smaller eggs with higher specific gravity and shell thickness compared with the other treatments or D alone at 40 wk, which may be partly due to the lower body weight. In contrast, 25D had better feed conversion ratio (feed intake per dozen of eggs) at layer 2, and higher overall (22–60 wk) HDP compared with DD. For the egg quality analysis, at 25 and 33 wk, both DD and 25D had higher Haugh unit compared with D. However, 25OHD has no effects on eggshell quality during the entire production period and no beneficial effects on egg production during the later laying period (after 60 wk). In summary, long-term and early supplementation of 25OHD has positive effects on egg production and egg quality, and the beneficial effects were mainly observed during the early laying stage.
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Affiliation(s)
- C Chen
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - B Turner
- DSM Nutritional Products, North America, Animal Nutrition and Health, Parsippany, NJ 07054, USA
| | - T J Applegate
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - Gilberto Litta
- DSM Nutritional Products, Animal Nutrition and Health, Kaiseraugst, Switzerland
| | - W K Kim
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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15
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Affiliation(s)
- B Turner
- Person living with Type 1 diabetes, Director Policy, Campaigns and Care Improvement, Diabetes UK
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16
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Gouveia N, Brito P, Turner B, Lopes V, Bento A, Balsa F, Serra A, Sampaio L, Bogas V, Cunha P, Bento M, Porto M. Forensic analysis of MPS mtDNA data using QIAGEN biomedical genomics workbench and AQME tool – preliminary results. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Bunnell A, Turner B, Collin J, Yekikian M. Thyroid Surgery Outcomes in the Obese Patient. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Hicks DG, D'Aguiar M, Henry J, McMahon L, Buscaglia B, Turner B. Abstract P4-02-03: Impact of the 2018 ASCO/CAP HER2 focused update on human epidermal growth factor receptor-2 (HER2) testing in breast cancer: A retrospective review of a single institutional cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the 2013 ASCO/CAP HER2 update, new recommendations for HER2 diagnostic criteria in breast cancer organized in situ hybridization (ISH) results into five categories; group1 (amplified), group 2 (monosomy), group 3 (co-amplified), group 4 (equivocal) and group 5 (non-amplified). Patients falling into groups 2, 3 and 4 were potentially eligible for HER2 targeted therapy, however, there is uncertainty from limited prospective clinical trials that show patients in these uncommon groups would receive the same benefit as group 1. Concern over whether the interpretation criteria should be modified for these uncommon groups led to the recent publication of the 2018 HER2 focused update. This update has modified ISH criteria for groups 2, 3 and 4, recommending the final diagnosis take into consideration both immunohistochemistry (IHC) and ISH results. The publication of this new guideline has prompted us to investigate what impact this would have on our institution.
Materials & Methods: A retrospective review of the URMC pathology database revealed 2,281 cases that had undergone HER2 FISH analysis since the 2013 update. IHC for initial HER2 screening was used, followed by reflex testing of all 2+ results and cases with histopathologic discordance. All 2,281 FISH cases were sorted into their 5 HER2 categories based on the 2013 guidelines. The final HER2 diagnosis for groups 2, 3 and 4 were then re-determined after applying the new criteria presented in the 2018 focused update.
Results: The results from the 2,281 HER2 FISH cases are shown in Tables 1 and 2. The results for group 1 and group 5 cases remained the same. However, for ISH cases in groups 2, 3 and 4, there were alterations in the final HER2 results. All 25 monosomy cases, originally interpreted as HER2 positive by the 2013 guidelines, were now considered HER2 negative. All group 3 (co-amplified) cases remained positive (due to IHC 2+ results). The largest change was that the original 199 equivocal cases, based on the 2013 guidelines, became split into 198 HER2 negative (99.5%) and 1 HER2 positive (0.5%).
Conclusion: Comparison of the HER2 FISH cases between 2013 and 2018 revealed differences in the final HER2 status. Using the 2018 guideline, 13.72% (313 cases) of the 2281 cases were HER2 positive in contrast to 14.77% (337 cases) from 2013. While that is only a difference of 1.05%, the reclassification of 198 of 199 equivocal cases to negative indicates that 9.82% of the final HER2 results for the entire patient cohort was affected. With 266,000 new cases of breast cancer annually, the final HER2 status of approximately 26,000 patients and their potential eligibility for targeted-therapy would change. Further study of the clinical significance of these changes is warranted.
Final ISH HER2 Status (2013)AmplifiedMonosomyCo-AmplifiedEquivocalNon-Amplified272 cases (11.93%)25 cases (1.10%)40 cases (1.75%)199 cases (8.72%)1,745 cases (76.50%)
Citation Format: Hicks DG, D'Aguiar M, Henry J, McMahon L, Buscaglia B, Turner B. Impact of the 2018 ASCO/CAP HER2 focused update on human epidermal growth factor receptor-2 (HER2) testing in breast cancer: A retrospective review of a single institutional cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-03.
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Affiliation(s)
- DG Hicks
- University of Rochester Medical Center, Rochester, NY
| | - M D'Aguiar
- University of Rochester Medical Center, Rochester, NY
| | - J Henry
- University of Rochester Medical Center, Rochester, NY
| | - L McMahon
- University of Rochester Medical Center, Rochester, NY
| | - B Buscaglia
- University of Rochester Medical Center, Rochester, NY
| | - B Turner
- University of Rochester Medical Center, Rochester, NY
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Buscaglia B, Turner B, Goda H, Huang W, Leitzel K, Natori T, Nakano Y, Okada H, Sperinde J, Ali S, Vasekar M, D'Aguiar M, McMahon L, Henry J, Lipton A, Hicks D. Abstract P1-03-02: ASCO/CAP human epidermal growth factor receptor-2 (HER2) in situ hybridization (ISH) categories evaluated by quantitative HER2 protein diagnostic methodologies: A comparative analysis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-03-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In 2013, the ASCO/CAP consensus panel published updated guidelines for HER2 testing in breast cancer that modified the definition of HER2 amplification by in situ hybridization (ISH), creating five new prognostic categories (group 1: classic amplified, group 2: monosomy, group 3: co-amplified (polysomy), group 4: equivocal, and group 5: classic non-amplified). Patients determined to be ISH amplified, were considered eligible for HER2-directed therapy. Concern over whether patients from non-classic groups 2-4 would benefit from treatment has led to the recent publication of the 2018 HER2 focused update. This update has modified the criteria for interpreting these ISH categories, recommending that the final diagnosis take into consideration a combination of HER2 immunohistochemistry (IHC) and ISH results. With increased emphasis on the HER2 protein assessment, it has prompted us to quantitatively examine HER2 protein expression in the ISH categories, using two different novel technologies. Materials & Methods: A cohort of 170 cases (URMC) and 102 cases (PSHMC) of invasive breast cancers, which had previously undergone HER2 IHC and ISH testing, were selected for this study. Cases were sorted and categorized into the HER2 ISH categories defined by ASCO/CAP. HER2 protein expression was quantitatively measured in the URMC and PSHMC cohorts using a novel immunodetection methodology (streptavidin-coated Phosphor-Integrated Dot (PID) fluorescent nanoparticles), and a novel dual-antibody, proximity-binding immunoassay (HERmark® Breast Cancer Assay, Monogram Biosciences, South San Francisco, California), respectively. HER2 protein expression was compared to the HER2 FISH and IHC results by ASCO/CAP category. Results: Cases in group 1 had a significantly (p < 0.01) higher average PID/cell and HERmark compared to cases in groups 2-5 (Table 1). Cases in groups 2-4 showed lower quantitative levels of HER2 protein expression, similar to the classic non-amplified cases (group 5). Group 1 was further divided into three subgroups (Table 2): Group A - ISH high-level amplified (ratio > 2, HER2 > 6, CEP17 < 2.7), Group B - amplified with elevated CEP17 (ratio > 2, CEP17 > 2.7), and Group C - low-level amplified (ratio > 2, HER2 > 4 and < 6). Group A and B had a significantly (p < 0.01) higher average PID/cell and HERmark compared to Group C. Group C was more comparable to cases in groups 2-5 (Table 1). Conclusion: Our results suggest that quantitative assessment of HER2 protein expression may help to further classify cases for HER2 status for targeted therapy, supporting the 2018 ASCO/CAP recommendation that non-classic ISH results might be resolved by evaluating protein expression. Follow up studies with a larger patient cohort and dual quantitative assessment are warranted.
Average PID/cell and HERmark in ASCO category groupsASCO category groupN (URMC)PID/cell (URMC)*N (PSHMC)HERmark (PSHMC)*18888.07761.521011.20N/A32016.0213.84238.5315.95296.3208.3*averageTable 2:Average PID/cell and HERmark in subgroups of Group 1SubgroupN (URMC)PID/cell (URMC)*N (PSHMC)HERmark (PSHMC)*A24157.66465.7B34101.61044.1C3016.9329.8*average
Citation Format: Buscaglia B, Turner B, Goda H, Huang W, Leitzel K, Natori T, Nakano Y, Okada H, Sperinde J, Ali S, Vasekar M, D'Aguiar M, McMahon L, Henry J, Lipton A, Hicks D. ASCO/CAP human epidermal growth factor receptor-2 (HER2) in situ hybridization (ISH) categories evaluated by quantitative HER2 protein diagnostic methodologies: A comparative analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-02.
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Affiliation(s)
- B Buscaglia
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - B Turner
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - H Goda
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - W Huang
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - K Leitzel
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - T Natori
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - Y Nakano
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - H Okada
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - J Sperinde
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - S Ali
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - M Vasekar
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - M D'Aguiar
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - L McMahon
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - J Henry
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - A Lipton
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
| | - D Hicks
- University of Rochester Medical Center, Rochester, NY; Konica Minolta, Hino-shi, Tokyo, Japan; Monogram Biosciences, South San Francisco, CA; Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA
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Hicks DG, Buscaglia B, Goda H, McMahon L, Natori T, Turner B, Soukiazian A, Okada H, Nakano Y. A novel detection methodology for HER2 protein quantitation in formalin-fixed, paraffin embedded clinical samples using fluorescent nanoparticles: an analytical and clinical validation study. BMC Cancer 2018; 18:1266. [PMID: 30563489 PMCID: PMC6299600 DOI: 10.1186/s12885-018-5172-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/03/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical assays for the assessment of the human epidermal growth factor receptor-2 (HER2) status in breast cancer include immunohistochemistry (IHC) and in situ hybridization (ISH), both of which have limitations. Recent studies have suggested that a more quantitative approach to the measurement of HER2 protein expression may improve specificity in selecting patients for HER-2 targeted therapy. In the current study, we have used HER2 expression in breast cancer cell lines and clinical samples as a model to explore the potential utility of a novel immunodetection technique, using streptavidin coated Phosphor Integrated Dot fluorescent nanoparticles (PID), which can be quantitatively measured using computer analysis. METHODS The expression of HER2 protein in cell lines was evaluated with antibody-binding capacity using fluorescence-activated cell sorting (FACS) for comparison with PID measurements to test for correlations with existing quantitative protein analysis methodologies. Various other analytic validation tests were also performed, including accuracy, precision, sensitivity, robustness and reproducibility. A methods comparison study investigated correlations between PID versus IHC and ISH in clinical samples. Lastly, we measured HER2 protein expression using PID in the pretreatment biopsies from 34 HER2-positive carcinomas that had undergone neoadjuvant trastuzumab-based chemotherapy. RESULTS In the analytic validation, PID HER2 measurements showed a strong linear correlation with FACS analysis in breast cell lines, and demonstrated significant correlations with all aspects of precision, sensitivity, robustness and reproducibility. PID also showed strong correlations with conventional HER2 testing methodologies (IHC and ISH). In the neoadjuvant study, patients with a pathologic complete response (pCR) had a significantly higher PID score compared with patients who did not achieve a pCR (p = 0.011), and was significantly correlated to residual cancer burden (RCB) class (p = 0.026, R2 = 0.9975). CONCLUSIONS Analytic testing of PID showed that it may be a viable testing methodology that could offer advantages over other experimental or conventional biomarker diagnostic methodologies. Our data also suggests that PID quantitation of HER2 protein may offer an improvement over conventional HER2 testing in the selection of patients who will be the most likely to benefit from HER2-targeted therapy. Further studies with a larger cohort are warranted.
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Affiliation(s)
- David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Brandon Buscaglia
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hideki Goda
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Loralee McMahon
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Takako Natori
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Bradley Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Armen Soukiazian
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hisatake Okada
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Yasushi Nakano
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
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Breaux A, Turner B, Wu X, Rai SN, Riley EC, Mandadi M, Sanders MA. Impact of 21-Gene Expression Assay on Staging Estrogen Receptor-Positive HER2-Negative Breast Cancer. Clin Breast Cancer 2018; 19:e261-e269. [PMID: 30509870 DOI: 10.1016/j.clbc.2018.10.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The 8th edition of the American Joint Committee on Cancer (AJCC) breast cancer staging system requires histologic grade (GR), estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and stage (assessed by the tumor, node, metastasis classification system). For T1-2 N0, ER+/HER2- tumors, if the 21-gene expression assay is ordered and Oncotype DX (ODX) recurrence score (RS) is 0 to 10, the stage is IA. The purpose of this study was to determine the impact of the ODXRS on staging ER+/HER2- tumors. MATERIALS AND METHODS This is a retrospective review of ER+/HER2- invasive breast cancer (BC) with ODXRS results from 2 institutions (n = 816) between 2006 and 2018. Stage based on the AJCC 7th and 8th editions, and stage using the 8th edition with and without ODXRS were compared. Significant associations among pathologic parameters and ODX risk groups were determined. Clinical histories were reviewed. RESULTS Nearly half of the patients (43%) had a change in BC stage using the new staging system. Only 4 patients changed stage as a direct result of ODXRS. Influence of ODXRS on staging is limited to T2N0 tumors that are either GR 3 and strongly ER+ and PR+ or GR 1-2 and ER+/PR-. Sixty-one percent of cases of recurrence (11/18) were downstaged using the new staging system. CONCLUSION ODXRS has little influence on staging, thus supporting the view of the AJCC 8th edition expert panel that ODX is not required for staging. Downstaging of more than half of cases of recurrence suggests that continued refinement of the staging system, as proposed by the expert panel, could be beneficial in this subgroup of patients.
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Affiliation(s)
- Andrea Breaux
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, KY
| | - Bradley Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Xiaoyong Wu
- Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Kosair Charities Clinical and Translational Research Building, Louisville, KY
| | - Shesh N Rai
- Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Kosair Charities Clinical and Translational Research Building, Louisville, KY; Department of Bioinformatics and Biostatistics, University of Louisville School of Medicine, Louisville, KY
| | - Elizabeth C Riley
- Department of Medicine, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, KY
| | - Mounika Mandadi
- Department of Medicine, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, KY
| | - Mary Ann Sanders
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, KY.
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22
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Karacosta LG, Fisk JC, Jessee J, Tati S, Turner B, Ghazal D, Ludwig R, Johnson H, Adams J, Sajjad M, Koury S, Roy R, Olson JR, Rittenhouse-Olson K. Preclinical Analysis of JAA-F11, a Specific Anti-Thomsen-Friedenreich Antibody via Immunohistochemistry and In Vivo Imaging. Transl Oncol 2018; 11:450-466. [PMID: 29477636 PMCID: PMC5834658 DOI: 10.1016/j.tranon.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 01/20/2023] Open
Abstract
The tumor specificity of JAA-F11, a novel monoclonal antibody specific for the Thomsen-Friedenreich cancer antigen (TF-Ag-alpha linked), has been comprehensively studied by in vitro immunohistochemical (IHC) staining of human tumor and normal tissue microarrays and in vivo biodistribution and imaging by micro-positron emission tomography imaging in breast and lung tumor models in mice. The IHC analysis detailed herein is the comprehensive biological analysis of the tumor specificity of JAA-F11 antibody performed as JAA-F11 is progressing towards preclinical safety testing and clinical trials. Wide tumor reactivity of JAA-F11, relative to the matched mouse IgG3 (control), was observed in 85% of 1269 cases of breast, lung, prostate, colon, bladder, and ovarian cancer. Staining on tissues from breast cancer cases was similar regardless of hormonal or Her2 status, and this is particularly important in finding a target on the currently untargetable triple-negative breast cancer subtype. Humanization of JAA-F11 was recently carried out as explained in a companion paper "Humanization of JAA-F11, a Highly Specific Anti-Thomsen-Friedenreich Pancarcinoma Antibody and In Vitro Efficacy Analysis" (Neoplasia 19: 716-733, 2017), and it was confirmed that humanization did not affect chemical specificity. IHC studies with humanized JAA-F11 showed similar binding to human breast tumor tissues. In vivo imaging and biodistribution studies in a mouse syngeneic breast cancer model and in a mouse-human xenograft lung cancer model with humanized 124I- JAA-F11 construct confirmed in vitro tumor reactivity and specificity. In conclusion, the tumor reactivity of JAA-F11 supports the continued development of JAA-F11 as a targeted cancer therapeutic for multiple cancers, including those with unmet need.
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Affiliation(s)
| | | | | | | | - Bradley Turner
- Department of Pathology, University of Rochester, Rochester, NY.
| | | | | | | | - Julia Adams
- Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, Buffalo, NY.
| | - Munawwar Sajjad
- Department of Nuclear Medicine, University at Buffalo, Buffalo, NY.
| | - Steven Koury
- Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, Buffalo, NY.
| | - Rene Roy
- Glycovax Pharma Inc., Montreal, Quebec, Canada.
| | - James R Olson
- For-Robin, Inc, Buffalo, NY; Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, NY.
| | - Kate Rittenhouse-Olson
- For-Robin, Inc, Buffalo, NY; Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, Buffalo, NY.
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23
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Zhang L, Turner B, Ribbeck K, Ten Hagen KG. Loss of the mucosal barrier alters the progenitor cell niche via Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling. J Biol Chem 2017; 292:21231-21242. [PMID: 29127201 PMCID: PMC5766965 DOI: 10.1074/jbc.m117.809848] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/23/2017] [Indexed: 01/09/2023] Open
Abstract
The mucous barrier of our digestive tract is the first line of defense against pathogens and damage. Disruptions in this barrier are associated with diseases such as Crohn's disease, colitis, and colon cancer, but mechanistic insights into these processes and diseases are limited. We have previously shown that loss of a conserved O-glycosyltransferase (PGANT4) in Drosophila results in aberrant secretion of components of the peritrophic/mucous membrane in the larval digestive tract. Here, we show that loss of PGANT4 disrupts the mucosal barrier, resulting in epithelial expression of the IL-6-like cytokine Upd3, leading to activation of JAK/STAT signaling, differentiation of cells that form the progenitor cell niche, and abnormal proliferation of progenitor cells. This niche disruption could be recapitulated by overexpressing upd3 and rescued by deleting upd3, highlighting a crucial role for this cytokine. Moreover, niche integrity and cell proliferation in pgant4-deficient animals could be rescued by overexpression of the conserved cargo receptor Tango1 and partially rescued by supplementation with exogenous mucins or treatment with antibiotics. Our findings help elucidate the paracrine signaling events activated by a compromised mucosal barrier and provide a novel in vivo screening platform for mucin mimetics and other strategies to treat diseases of the oral mucosa and digestive tract.
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Affiliation(s)
- Liping Zhang
- From the Developmental Glycobiology Section, NIDCR, National Institutes of Health, Bethesda, Maryland 20892-4370 and
| | - Bradley Turner
- the Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Katharina Ribbeck
- the Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Kelly G Ten Hagen
- From the Developmental Glycobiology Section, NIDCR, National Institutes of Health, Bethesda, Maryland 20892-4370 and
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Dubuisson N, Paterson A, Turner B, Westcott M, Thomson A, Giovannoni G. Self-monitoring visual function via a smartphone application. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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25
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Turner B, Tang P, Hicks D. The value of algorithms predicting the Oncotype DX recurrence score should not be underestimated! Breast Cancer Res Treat 2017; 164:249-250. [DOI: 10.1007/s10549-017-4236-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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26
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Shinzawa H, Turner B, Mizukado J, Kazarian SG. Protein hydration in living cells probed by Fourier transform infrared (FT-IR) spectroscopic imaging. Analyst 2017; 142:2475-2483. [DOI: 10.1039/c7an00337d] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
FT-IR spectra of a HEK cell were analyzed with 2D disrelation mapping to reveal molecular states of water and protein hydration.
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Affiliation(s)
- H. Shinzawa
- Department of Chemical Engineering
- Imperial College London
- UK
- National Institute of Advanced Industrial Science and Technology (AIST)
- Japan
| | - B. Turner
- Department of Chemical Engineering
- Imperial College London
- UK
| | - J. Mizukado
- National Institute of Advanced Industrial Science and Technology (AIST)
- Japan
| | - S. G. Kazarian
- Department of Chemical Engineering
- Imperial College London
- UK
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27
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Smith T, Kanani R, Turner B, Dickson J. 70: Adjuvant chemotherapy for NSCLC: Experience from one cancer centre. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30120-4] [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: 10/20/2022]
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Abstract
BACKGROUND The Central Statistics Office released new figures on Ireland's health spending in December 2015, based on the System of Health Accounts (SHA2011). These figures differ from previous figures, by virtue of an expanded definition of what constitutes health care. The new figures also provide more detail on health expenditure than the previous figures allowed. AIMS This article examines the new figures, drawing out findings of note and discussing the implications of these for the Irish health care system. It also compares Ireland with international health systems, highlighting where Ireland is unusual or comparable to international norms. FINDINGS Healthcare spending in Ireland as a percentage of GDP is higher than in many other countries, having increased during the economic downturn, although this was due more to the contraction in GDP than an increase in spending. While the majority of healthcare expenditure in Ireland comes from the Government, the share of private expenditure on healthcare in Ireland has increased, with implications for equity in the system. Over half of the expenditure is on curative and rehabilitative services, broadly in line with other countries. The proportion of spending going to long-term care facilities is relatively high by international standards. CONCLUSION Suggestions that Ireland is over-spending on health need to be tempered by cognisance that the Irish health system is under-resourced in a number of areas (particularly the number of doctors and the number of hospital beds) and has not fully recovered from cutbacks in the late 1980s and early 1990s.
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Affiliation(s)
- B Turner
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
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29
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Karacosta L, Johnson H, Abdullah J, Chrisikos T, Ludwig R, Turner B, Tati S, Ghazal D, Sajjad M, Koury S, Morey S, Adams J, Rittenhouse-Olson K. Abstract 576: Immunohistochemistry and radioimaging with hJAA-11 antibody to the Thomsen-Friedenreich antigen: Potential theranostic application for breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Theranostics through the utilization of immunohistochemistry followed by radioimaging to determine if metastatic foci will react with a therapeutic antibody will allow for the selection of the patient population that will most benefit from this immunotherapy. The Thomsen-Friedenreich antigen (TF-Ag) has been shown to be involved in ∼90% of carcinomas, specifically breast carcinomas, making it a suitable target for radioimaging and therapy. The anti-TF-Ag antibody, JAA-F11, a mouse monoclonal antibody (mAb), has had success in localization, blocking metastasis, and inhibiting cell proliferation, and binds to ∼80% of breast cancer cell lines, without preference to receptor status. This is significant since the triple negative breast cancer (ER-/PR-/HER2-) has no current targeted treatment. Studies are extended to human breast cancer tissue microarray immunohistochemical (IHC) analysis, which was scored blindly by a pathologist on a semi- quantitative scale. JAA-F11 stained approximately 76% of all breast cancer specimens, which included cases of mucinous, medullary, invasive ductal and neuroendocrine carcinomas. The staining observed was irrespective of receptor status, whereas in normal breast tissue, staining was either absent or very weak/weak. In addition, all available matched lymph node metastasis stained, with greater intensity observed in 39% of cases. JAA-F11 IHC studies performed on human normal organ tissue arrays, showed staining that for the most part was not significantly different from staining obtained with isotype control antibody, or was observed in areas that would not be therapeutically accessible. Furthermore, in an additional IHC study, preliminary results suggest that JAA-F11 significantly stained other carcinomas including those of the colon, bladder, ovary and prostate. In vitro studies show that the humanized JAA-F11 (hJAA-F11) has similar chemical specificity and higher affinity towards the TF-Ag. Imaging studies were performed in a BALB/c mouse breast cancer model with the hJAA-F11 to determine biological reactivity and to predict the feasibility of theranostic imaging prior to therapy. After ∼10 days of tumor growth, mice pretreated with cold iodine water and rabbit IgG to inhibit binding to Fc receptors, were given tail vein injections of hJAA-F11 conjugated with [124]-I. Clear tumor images were obtained up to 144 hours post injection. Biodistribution analysis has provided further results indicating increased%ID/g (7.0±3.9%) in tumor tissue as compared to healthy tissues (brain%ID/g to be 0.21±.09, stomach 0.80±0.19%, and bone 0.90±2.4%). Results support that the hJAA-F11 antibody can be used in a multi-step theranostic approach, with analysis of tumor binding in IHC, followed by imaging to determine in vivo tumor targeting prior to direct immunotherapy or antibody drug conjugate therapy with hJAA-F11.
Citation Format: Loukia Karacosta, Holly Johnson, Julia Abdullah, Taylor Chrisikos, Rachel Ludwig, Bradley Turner, Swetha Tati, Diala Ghazal, Munnawar Sajjad, Stephen Koury, Susan Morey, Julie Adams, Kate Rittenhouse-Olson. Immunohistochemistry and radioimaging with hJAA-11 antibody to the Thomsen-Friedenreich antigen: Potential theranostic application for breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 576.
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Mungrue K, Chase H, Gordon J, Knowles D, Lockhart K, Miller N, Morley T, Sealey L, Turner B. Breast Cancer in the Bahamas in 2009-2011. Breast Cancer (Auckl) 2016; 10:45-52. [PMID: 27127408 PMCID: PMC4841291 DOI: 10.4137/bcbcr.s32792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common form of cancer affecting women in the Bahamas, which consists of many islands. This is the first attempt to identify which island has the highest occurrence of breast cancer. OBJECTIVE The aim of this study was to describe the sociodemographical and spatial features of breast cancer in the Bahamas in 2009-2011. METHODS A review of the medical records of all women with a confirmed diagnosis of breast cancer during the period January 1, 2009-December 31, 2011, was undertaken. Data were first obtained from the National Oncology Board of the Bahamas and validated by a review of the medical records. The patient address was geocoded and mapped using ArcGIS 10.0 Environmental Systems Research Institute (ESRI) to satellite images obtained from The Nature Conservancy in the Bahamas. RESULTS We recruited 270 patients who satisfied the entry criteria. The cumulative incidences of breast cancer for the years 2009-2011 were 51.4, 45.4, and 51.4, respectively. Breast cancer occurred most often in women of African origin with a mean age at diagnosis of 56.6 ± 13.8 years. Ductal carcinoma was the most common histological type observed with most cancers occurring in Grade II or higher and presenting as late stage (≥ Stage II). Surgery was the preferred method of treatment with modified radical mastectomy being the procedure of choice. Spatial distribution of cases across the Bahamas revealed one cluster, which is present on the island of New Providence. Further analysis of New Providence showed a consistently skewed kernel density in the central and eastern regions, compared with a scattered distribution in the southern and western regions. CONCLUSION The island of New Providence had the highest occurrence of breast cancer among all the islands of the Bahamas. The increasing incidence of breast cancer in young women is likely to impose a significant burden on the future of Bahamian health care.
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Affiliation(s)
- K Mungrue
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - H Chase
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - J Gordon
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - D Knowles
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - K Lockhart
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - N Miller
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - T Morley
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - L Sealey
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - B Turner
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
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31
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Ghani S, Vilensky J, Turner B, Tubbs RS, Loukas M. Meta-analysis of vagus nerve stimulation treatment for epilepsy: correlation between device setting parameters and acute response. Childs Nerv Syst 2015; 31:2291-304. [PMID: 26493055 DOI: 10.1007/s00381-015-2921-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is an adjunctive neurophysiological treatment for those patients who have pharmacoresistant or surgically resistant partial onset epilepsy. OBJECTIVE The aim of this study is to determine the effects of high and low stimulation paradigms on a responder rate of ≥50 and ≥75% reduction in seizure frequency and associated adverse effects in adults and children. METHOD A literature search was performed using Medline, PubMed, EMBASE, and Cochrane library for studies using vagus nerve stimulation published from January 1980 until July 2014 for medically or surgically resistant partial onset seizures, in children and adults. No restrictions on languages were imposed. DATA COLLECTION AND ANALYSIS Four authors reviewed and selected studies for inclusion and exclusion. The search identified five randomized control trials that fit with our inclusion criteria. The following outcomes were evaluated: 50% or greater reduction in total seizure frequency, 75% or greater reduction in total seizure frequency, and adverse effects. RESULTS Four randomized controlled trials were analyzed in this meta-analysis. Results indicate high stimulation is more effective in adult patients who experienced ≥50 and ≥75% reduction in seizure frequency with a significant difference within both high and low stimulation groups. In children, there was no significant difference between the two groups and patients with ≥50 % reduction in seizures. Adverse effects such as hoarseness and dyspnea were more common in the high stimulation group where the remaining side effects were not statistically different among both groups. CONCLUSION High stimulation is more effective than low stimulation in producing a greater reduction in seizure frequency in patients with medically and surgically resistant epilepsy.
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Affiliation(s)
- S Ghani
- Department of Psychiatry, School of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA
| | - J Vilensky
- Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Fort Wayne, IN, USA
| | - B Turner
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA
| | - R S Tubbs
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA.,Pediatric Neurosurgery, Children's Hospital, Birmingham, AL, USA
| | - M Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA.
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Gosden CA, Barnard K, Williams DRR, Tinati T, Turner B, Holt RIG. A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change. Diabet Med 2015; 32:1662-6. [PMID: 25916313 DOI: 10.1111/dme.12786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Abstract
AIMS To assess the impact of continual major National Health Service reorganization on commissioning, organizational and delivery arrangements for secondary care diabetes services. To explore how consultant diabetologists and diabetes specialist nurses perceive the issues facing diabetes specialist services in 2011 and how these have changed in the preceding decade. METHODS We used a longitudinal case study approach that combined quantitative and qualitative methods. Five locations in England were purposively selected to represent the wider diabetes specialist community, and seven semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Findings were compared with and contrasted to results from national quantitative surveys of diabetes specialist services undertaken in 2000 and 2006. RESULTS Clinicians viewed positively the expertise and commitment of multidisciplinary teams and their ability to adapt to new situations. Negative perceptions persisted throughout the decade, relating to the continual change that threatens to dismantle relationships and services which had taken many years to establish. Lack of resources, inadequate manpower planning and poor access to psychological support for people with diabetes remained constant themes from 2000 to 2011. CONCLUSIONS A willingness to innovate and work differently to improve services was identified; however, clinicians must be supported through organizational changes to ensure people with diabetes receive high-quality care. The disruptive nature of organizational change was a recurrent theme throughout the decade. Periods of stability must exist within commissioning to allow relationships, which are key to integration, to be maintained and permit service improvements to develop.
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Affiliation(s)
- C A Gosden
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K Barnard
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - T Tinati
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Jones K, Turner B, Brandão J, Hubbard SA, Magee D, Baughman B, Wills R, Tully T. Pilot Study: Colostomy and Urine Collection Protocol for Investigating Potential Inciting Causes of Hen Diuresis Syndrome. Avian Dis 2015; 59:227-34. [PMID: 26473672 DOI: 10.1637/10953-100614-reg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hen diuresis syndrome has emerged over the past 5 yr as a significant cause of mortality in the U.S. broiler breeder industry. The condition affects hens in production and is characterized by transient muscle weakness in the vent region, transient diuresis, and often urate deposits on the skin below the vent. Affected hens are often seen straining to lay an egg, which suggests oviduct contraction is also impaired. Related hen mortality, often reaching 1% or more a week, is believed to be primarily the result of male aggression of the vent region (Turner et al., "Investigating Causes of Excessive Urate Production in Broiler Breeder Hens Associated with Peritonitis and Cannibalism Mortality," Oral Presentation at The American Association of Avian Pathologists Annual Meeting, p. 139, 2010). The exact association between the cause of mortality and this syndrome is unknown, but it may be the consequence of transient partial to full oviduct prolapse, which predisposes or stimulates cannibalism and aggression. Based on unpublished work done prior to this study (Turner et al., ibid.), the evidence suggests the underlying problem is metabolic. We feel that urine collection and analysis is an essential component to understanding this condition. This study serves as a pilot study for future investigations that attempt to identify the nature and cause of the metabolic disturbance through paired urine and serum collection and analysis. For the purpose of this study, a small sample of 10 affected and 10 unaffected birds was used for sample collection. In order to collect pure urine, the birds were surgically colostomized. Colostomy did prove to be a useful means of collecting urine free of feces, and for the purposes of our study it yielded adequate urine samples for analysis. There were statistically relevant urine values observed. Affected birds had a higher presence of blood in the urine, a lower uric acid excretion rate (mg/hr), higher concentration (mEq/L) of urine Na+, and a lower concentration (mEq/L) of urine K+ than unaffected birds. This pilot study helps to address some of the pitfalls previously associated with colostomy and to determine when collection can begin postoperatively so that we can better understand when and how to begin our sampling in future trials to address the etiology of this condition.
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Affiliation(s)
- Kelli Jones
- A Department of Pathobiology and Population Medicine, Poultry Research and Diagnostic Laboratory, College of Veterinary Medicine, Mississippi State University, P.O. Box 97813, Pearl, MS 39288
| | - Bradley Turner
- C DSM Nutritional Products, 45 Waterview Boulevard, Parsippany, NJ 07054
| | - João Brandão
- D Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Room 002G, Stillwater, OK 74078
| | - Sue Ann Hubbard
- A Department of Pathobiology and Population Medicine, Poultry Research and Diagnostic Laboratory, College of Veterinary Medicine, Mississippi State University, P.O. Box 97813, Pearl, MS 39288
| | - Danny Magee
- A Department of Pathobiology and Population Medicine, Poultry Research and Diagnostic Laboratory, College of Veterinary Medicine, Mississippi State University, P.O. Box 97813, Pearl, MS 39288
| | - Brittany Baughman
- A Department of Pathobiology and Population Medicine, Poultry Research and Diagnostic Laboratory, College of Veterinary Medicine, Mississippi State University, P.O. Box 97813, Pearl, MS 39288
| | - Robert Wills
- E Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, P.O. Box 6100, Mississippi State, MS 39762
| | - Thomas Tully
- F Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803
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Simmons D, Deakin T, Walsh N, Turner B, Lawrence S, Priest L, George S, Vanterpool G, McArdle J, Rylance A, Terry G, Little P. Diabetes UK Position Statement. Competency frameworks in diabetes. Diabet Med 2015; 32:576-84. [PMID: 25611804 DOI: 10.1111/dme.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
The quality, skills and attitudes of staff working in the healthcare system are central to multidisciplinary learning and working, and to the delivery of the quality of care patients expect. Patients want to know that the staff supporting them have the right knowledge and attitudes to work in partnership, particularly for conditions such as diabetes where 95% of all care is delivered by the person with diabetes themselves. With the current changes in the NHS structures in England, and the potential for greater variation in the types of 'qualified provider', along with the recent scandal at Mid-Staffordshire Hospital, staff need to be shown to be competent and named/accredited or recognized as such. This will help to restore faith in an increasingly devolved delivery structure. The education and validation of competency needs to be consistently delivered and assured to ensure standards are maintained for different roles and disciplines across each UK nation. Diabetes UK recommends that all NHS organizations prioritize healthcare professional education, training and competency through the implementation of a National Diabetes Competency Framework and the phased approach to delivery to address this need.
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Affiliation(s)
- D Simmons
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Khoury T, Chen X, Wang D, Kumar P, Qin M, Liu S, Turner B. Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology 2015; 67:106-20. [DOI: 10.1111/his.12635] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/14/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Thaer Khoury
- Department of Pathology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Xiwei Chen
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Dan Wang
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Prasanna Kumar
- Department of Radiology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Maochun Qin
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Song Liu
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Bradley Turner
- Department of Pathology; Roswell Park Cancer Institute; Buffalo NY USA
- Department of Pathology; University of Rochester Medical Center; Rochester NY USA
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Hicks DG, Turner B. Pathologic diagnosis, immunohistochemistry, multigene assays and breast cancer treatment: progress toward "precision" cancer therapy. Biotech Histochem 2014; 90:81-92. [PMID: 25434396 DOI: 10.3109/10520295.2014.978893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical decisions regarding the suitability of adjuvant systemic therapy for individual patients with breast cancer depends on comprehensive assessment of the underlying biology of each patient's tumor. The previous clinical-pathologic paradigm for treatment, which had been used for decades, now has been augmented by significant advances in molecular analysis of breast tumor tissue samples. Molecular testing has the potential to understand better both tumor biology and clinical behavior, which enables more appropriate therapy choices to be made. We review the rapid evolution in profiling breast cancer tissues, and discuss the current evidence for clinical use of this information and how the emerging molecular paradigm can be integrated into the clinical-pathologic context as we progress toward "precision" therapy for patients with breast cancer and other solid tumors.
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Affiliation(s)
- D G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center , 601 Elmwood Avenue, Box 626, Rochester , New York
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Ethier S, Irish J, Wilson R, Turner B. 583 The 8p11 amplicon in luminal breast cancers harbors multiple interacting epigenome modifying oncogenes: implications for epigenome-targeted therapy. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Prostate cancer is linked to the male sex hormone testosterone. In advanced disease, blocking the production of testosterone using androgen deprivation therapy causes regression of prostate cancer and minimises or prevents symptoms associated with the disease. Luteinising hormone-releasing hormone agonists are commonly used in the management of prostate cancer, however less is known about the role of the newer gonadotrophin-releasing hormone (GnRH) antagonists. This article focuses on the differences between the two treatments and provides nurses with the knowledge to explain the use of GnRH antagonists to patients and administer this therapy effectively.
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Affiliation(s)
- B Turner
- Homerton University Hospital, London and Barts Health Hospitals, London
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García G, Gutiérrez V, Ríos N, Turner B, Santiñaque F, López-Carro B, Folle G. Burst speciation processes and genomic expansion in the neotropical annual killifish genus Austrolebias (Cyprinodontiformes, Rivulidae). Genetica 2014; 142:87-98. [DOI: 10.1007/s10709-014-9756-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
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Khocht A, Russell B, Cannon JG, Turner B, Janal M. Oxidative burst intensity of peripheral phagocytic cells and periodontitis in Down syndrome. J Periodontal Res 2013; 49:29-35. [PMID: 23488730 DOI: 10.1111/jre.12075] [Citation(s) in RCA: 9] [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] [Accepted: 02/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigated the oxidative burst function of peripheral phagocytic cells (granulocytes and monocytes) and assessed the relation between oxidative burst and periodontal status in adult individuals with Down syndrome (DS) vs. other groups. METHODS Of 55 DS individuals (18-56 years old), 74 individuals with mental retardation (MR) and 88 medically healthy controls (HC) participated in the study. The MR and HC groups were age, race and gender matched with the DS group. Gingival index, plaque index, probing depth, attachment level and bleeding on probing were recorded for each subject. Whole blood was collected for granulocyte/monocyte oxidative burst tests. Oxidative burst was determined by flow cytometry in terms of percentage of cells actively involved in oxidative burst, and oxidative intensity (magnitude of ROIs per cell). RESULTS The basal oxidative burst intensity of DS granulocytes was higher than that of HC and MR granulocytes (p = 0.05). The Escherichia coli stimulated oxidative burst intensity of DS monocytes was higher than that of HC and MR monocytes (p = 0.05). Regression analysis controlling for age, sex, race and plaque levels showed a significant association between monocyte oxidative burst intensity and loss of periodontal attachment in DS subjects (p < 0.01). Regression analysis also showed a significant association between granulocyte oxidative burst intensity and bleeding on probing in all subjects (p < 0.05). CONCLUSIONS Oxidative burst activity of peripheral monocytes and granulocytes is elevated in DS affected individuals and may contribute to periodontal tissue inflammation and loss of periodontal attachment in this susceptible group.
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Affiliation(s)
- A Khocht
- Temple University School of Dentistry, Philadelphia, PA, USA
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Leyland-Jones B, Faoro L, Barnholt K, Kiefer A, Yager S, Yi J, Turner B, Keane A, Wang L, Eriksson N, Milián ML, O'Neill V. Abstract OT3-4-04: InVite: an observational pilot study evaluating the feasibility of genome-wide association studies using self-reported data from patients with metastatic breast cancer treated with bevacizumab. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-ot3-4-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Personalized healthcare tailors treatments to patients and their disease characteristics through the use of genetics and other biomarkers. Genetic differences among individuals may explain variations in drug treatment response, including side effects. With such information physicians could make more informed decisions about drugs and dosing for a given individual, thereby improving patient care. Although there has been some success, to a large extent genetic variation related to drug response remains unexplained.
Bevacizumab, a humanized monoclonal antibody against the angiogenic factor VEGF, has demonstrated activity in patients with metastatic breast cancer (MBC). The InVite study will evaluate the feasibility of performing genomewide association studies using self-reported information collected via an online platform from patients with MBC who have been treated with bevacizumab. Using novel methodology in a convenient, user-friendly, and scientifically rigorous format, InVite ultimately aims to identify potential pharmacogenetic associations in this patient population.
Trial design: InVite is a pilot, non-interventional, observational, web-based, prospective cohort study designed to collect patient-reported safety, efficacy, and genetic data from patients with MBC treated with bevacizumab. Data on demographics, breast cancer disease status, cancer treatment history, bevacizumab-related outcomes, and certain safety events will be collected directly from patients entirely via online surveys. Patients will be asked to complete surveys at the time of enrollment and then every 3 months for 1 year after enrollment. A saliva sample for DNA collection will be gathered using an at-home kit. Evaluations of data quality and collection feasibility will be conducted intermittently. There will be an optional substudy to allow for blood sample collection for DNA analysis.
Eligibility criteria: ≥18 years of age, residing in the US, locally recurrent breast cancer or MBC, currently being or having been treated with bevacizumab starting on or before Dec 31, 2011, fluent in English, and access to a computer with an internet connection.
Specific aims: The primary objective is to assess the feasibility of recruiting subjects and collecting biospecimens and self-reported data online. The secondary objective is to characterize the patient population. Exploratory objectives include analyzing potential associations between genetic polymorphisms and 1) bevacizumab-induced hypertension, the most common bevacizumab-related adverse event, and 2) patient-reported time-to-progression.
Statistical methods: Baseline demographics, clinical and treatment characteristics of enrolled patients will be summarized. Each polymorphism genotyped will be tested for association with the defined endpoint using appropriate statistical modeling.
Present and target accrual: Accrual as of May 23, 2012 is 82 patients. Target accrual is 1000 patients.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT3-4-04.
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Affiliation(s)
| | - L Faoro
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - K Barnholt
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - A Kiefer
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - S Yager
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - J Yi
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - B Turner
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - A Keane
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - L Wang
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - N Eriksson
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - ML Milián
- Genentech, Inc.; 23 and Me; Sanford Research/USD
| | - V O'Neill
- Genentech, Inc.; 23 and Me; Sanford Research/USD
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Eamens GJ, Gonsalves JR, Whittington AM, Turner B. Evaluation of serovar-independent ELISA antigens ofActinobacillus pleuropneumoniaein pigs following vaccination or experimental challenge with respiratory pathogens and naturalA. pleuropneumoniaeserovar 1 challenge. Aust Vet J 2012. [DOI: 10.1111/j.1751-0813.2012.01008.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- GJ Eamens
- Industry & Investment NSW; Elizabeth Macarthur Agricultural Institute; Camden; New South Wales; 2570; Australia
| | - JR Gonsalves
- Industry & Investment NSW; Elizabeth Macarthur Agricultural Institute; Camden; New South Wales; 2570; Australia
| | - A-M Whittington
- Industry & Investment NSW; Elizabeth Macarthur Agricultural Institute; Camden; New South Wales; 2570; Australia
| | - B Turner
- Industry & Investment NSW; Elizabeth Macarthur Agricultural Institute; Camden; New South Wales; 2570; Australia
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Narine N, Rana D, Stewart G, Thottakam B, Donnini A, Wilson A, Turner B, Burrill W, Saeb-Parsy K, Harrison D. MCM As A Useful Biomarker For Graded Differentiation In Urothelial Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32809-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: 11/29/2022] Open
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Eamens GJ, Gonsalves JR, Whittington AM, Turner B. Evaluation of serovar-independent ELISA antigens of Actinobacillus pleuropneumoniae in pigs, following experimental challenge with A. pleuropneumoniae, Mycoplasma hyopneumoniae and Pasteurella multocida. Aust Vet J 2012; 90:225-34. [PMID: 22632286 DOI: 10.1111/j.1751-0813.2012.00934.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
OBJECTIVE To compare the sensitivity and specificity of six serological enzyme-linked immunosorbent assays (ELISAs) based on serovar-independent antigens of Actinobacillus pleuropneumoniae (App) and investigate cross-reactivity in disease-free pigs challenged with Mycoplasma hyopneumoniae and Pasteurella multocida. DESIGN Five experimental pig trials using direct challenge with App serovars 1, 7 or 15 or direct challenge with M. hyopneumoniae and/or various dose rates of P. multocida. PROCEDURE A 39-kDa outer membrane protein antigen and five recombinant antigens from the apxIVA gene of App were evaluated. The latter were derived from the ApxIVA N-terminus (ApxIVA-N, ApxIVA-NP, ApxIVA-NPS) or C-terminus (ApxIVA-C, ApxIVA-CP). Pigs were sampled after challenge and clinical and necropsy findings evaluated. RESULTS The 39-kDa ELISA had high sensitivity but lacked specificity, with significantly increased cross-reactivity following P. multocida challenge. ELISAs based on ApxIVA N-terminus antigens were significantly more sensitive than C-terminus antigens for the detection of App-induced disease. Although ApxIVA-N and ApxIVA-NP ELISAs had increased reactivity following P. multocida challenge, they retained high specificity for App-induced disease (90-93%). Affinity purified ApxIVA-NP antigen had marginally better specificity than ApxIVA-N, without reduced sensitivity. Mycoplasma hyopneumoniae did not affect serological cross-reactivity. In disease-free pigs, the specificity of the ApxIVA-NPS ELISA may be adversely affected by nasal carriage of apparently low-virulence App strains. CONCLUSIONS ApxIVA-N-based ELISAs can be used for evaluating App status in commercial herds, but some appear limited by high carriage rates of low-virulence App. The 39-kDa antigen is only of merit in exclusion of App disease by negative serology.
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Affiliation(s)
- G J Eamens
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Camden New South Wales, 2570, Australia.
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Abstract
The increasing prevalence of diabetes, the drive to develop community services for diabetes and the Quality and Outcomes Framework for diabetes have led to improvements in the management of diabetes in primary care settings, with services traditionally provided only in specialist care now provided for many patients with diabetes by non-specialists. Consequently, there is a need to redefine roles, responsibilities and components of a specialist diabetes service to provide for the needs of patients in the National Health Service (NHS) today. The delivery of diabetes care is complex and touches on almost every aspect of the health service. It is the responsibility of those working within commissioning and specialist provider roles to work together with people with diabetes to develop, organize and deliver a full range of integrated diabetes care services. The local delivery model agreed within the local diabetes network, comprising specialist teams, primary care teams, commissioners and people with diabetes, should determine how the diabetes specialist services are organizsed. It should identify the roles and responsibilities of provider organizations to ensure that the right person provides the right care, at the right time, and in the right place. We summarize a report entitled 'Commissioning Diabetes Specialist Services for Adults with Diabetes', which has been produced, as a 'Task and Finish' group activity within Diabetes UK, to assist managers, commissioners and healthcare professionals to provide advice on the structure, roles and components of specialist diabetes services for adults.
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Affiliation(s)
- N Goenka
- Diabetes Centre, Countess of Chester NHS Foundation Trust, Chester, UK
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Abstract
BACKGROUND This study investigated the phagocytic function of peripheral granulocytes and monocytes from adult individuals with Down syndrome (DS) and assessed the relation between phagocytic function and periodontal status. METHODS Fifty-five DS individuals (18-56 years old), 74 mentally retarded individuals, and 88 medically healthy controls (HC) participated in the study. Gingival inflammation index, plaque index, probing depth, periodontal attachment level (AL), and bleeding on probing were taken for each subject. Whole blood was collected for granulocyte/monocyte phagocytosis tests. Phagocytic function was determined by flow cytometry in terms of percentage of cells actively involved in phagocytosis, and phagocytic intensity (magnitude of the bacterial staining per cell). RESULTS Phagocytic intensity of both granulocytes and monocytes was comparable in HC and DS subjects. While AL was directly related to phagocytic intensity of both granulocytes (r = 0.14, P = 0.03) and monocytes (r = 0.2, P = 0.003) in all subjects, this relationship was stronger in DS than in other subjects, even after controlling for known risk factors for periodontitis (P < 0.05). Monocyte phagocytic intensity was the only necessary predictor of AL (P = 0.003), indicating a similar relationship between AL and phagocytic activity in either cell type. CONCLUSIONS While granulocyte and monocyte phagocytic intensities are similar in Down and non-DS individuals, phagocytic intensity was associated with more AL in DS than non-DS individuals.
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Affiliation(s)
- A Khocht
- Department of Periodontology, Temple University School of Dentistry, Philadelphia, PA 19140, USA.
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Cheng L, Qureshi A, Fazel S, Lankathilake P, Turner B, Ali E, Qureshi R, Ezsias A, Hutchison I, Bridle C, Jones J. Medical treatment of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and fast track referral system. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rand KH, Turner B, Seifert H, Hansen C, Johnson JA, Zimmer A. Clinical laboratory detection of AmpC β-lactamase: does it affect patient outcome? Am J Clin Pathol 2011; 135:572-6. [PMID: 21411779 DOI: 10.1309/ajcp7vd0nmamqcwa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been associated with poor clinical outcomes, but they are not readily identified in hospital microbiology laboratories. We tested 753 gram-negative bloodstream isolates for AmpC by using the EDTA disk test and the modified Hodge test (n = 172) and the modified Hodge test alone (n = 581). The 30-day mortality for the AmpC group was 9% (2/23) and was 6% (3/51) for the control group. The clinical response was similar: afebrile on day 2 (AmpC group, 16/23 [70%]; control group, 32/45 [71%]) and on day 4 (AmpC group, 19/22 [86%]; control group, 37/44 [84%]). Patients with isolates in the AmpC group were more likely to be in an intensive care unit at the time of the positive blood culture (P = .01) and more likely to be intubated (P = .05) than patients with isolates in the control group. Effective antibiotic treatment within the first 48 hours was given to 47 (92%) of 51 patients with isolates in the control group but to only 14 (61%) of 23 patients with isolates in the AmpC group (P = .001). The modified Hodge test and the EDTA disk test did not identify patients at risk for a poor outcome from AmpC-producing bacterial infections.
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Chibbaro S, Di Rocco F, Makiese O, Mirone G, Marsella M, Lukaszewicz AC, Vicaut E, Turner B, Hamdi S, Spiriev T, Di Emidio P, Pirracchio R, Payen D, George B, Bresson D. Neurosurgery and elderly: analysis through the years. Neurosurg Rev 2011; 34:229-34. [PMID: 21301916 DOI: 10.1007/s10143-010-0301-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 11/07/2010] [Accepted: 11/10/2010] [Indexed: 11/26/2022]
Abstract
The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.
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Affiliation(s)
- Salvatore Chibbaro
- Neurosurgery Department, Lariboisiere University Hospital, Paris, France.
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Weissinger E, Hertenstein B, Metzger J, Holler E, Schleuning M, Dickinson A, Greinix H, Turner B, Buchholz S, Ferrara J, Kolb HJ, Hahn N, Schiffer E, Krons A, Krauter J, Ganser A. Prospective Evaluation Of Proteomic Pattern Specific For aGvHD In More Than 300 Patients. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.059] [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: 11/15/2022]
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