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Katsimperis S, Tzelves L, Tandogdu Z, Ta A, Geraghty R, Bellos T, Manolitsis I, Pyrgidis N, Schulz GB, Sridhar A, Shaw G, Kelly J, Skolarikos A. Complications After Radical Cystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials with a Meta-regression Analysis. Eur Urol Focus 2023; 9:920-929. [PMID: 37246124 DOI: 10.1016/j.euf.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/15/2023] [Revised: 04/14/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
CONTEXT Radical cystectomy is considered a procedure of high complexity with a relative high complication rate. OBJECTIVE To systematically summarize the literature regarding the complications of radical cystectomy and the factors that contribute to them. EVIDENCE ACQUISITION We searched MEDLINE/PubMed, ClinicalTrials.gov, and Cochrane Library, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for randomized controlled trials (RCTs) on complications related to radical cystectomy. EVIDENCE SYNTHESIS A total of 3766 studies were screened, and 44 studies were included in this systematic review and meta-analysis. Complications following radical cystectomy are quite common. The most common complications were gastrointestinal complications (20%), infectious complications (17%), and ileus (14%). The majority of complications occurring were Clavien I-II (45%). Specific measurable patient factors are related to certain complications and can be used to stratify risk and assist in preoperative counseling, while proper design of high-quality RCTs may better reflect real-life complication rates. CONCLUSIONS In our study, RCTs with a low risk of bias had higher complication rates than studies with a high risk of bias, underlining the need for further improvement on complication reporting in order to refine surgical outcomes. PATIENT SUMMARY Radical cystectomy is usually followed by high complication rates, which affect patients and are, in turn, strongly associated with patients' preoperative health status.
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Affiliation(s)
| | - Lazaros Tzelves
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Zafer Tandogdu
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Anthony Ta
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, England
| | | | | | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Ashwin Sridhar
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Gregory Shaw
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- University College of London Hospitals NHS Foundation Trust, London, UK
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2
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Samra G, Mahabir S, Madgula A, Kanwar M, Trombetta M, Seungjong O, Cherian T, Silverstein J, Belden W, Friehling M, Liu E, Thosani A, Shaw G. Stereotactic Arrhythmia Radioablation (STAR) as Treatment for Recurrent Ventricular Tachycardia (VT) in Two Patients with Left Ventricle Assist Devices (LVAD). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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3
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Christodoulou P, Tipples K, Shaw G. Management Outcomes of Ductal Adenocarcinoma of the Prostate: a Single Centre Retrospective Study. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.026] [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: 01/13/2023]
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4
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Al-Hammouri T, Almeida-Magana R, Lawrence R, Duffy T, Kudahetti S, Berney D, Gabe R, Shaw G, Lu Y. Predicting treatment failure after radical prostatectomy by circulating tumour cells status (C-ProMeta-1). A single site prospective cohort: A study protocol. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00576-6] [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: 02/12/2023]
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Al-Hammouri T, Almeida-Magana R, Tandogdu Z, Shaw G. Beyond bladder neck sparing: Complete Urethral Preservation (CUP) during RARP. Video description of surgical technique and reported continence outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01461-6] [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: 02/12/2023]
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6
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Almeida-Magana R, Al-Hammouri T, Au M, Haider A, Freeman A, Ta A, Shaw G. Optimizing fluorescence confocal microscopy margin assessment during RARP, the LaserSAFE technique. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01373-8] [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: 02/12/2023]
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7
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Britton S, Lee K, Azizova L, Shaw G, Ayre WN, Mansell JP. Immobilised teicoplanin does not demonstrate antimicrobial activity against Staphylococcus aureus. Sci Rep 2022; 12:16661. [PMID: 36198734 PMCID: PMC9534865 DOI: 10.1038/s41598-022-20310-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Antibacterial bone biomaterial coatings appeal to orthopaedics, dentistry and veterinary medicine. Achieving the successful, stable conjugation of suitable compounds to biomaterial surfaces is a major challenge. A pragmatic starting point is to make use of existing, approved antibiotics which are known to remain functional in a stationary, immobilised state. This includes the macrocyclic glycopeptide, teicoplanin, following the discovery, in the 1990's, that it could be used as a chiral selector in chromatographic enantiomeric separations. Importantly teicoplanin works at the level of the bacterial cell wall making it a potential candidate for biomaterial functionalisations. We initially sought to functionalise titanium (Ti) with polydopamine and use this platform to capture teicoplanin, however we were unable to avoid the natural affinity of the antibiotic to the oxide surface of the metal. Whilst the interaction between teicoplanin and Ti was robust, we found that phosphate resulted in antibiotic loss. Before contemplating the covalent attachment of teicoplanin to Ti we examined whether a commercial teicoplanin stationary phase could kill staphylococci. Whilst this commercially available material could bind N-Acetyl-L-Lys-D-Ala-D-Ala it was unable to kill bacteria. We therefore strongly discourage attempts at covalently immobilising teicoplanin and/or other glycopeptide antibiotics in the pursuit of novel antibacterial bone biomaterials.
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Affiliation(s)
- S Britton
- Department of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - K Lee
- Department of Chemistry, Green-Nano Materials Research Center, Kyungpook National University, Daegu, 41566, South Korea
| | - L Azizova
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - G Shaw
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - W Nishio Ayre
- School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK
| | - J P Mansell
- Department of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
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Thavarajah V, Akman G, Carmona Echeverria L, Griffin J, Freeman A, Haider A, Shaw G, Narashima Sridhar A, Kelly J, Pye H, Crompton J, Enica A, Whitaker H, Okoli U, Cheema U, Heavey S. 120P The compartment-specific spatial transcriptomic landscape of 3D cultured Gleason 7 prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.121] [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: 11/01/2022] Open
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9
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Okoli U, Akman G, Thavarajah V, Carmona Echeverria L, Griffin J, Ohayi R, Freeman A, Haider A, Shaw G, Sridhar A, Kelly J, Simpson B, Pye H, Crompton J, Whitaker H, Cheema U, Heavey S. 99P The transcriptional atlas of co-targeted PIM/PI3K/mTOR ex-vivo patient-derived prostate cancer as revealed by spatial transcriptomics. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.100] [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: 11/01/2022] Open
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Nathan A, Ng A, Mitra A, Davda R, Sooriakumaran P, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H,. Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chalmers S, Shaw G, Mujika I, Jay O. Thermal Strain During Open-Water Swimming Competition in Warm Water Environments. Front Physiol 2022; 12:785399. [PMID: 35002767 PMCID: PMC8733577 DOI: 10.3389/fphys.2021.785399] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Open-water swim racing in warm water is associated with significant physiological strain. However, existing international policy that governs safe participation during competition relies only on a fixed water temperature threshold for event cancellation and has an unclear biophysical rationale. The current policy does not factor other environmental factors or race distance, nor provide a stratification of risk (low, moderate, high, or extreme) prior to the threshold for cancellation. Therefore, the primary aim of this Perspectives article is to highlight considerations for the development of modernized warm-water competition policies. We highlight current accounts (or lack thereof) of thermal strain, cooling interventions, and performance in warm-water swimming and opportunities for advancement of knowledge. Further work is needed that systematically evaluate real-world thermal strain and performance during warm water competition (alongside reports of environmental conditions), novel preparatory strategies, and in-race cooling strategies. This could ultimately form a basis for future development of modernized policies for athlete cohorts that stratifies risk and mitigation strategies according to important environmental factors and race-specific factors (distance).
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Affiliation(s)
- Samuel Chalmers
- Alliance for Research in Exercise, Nutrition, and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.,Thermal Ergonomics Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory Shaw
- High Performance Unit, Swimming Australia, Brisbane, QLD, Australia
| | - Iñigo Mujika
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Spain.,Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Nathan A, Ng A, Mitra A, Sooriakumaran P, Davda R, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H. Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2021; 34:e69-e78. [PMID: 34740477 DOI: 10.1016/j.clon.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
AIMS Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). MATERIALS AND METHODS Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. RESULTS High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. CONCLUSION We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.
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Affiliation(s)
- A Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK; The Royal College of Surgeons of England, London, UK.
| | - A Ng
- University College London, London, UK
| | - A Mitra
- University College London Hospitals NHS Trust, London, UK
| | - P Sooriakumaran
- University College London Hospitals NHS Trust, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Davda
- University College London Hospitals NHS Trust, London, UK
| | - S Patel
- University College London, London, UK
| | | | - J Kelly
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - G Shaw
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - P Rajan
- University College London Hospitals NHS Trust, London, UK
| | - A Sridhar
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - S Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - H Payne
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
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13
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [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]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - N Hanna
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [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
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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15
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Fricker M, Nathan A, Hannah N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.055] [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
Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.
Result
Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.
Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.
Conclusion
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
Take-home Message
Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.
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Affiliation(s)
| | - A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- University College London
| | - N Hannah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | | | | | | | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Nuffield Department of Surgical Sciences, University of Oxford
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
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16
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Dinneen E, Grierson J, Haider A, Allen C, Heffernan-Ho D, Clow R, Freeman A, Briggs T, Nathan S, Brew-Graves C, Mallett S, Williams N, Persad R, Aning J, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond J, Marzena R, Ben-Salha I, Kelly J, Shaw G. NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01245-8] [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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17
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Giganti F, Dinneen E, Kasivisvanathan V, Haider A, Freeman A, Emberton M, Shaw G, Moore C, Allen C. Interobserver reproducibility of the Prostate Imaging Quality (PI-QUAL) score for prostate MRI quality. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01289-6] [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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18
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Sharma A, Cleaveland P, Kasivisvanatha V, William N, Mia S, Collin J, Sridha A, Kelka A, Sha N, Kell J, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.388] [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
Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.
Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.
Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).
Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
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Affiliation(s)
- A Nathan
- University College London Hospitals, London, United Kingdom
| | - N Hanna
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - A Rashid
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Patel
- University College London Hospitals, London, United Kingdom
| | - Y Phuah
- University College London Hospitals, London, United Kingdom
| | - K Flora
- University College London Hospitals, London, United Kingdom
| | - A Sharma
- University College London Hospitals, London, United Kingdom
| | - P Cleaveland
- University College London Hospitals, London, United Kingdom
| | | | - N William
- University College London Hospitals, London, United Kingdom
| | - S Mia
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Collin
- University College London Hospitals, London, United Kingdom
| | - A Sridha
- University College London Hospitals, London, United Kingdom
| | - A Kelka
- University College London Hospitals, London, United Kingdom
| | - N Sha
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Kell
- University College London Hospitals, London, United Kingdom
| | - T Briggs
- University College London Hospitals, London, United Kingdom
| | - G Shaw
- University College London Hospitals, London, United Kingdom
| | | | - P Rajan
- University College London Hospitals, London, United Kingdom
| | - B Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Nathan
- University College London Hospitals, London, United Kingdom
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20
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Fitzgerald J, Shaw G, Jones D, Murphy M, Barry F. A novel xeno/serum-free medium to support the isolation and expansion of human adipose-derived mesenchymal stem cells. Cytotherapy 2021. [DOI: 10.1016/s1465324921003595] [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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21
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Brennan PA, Shaw G, Davies RJ, Oeppen RS. Erratum to 'Personal black box' thinking to improve our communication, behaviour and interaction with others' [Br. J. Oral and Maxillofac. Surg. 58 (2020) 882-884]. Br J Oral Maxillofac Surg 2020; 59:143. [PMID: 33272703 DOI: 10.1016/j.bjoms.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P A Brennan
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
| | - G Shaw
- Critical Factors Ltd, 2, Melrose Avenue, Borehamwood, WB6 2BJ, UK
| | - R J Davies
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - R S Oeppen
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD UK
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22
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Izquierdo M, Young SD, Bailey EH, Crout NMJ, Lofts S, Chenery SR, Shaw G. Kinetics of uranium(VI) lability and solubility in aerobic soils. Chemosphere 2020; 258:127246. [PMID: 32535442 DOI: 10.1016/j.chemosphere.2020.127246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Uranium may pose a hazard to ecosystems and human health due to its chemotoxic and radiotoxic properties. The long half-life of many U isotopes and their ability to migrate raise concerns over disposal of radioactive wastes. This work examines the long-term U bioavailability in aerobic soils following direct deposition or transport to the surface and addresses two questions: (i) to what extent do soil properties control the kinetics of U speciation changes in soils and (ii) over what experimental timescales must U reaction kinetics be measured to reliably predict long-term of impact in the terrestrial environment? Soil microcosms spiked with soluble uranyl were incubated for 1.7 years. Changes in UVI fractionation were periodically monitored by soil extractions and isotopic dilution techniques, shedding light on the binding strength of uranyl onto the solid phase. Uranyl sorption was rapid and strongly buffered by soil Fe oxides, but UVI remained reversibly held and geochemically reactive. The pool of uranyl species able to replenish the soil solution through several equilibrium reactions is substantially larger than might be anticipated from typical chemical extractions and remarkably similar across different soils despite contrasting soil properties. Modelled kinetic parameters indicate that labile UVI declines very slowly, suggesting that the processes and transformations transferring uranyl to an intractable sink progress at a slow rate regardless of soil characteristics. This is of relevance in the context of radioecological assessments, given that soil solution is the key reservoir for plant uptake.
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Affiliation(s)
- M Izquierdo
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom; Institute of Environmental Assessment and Water Research, 18-26 Jordi Girona, Barcelona, 08034, Spain.
| | - S D Young
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - E H Bailey
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - N M J Crout
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
| | - S Lofts
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, United Kingdom
| | - S R Chenery
- British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, NG12 5GG, United Kingdom
| | - G Shaw
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom
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23
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-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: 10/23/2022] Open
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24
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Hardie J, Oeppen R, Shaw G, Holden C, Tayler N, Brennan P. You Have Control: aviation communication application for safety-critical times in surgery. Br J Oral Maxillofac Surg 2020; 58:1073-1077. [PMID: 32933788 PMCID: PMC7449978 DOI: 10.1016/j.bjoms.2020.08.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.
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Affiliation(s)
- J.A. Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley, GU16 7UJ, UK,Corresponding author
| | - R.S. Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, SO16 6YD, UK
| | - G. Shaw
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - C. Holden
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - N. Tayler
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - P.A. Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
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25
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Whitfield J, Harris RC, Broad EM, Patterson AK, Ross MLR, Shaw G, Spriet LL, Burke LM. Chronic pantothenic acid supplementation does not affect muscle coenzyme A content or cycling performance. Appl Physiol Nutr Metab 2020; 46:280-283. [PMID: 33075232 DOI: 10.1139/apnm-2020-0692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study determined if supplementation with pantothenic acid (PA) for 16 weeks could increase skeletal muscle coenzyme A (CoASH) content and exercise performance. Trained male cyclists (n = 14) were matched into control or PA (6 g·day-1) groups. At 0, 4, 8, and 16 weeks, subjects performed an incremental time to exhaustion cycle with muscle biopsies taken prior to and following exercise. Prolonged PA supplementation did not change skeletal muscle CoASH and acetyl-CoA contents or exercise performance. Novelty: Supplementation with pantothenic acid for 16 weeks had no effect on skeletal muscle CoASH and acetyl-CoA content or exercise performance in trained male cyclists.
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Affiliation(s)
- Jamie Whitfield
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | | | | | | | - Megan L R Ross
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia.,Australian Institute of Sport, Belconnen, ACT 2616, Australia
| | - Gregory Shaw
- Australian Institute of Sport, Belconnen, ACT 2616, Australia
| | - Lawrence L Spriet
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Louise M Burke
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia.,Australian Institute of Sport, Belconnen, ACT 2616, Australia
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26
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Brennan P, Shaw G, Davies R, Oeppen R. “Personal black box” thinking to improve our communication, behaviour, and interaction with others. Br J Oral Maxillofac Surg 2020; 58:882-884. [DOI: 10.1016/j.bjoms.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022]
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27
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Boegman S, Stellingwerff T, Shaw G, Clarke N, Graham K, Cross R, Siegler JC. The Impact of Individualizing Sodium Bicarbonate Supplementation Strategies on World-Class Rowing Performance. Front Nutr 2020; 7:138. [PMID: 33015117 PMCID: PMC7509055 DOI: 10.3389/fnut.2020.00138] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
Contemporary meta-analyses have generally demonstrated a positive effect of sodium bicarbonate (NaHCO3) supplementation on exercise performance. However, despite these claims, there is limited data on contrasting individualized and standardized timing of NaHCO3 ingestion prior to exercise to further enhance performance outcomes. Purpose: To determine whether NaHCO3 ingestion timing impacts 2,000-m rowing time-trial (TT) performance in elite-level rowers (Senior National team including Olympic/World Championships level) adhering to their own individualized pre-race strategies (e.g. nutrition, warm-up, etc.). Methods: Twenty three (n = 23) rowers across two research centers (using the exact same methods/protocols) completed three trials: NaHCO3 loading profile at rest to determine the individual's time-to-peak bicarbonate concentration [HCO3-], followed by two randomized 0.3 g·kgBM−1 NaHCO3 supplementation experimental trials conducted at different time points [consensus timing (CON): TT performed 60 min post-NaHCO3 ingestion; and individualized peak (IP): TT performed at the rower's individual peak [HCO3-] determined from the profiling trial post-NaHCO3 ingestion]. Results: There was a significant mean difference of +2.9 [± 0.4 mmol·L−1HCO3- for IP vs. CON (95% CI 2.0 to 3.8 mmol·L−1); p = 0.02; d = 1.08] at pre warm-up, but not immediately prior to the TT (post warm-up). Performance times were significantly different between IP (367.0 ± 10.5 s) vs. CON (369.0 ± 10.3 s); p = 0.007; d = 0.15). Conclusions: The present study demonstrated a small but significant performance effect of an individualized NaHCO3 ingestion strategy. Similarities after warm-up between pre-TT sHCO3- values (CON ~ + 5.5 mmol·L−1; IP ~ + 6 mmol·L−1), however, would suggest this effect was not a result of any meaningful differences in blood alkalinity.
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Affiliation(s)
- Susan Boegman
- Canadian Sport Institute Pacific, Victoria, BC, Canada
| | - Trent Stellingwerff
- Canadian Sport Institute Pacific, Victoria, BC, Canada.,Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, BC, Canada
| | - Gregory Shaw
- Swimming Australia, High Performance Unit, Brisbane, QLD, Australia
| | - Nick Clarke
- Canadian Sport Institute Pacific, Victoria, BC, Canada.,Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, BC, Canada
| | - Kenneth Graham
- Sport and Exercise Science Program, School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Rebecca Cross
- Sport and Exercise Science Program, School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Jason C Siegler
- Sport and Exercise Science Program, School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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28
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Abstract
Mammalian embryonic diapause is a reproductive phenomenon defined by the reversible arrest in blastocyst development and metabolic activity within the uterus which synchronously becomes quiescent to implantation. This natural strategy, evident in over 130 species across eight orders, can temporally uncouple conception from delivery until conditions are favorable for the survival of the mother and newborn. While the maternal endocrine milieu has been shown to be important for this process, the local molecular mechanisms by which the uterus and embryo achieve quiescence, maintain blastocyst survival and then resumes blastocyst activation with subsequent implantation in response to endocrine cues remains unclear. Here we review the first evidence that the proximal molecular control of embryonic diapause is conserved in three unrelated mammalian species which employ different endocrine programs to initiate diapause. In particular, uterine expression of muscle segment homeobox (Msx) genes Msx1 or Msx2 persists during diapause, followed by downregulation with blastocyst reactivation and implantation. Mice (Mus musculus) with conditional inactivation of Msx1 and Msx2 in the uterus fail to achieve diapause and reactivation. Remarkably, the mink (Neovison vison) and tammar wallaby (Macropus eugenii) share this pattern of MSX1 or MSX2 expression as in mice during delay - it persists during diapause and is rapidly downregulated upon implantation. Therefore, these findings were the first to provide evidence that there are common conserved molecular regulators in the uterus of unrelated mammals during embryonic diapause.
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Affiliation(s)
- J Cha
- Division of Reproductive Sciences, Cincinnati Children's Hospital Medical Center, USA.,Present address: Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, USA
| | - J C Fenelon
- School of Biosciences, University of Melbourne, Melbourne, Australia
| | - B D Murphy
- Centre de recherche en reproduction et fertilité, Université de Montréal, Québec, Canada
| | - G Shaw
- School of Biosciences, University of Melbourne, Melbourne, Australia
| | - M B Renfree
- School of Biosciences, University of Melbourne, Melbourne, Australia
| | - S K Dey
- Division of Reproductive Sciences, Cincinnati Children's Hospital Medical Center, USA
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29
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Oeppen RS, Shaw G, Brennan PA. Human factors recognition at virtual meetings and video conferencing: how to get the best performance from yourself and others. Br J Oral Maxillofac Surg 2020; 58:643-646. [PMID: 32417017 PMCID: PMC7211617 DOI: 10.1016/j.bjoms.2020.04.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/15/2022]
Abstract
During the current coronavirus pandemic, social distancing and restrictions on travel have resulted in a dramatic rise in the use of technology (including video conferencing) for remote meetings. From local multidisciplinary team (MDT) meetings to national and international committees, this form of communication has been vital to ensure patient-related and other business can continue, albeit in a sometimes unfamiliar environment. In this article we consider some of the human factors elements of remote meetings and provide suggestions to enhance the experience of team and committee members during this unsettling time. It is possible that this form of communication will continue to flourish after the pandemic is over.
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Affiliation(s)
- R S Oeppen
- University Hospitals Southampton, Southampton SO16 6YD
| | - G Shaw
- Critical Factors Ltd, 2 Melrose Avenue Borehamwood WD6 2BJ, UK
| | - P A Brennan
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
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30
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Duffy N, James S, Shaw G, Leahy M, Murphy M. Investigation of nanostar-labeled mesenchymal stem cells for in vivo cell tracking in osteoarthritis using optoacoustic imaging. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.286] [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: 11/24/2022]
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31
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Shaw G, Whelan ME, Armitage LC, Roberts N, Farmer AJ. Are COPD self-management mobile applications effective? A systematic review and meta-analysis. NPJ Prim Care Respir Med 2020; 30:11. [PMID: 32238810 PMCID: PMC7113264 DOI: 10.1038/s41533-020-0167-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
The burden of chronic obstructive pulmonary disease (COPD) to patients and health services is steadily increasing. Self-management supported by mobile device applications could improve outcomes for people with COPD. Our aim was to synthesize evidence on the effectiveness of mobile health applications compared with usual care. A systematic review was conducted to identify randomized controlled trials. Outcomes of interest included exacerbations, physical function, and Quality of Life (QoL). Where possible, outcome data were pooled for meta-analyses. Of 1709 citations returned, 13 were eligible trials. Number of exacerbations, quality of life, physical function, dyspnea, physical activity, and self-efficacy were reported. Evidence for effectiveness was inconsistent between studies, and the pooled effect size for physical function and QoL was not significant. There was notable variation in outcome measures used across trials. Developing a standardized outcome-reporting framework for digital health interventions in COPD self-management may help standardize future research.
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Affiliation(s)
- G Shaw
- Exeter College, University of Oxford, Oxford, UK
| | - M E Whelan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - L C Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - A J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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32
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Muscedere J, Afilalo J, Araujo de Carvalho I, Cesari M, Clegg A, Eriksen HE, Evans KR, Heckman G, Hirdes JP, Kim PM, Laffon B, Lynn J, Martin F, Prorok JC, Rockwood K, Rodrigues Mañas L, Rolfson D, Shaw G, Shea B, Sinha S, Theou O, Tugwell P, Valdiglesias V, Vellas B, Veronese N, Wallace LMK, Williamson PR. Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research. J Frailty Aging 2020; 9:14-22. [PMID: 32150209 DOI: 10.14283/jfa.2019.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.
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Affiliation(s)
- J Muscedere
- John Muscedere, Queen's University and Kingston General Hospital, Canada, E-Mail:
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Brennan PA, Holden C, Shaw G, Morris S, Oeppen RS. Leading article: What can we do to improve individual and team situational awareness to benefit patient safety? Br J Oral Maxillofac Surg 2020; 58:404-408. [PMID: 32115301 DOI: 10.1016/j.bjoms.2020.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/28/2020] [Indexed: 01/17/2023]
Abstract
It is increasingly being recognised that human factors can contribute to error in complex safety systems. Healthcare, however, has a long way to go before the promotion of training in, and awareness of, human factors will catch up with other high-risk organisations. A critical component that is deemed essential both for improving clinical performance and reducing medical error is situational awareness (SA). This is dynamic and can reduce quickly or be lost entirely, particularly when the workload is heavy. Tunnel vision, in which healthcare professionals concentrate on a single aspect of a patient's care, is just one example of reduced awareness that can be detrimental to safety. As in aviation and other high-risk organisations, a reduction in SA, if not recognised by individuals or the wider team, can lead to serious or potentially fatal outcomes. We therefore give an overview of SA and show how it can easily be reduced. We also suggest some simple but effective ways to improve it and in turn improve patient safety. We emphasise the importance of clinical teams looking out for each other, particularly in the operating theatre.
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Affiliation(s)
- P A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - C Holden
- Heathrow Airport, Middlesex TW6 1EW, UK
| | - G Shaw
- Heathrow Airport, Middlesex TW6 1EW, UK
| | - S Morris
- Red 5, The Red Arrows Acrobatic Team, RAF Scampton, Lincolnshire LN1 2ST, UK
| | - R S Oeppen
- Department of Clinical Radiology, University Hospital, Southampton SO16 6YD, UK
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Wang J, Bailey EH, Sanders HK, Izquierdo M, Crout NMJ, Shaw G, Yang L, Li H, Wei B, Young SD. Using chemical fractionation and speciation to describe uptake of technetium, iodine and selenium by Agrostis capillaris and Lolium perenne. J Environ Radioact 2020; 212:106131. [PMID: 31885365 DOI: 10.1016/j.jenvrad.2019.106131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
To understand the dynamic mechanisms governing soil-to-plant transfer of selenium (Se), technetium-99 (99Tc) and iodine (I), a pot experiment was undertaken using 30 contrasting soils after spiking with 77Se, 99Tc and 129I, and incubating for 2.5 years. Two grass species (Agrostis capillaris and Lolium perenne) were grown under controlled conditions for 4 months with 3 cuts at approximately monthly intervals. Native (soil-derived) 78Se and127I, as well as spiked 77Se, 99Tc and 129I, were assayed in soil and plants by ICP-MS. The grasses exhibited similar behaviour with respect to uptake of all three elements. The greatest uptake observed was for 99Tc, followed by 77Se, with least uptake of 129I, reflecting the transformations and interactions with soil of the three isotopes. Unlike soil-derived Se and I, the available pools of 77Se, 99Tc and 129I were substantially depleted by plant uptake across the three cuts with lower concentrations observed in plant tissues in each subsequent cut. Comparison between total plant offtake and various soil species suggested that 77SeO42-, 99TcO4- and 129IO3-, in soluble and adsorbed fractions were the most likely plant-available species. A greater ratio of 127I/129I in the soil solid phase compared to the solution phase confirmed incomplete mixing of spiked 129I with native 127I in the soil, despite the extended incubation period, leading to poor buffering of the spiked available pools. Compared to traditional expressions of soil-plant transfer factor (TFtotal), a transfer factor (TFavailable) expressed using volumetric concentrations of speciated 'available' fractions of each element showed little variation with soil properties.
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Affiliation(s)
- J Wang
- Key Laboratory for Geographical Process Analysis & Simulation, Research Institute of Sustainable Development, Central China Normal University, Wuhan, 430079, People's Republic of China; Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, People's Republic of China
| | - E H Bailey
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - H K Sanders
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom
| | - M Izquierdo
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom
| | - N M J Crout
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom
| | - G Shaw
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom
| | - L Yang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, People's Republic of China
| | - H Li
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, People's Republic of China
| | - B Wei
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, People's Republic of China
| | - S D Young
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, United Kingdom
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Bruning-Richardson A, Sanganee H, Barry S, Tams D, Brend T, King H, Morton R, Ward T, Steele L, Shaw G, Esteves F, Droop A, Lawler S, Short S. PL3.6 Targeting GSK-3 activity promotes mitotic catastrophe via centrosome destabilisation and enhances the effect of radiotherapy in glioma models. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Targeting kinases as regulators of cellular processes that drive cancer progression is a promising approach to improve patient outcome in GBM management. The glycogen synthase kinase 3 (GSK-3) plays a role in cancer progression and is known for its pro-proliferative activity in gliomas. The anti-proliferative and cytotoxic effects of the GSK-3 inhibitor AZD2858 were assessed in relevant in vitro and in vivo glioma models to confirm GSK-3 as a suitable target for improved single agent or combination treatments.
MATERIAL AND METHODS
The immortalised cell line U251 and the patient derived cell lines GBM1 and GBM4 were used in in vitro studies including MTT, clonogenic survival, live cell imaging, immunofluorescence microscopy and flow cytometry to assess the cytotoxic and anti-proliferative effects of AZD2858. Observed anti-proliferative effects were investigated by microarray technology for the identification of target genes with known roles in cell proliferation. Clinical relevance of targeting GSK-3 with the inhibitor either for single agent or combination treatment strategies was determined by subcutaneous and orthotopic in vivo modelling. Whole mount mass spectroscopy was used to confirm drug penetration in orthotopic tumour models.
RESULTS
AZD2858 was cytotoxic at low micromolar concentrations and at sub-micromolar concentrations (0.01 - 1.0 μM) induced mitotic defects in all cell lines examined. Prolonged mitosis, centrosome disruption/duplication and cytokinetic failure leading to cell death featured prominently among the cell lines concomitant with an observed S-phase arrest. No cytotoxic or anti-proliferative effect was observed in normal human astrocytes. Analysis of the RNA microarray screen of AZD2858 treated glioma cells revealed the dysregulation of mitosis-associated genes including ASPM and PRC1, encoding proteins with known roles in cytokinesis. The anti-proliferative and cytotoxic effect of AZD2858 was also confirmed in both subcutaneous and orthotopic in vivo models. In addition, combination treatment with AZD2858 enhanced clinically relevant radiation doses leading to reduced tumour volume and improved survival in orthotopic in vivo models.
CONCLUSION
GSK-3 inhibition with the small molecule inhibitor AZD2858 led to cell death in glioma stem cells preventing normal centrosome function and promoting mitotic failure. Normal human astrocytes were not affected by treatment with the inhibitor at submicromolar concentrations. Drug penetration was observed alongside an enhanced effect of clinical radiotherapy doses in vivo. The reported aberrant centrosomal duplication may be a direct consequence of failed cytokinesis suggesting a role of GSK-3 in regulation of mitosis in glioma. GSK-3 is a promising target for combination treatment with radiation in GBM management and plays a role in mitosis-associated events in glioma biology.
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Affiliation(s)
| | | | - S Barry
- Astra Zeneca, Cambridge, United Kingdom
| | - D Tams
- University of Leeds, Leeds, United Kingdom
| | - T Brend
- University of Leeds, Leeds, United Kingdom
| | - H King
- University of Leeds, Leeds, United Kingdom
| | - R Morton
- University of Leeds, Leeds, United Kingdom
| | - T Ward
- University of Leeds, Leeds, United Kingdom
| | - L Steele
- University of Leeds, Leeds, United Kingdom
| | - G Shaw
- University of Leeds, Leeds, United Kingdom
| | - F Esteves
- University of Leeds, Leeds, United Kingdom
| | - A Droop
- University of Leeds, Leeds, United Kingdom
| | - S Lawler
- Harvard University, Boston, MA, United States
| | - S Short
- University of Leeds, Leeds, United Kingdom
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Salvatore D, Shaw G, Wright J, Teh I, Koch-Paszkowski J, Murray L, Scarsbrook A, Schneider J, Ottobrini L, Short S. P11.13 Radiotherapy combined with a multimodal imaging approach in a glioblastoma preclinical model. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma multiforme (GBM) carries a poor prognosis, partly due to biological and anatomical heterogeneity. Although radiotherapy (RT) is effective, high doses damage surrounding healthy tissues. Multimodal imaging with Magnetic Resonance (MRI) and Positron Emission Tomography (PET) may represent a useful approach for identifying GBM heterogeneity and visualising metabolic tumour properties. PET radiotracer [18F]-fluciclovine is preferentially accumulated in gliomas compared to healthy brain tissue via the cellular transport systems, LAT1 and ASCT2. In this study the effect of fractionated RT using multimodal imaging including [18F]-fluciclovine uptake and immunohistochemistry (IHC) in a GBM preclinical model will be validated.
MATERIAL AND METHODS
Two C57BL/6J mice cohorts were injected intracranially (i.c.) with murine CT2A-luc cells and subsequently submitted to multiparametric MRI and [18F]-fluciclovine PET imaging during hemi-brain RT (3Gy on 2 days/each week) for maximum 25 days after i.c. injection. Brains were collected for IHC characterization including LAT1 and ASCT2 staining.
RESULTS
Preliminary data showed that both MRI and PET were effective modalities to track tumour growth in this model. PET data revealed up to greater than 3-fold increase in SUVmax from regions of interest around the tumour site compared to healthy brain tissue. Time activity curves showed a steady increase in tumour uptake over 90 minutes. MRI showed a 25% increase in T2 values in tumours relative to unaffected contralateral regions. Confirmation of treatment response through matched imaging and IHC are ongoing, from which changes in glioma cell biology as well as amino acid transporter protein levels will be analysed.
CONCLUSION
These preliminary results show that multimodal imaging presents novel data in the assessment of treatment response in this model and will permit parallel IHC analyses to better define GBM tumour heterogeneity aligned with imaging changes. These data will also inform an on-going clinical study using the same imaging modalities.
Work at authors’ labs are supported by an Investigator initiated project from Blue Earth Diagnostics (AS, SCS) and a University of Leeds Biswas studentship (SCS, DS). Daniela Salvatore is also supported by a Scholarship provided by Molecular and Translational Medicine Doctorate School of University of Milan (Italy).
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Affiliation(s)
- D Salvatore
- Leeds Institute of Medical Research (LIMR), Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
- Department of Pathophysiology and Transplantation, University of Milan, Segrate, Milan, Italy
| | - G Shaw
- Leeds Institute of Medical Research (LIMR), Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
| | - J Wright
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, United Kingdom
| | - I Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, United Kingdom
| | - J Koch-Paszkowski
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, United Kingdom
| | - L Murray
- Leeds Institute of Medical Research (LIMR), Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
| | - A Scarsbrook
- Leeds Institute of Medical Research (LIMR), Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
| | - J Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, United Kingdom
| | - L Ottobrini
- Department of Pathophysiology and Transplantation, University of Milan, Segrate- Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Milan, Italy
| | - S Short
- Leeds Institute of Medical Research (LIMR), Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
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Slater GJ, Dieter BP, Marsh DJ, Helms ER, Shaw G, Iraki J. Is an Energy Surplus Required to Maximize Skeletal Muscle Hypertrophy Associated With Resistance Training. Front Nutr 2019; 6:131. [PMID: 31482093 PMCID: PMC6710320 DOI: 10.3389/fnut.2019.00131] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 04/08/2019] [Accepted: 08/02/2019] [Indexed: 01/11/2023] Open
Abstract
Resistance training is commonly prescribed to enhance strength/power qualities and is achieved via improved neuromuscular recruitment, fiber type transition, and/ or skeletal muscle hypertrophy. The rate and amount of muscle hypertrophy associated with resistance training is influenced by a wide array of variables including the training program, plus training experience, gender, genetic predisposition, and nutritional status of the individual. Various dietary interventions have been proposed to influence muscle hypertrophy, including manipulation of protein intake, specific supplement prescription, and creation of an energy surplus. While recent research has provided significant insight into optimization of dietary protein intake and application of evidence based supplements, the specific energy surplus required to facilitate muscle hypertrophy is unknown. However, there is clear evidence of an anabolic stimulus possible from an energy surplus, even independent of resistance training. Common textbook recommendations are often based solely on the assumed energy stored within the tissue being assimilated. Unfortunately, such guidance likely fails to account for other energetically expensive processes associated with muscle hypertrophy, the acute metabolic adjustments that occur in response to an energy surplus, or individual nuances like training experience and energy status of the individual. Given the ambiguous nature of these calculations, it is not surprising to see broad ranging guidance on energy needs. These estimates have never been validated in a resistance training population to confirm the "sweet spot" for an energy surplus that facilitates optimal rates of muscle gain relative to fat mass. This review not only addresses the influence of an energy surplus on resistance training outcomes, but also explores other pertinent issues, including "how much should energy intake be increased," "where should this extra energy come from," and "when should this extra energy be consumed." Several gaps in the literature are identified, with the hope this will stimulate further research interest in this area. Having a broader appreciation of these issues will assist practitioners in the establishment of dietary strategies that facilitate resistance training adaptations while also addressing other important nutrition related issues such as optimization of fuelling and recovery goals. Practical issues like the management of satiety when attempting to increase energy intake are also addressed.
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Affiliation(s)
- Gary John Slater
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
- Australian Institute of Sport, Canberra, ACT, Australia
| | - Brad P. Dieter
- Department of Pharmaceutical Sciences, Washington State University, WA Spokane, WA, United States
| | | | - Eric Russell Helms
- Auckland University of Technology, Sports Performance Research Institute New Zealand, Auckland, New Zealand
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Dinneen E, Haider A, Grierson J, Briggs T, Persad R, Oakley N, Freeman A, Shaw G. Re: What is the role of NeuroSAFE in robotic radical prostatectomy? J Robot Surg 2019; 13:707-708. [PMID: 30980228 DOI: 10.1007/s11701-019-00962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TS, UK. .,Department of Urology, University College London Hospital, London, UK.
| | - A Haider
- Department of Histopathology, University College London Hospital, London, UK
| | - J Grierson
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - T Briggs
- Department of Urology, University College London Hospital, London, UK
| | - R Persad
- Department of Urology, North Bristol Hospitals Trust, Bristol, UK
| | - N Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Freeman
- Department of Histopathology, University College London Hospital, London, UK
| | - G Shaw
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TS, UK.,Department of Urology, University College London Hospital, London, UK
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Shaw G, Serpell B, Baar K. Rehabilitation and nutrition protocols for optimising return to play from traditional ACL reconstruction in elite rugby union players: A case study. J Sports Sci 2019; 37:1794-1803. [PMID: 30967011 DOI: 10.1080/02640414.2019.1594571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Current nutrition and exercise focus during rehabilitation periods has been on reducing muscle atrophy associated with immobilisation. This case report outlines a best practice anterior cruciate ligament (ACL) rehabilitation programme undertaken by two professional rugby athletes, with the addition of an evidence-based supplementation (gelatine and vitamin C) and exercise protocol focused on collagenous tissue. Both players ruptured their left ACL and were repaired with a traditional hamstring graft. Players undertook a structured rehabilitation programme for 34 weeks before being clinically assessed ready to play. Players saw minimal changes in body composition in the early rehabilitation period (P1 - 0.8 kg; P2 - 0.4 kg). Leg lean mass reduced in both legs of Player 1 (Injured - 0.8 kg, Non-injured - 0.6 kg) at 17 weeks, with Player 2 only experiencing a loss of 0.3 kg of lean tissue in the injured leg. Both players returned to baseline body compositions after 24 weeks. Leg strength returned to a maximum at 24 and 15 weeks, respectively, with knee function returning to baseline by 30 weeks. This case report provides evidence that nutrition and rehabilitation programmes targeted at minimising the effects of disuse in both muscle and connective tissue may assist return to play after ACL injury.
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Affiliation(s)
- Gregory Shaw
- a High Performance Unit , Swimming Australia , Brisbane , Australia
| | | | - Keith Baar
- c Department of Neurobiology, Physiology, and Behaviour , University of California Davis , Davis, CA , USA.,d Department of Physiology and Membrane Biology , University of California Davis , Davis , CA , USA.,e High Performance Unit , VA Northern California Health Care System , Mather , CA , USA
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40
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Itthipoonthanakorn T, Dann SE, Crout NMJ, Shaw G. Nuclear weapons fallout 137Cs in temperate and tropical pine forest soils, 50 years post-deposition. Sci Total Environ 2019; 660:807-816. [PMID: 30743966 DOI: 10.1016/j.scitotenv.2019.01.073] [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] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Following nuclear releases to the environment, 137Cs (half-life 30 years) is a long-term contaminant of many ecosystems, including forests. We recently sampled soils under pine forests in temperate and tropical climates to test the hypothesis that migration of 137Cs, 50 years after nuclear weapons fallout, is coupled with organic matter (OM) accumulation in these soils. Depth profiles of 137Cs, naturally-occurring 210Pb and weapons-derived 241Am were measured. After 50 years, migration of 137Cs into the temperate and tropical soils is limited to half-depths of 7-8 cm and 2-3 cm, respectively. At both locations, most 137Cs is associated with OM that accumulated from the early to mid-1960s. Illite, which immobilises radiocaesium, was undetectable by X-ray diffraction in the layer of peak 137Cs accumulation in the temperate forest soil, but apparent in the zone of peak concentration in the tropical soil. Data indicate that long-term (50 year) fate of 137Cs in organic-rich, temperate forest soil is coupled with OM accumulation; fixation of 137Cs by illite is more important in the tropical forest soil where OM is rapidly decomposed. Models of long-term radiocaesium migration in forest soils should explicitly account for the role of OM, especially when considering forests under contrasting climatic regimes.
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Affiliation(s)
| | - S E Dann
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, UK
| | - N M J Crout
- School of Biosciences, University of Nottingham, Sutton Bonington LE12 5RD, UK
| | - G Shaw
- School of Biosciences, University of Nottingham, Sutton Bonington LE12 5RD, UK.
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Dias Moreira AS, Grint K, Stepien R, Shaw G, Peek S. Tricuspid valve dysplasia and a patent foramen ovale resulting in severe tricuspid regurgitation and right-heart dilation in a Red Angus calf. J Vet Cardiol 2018; 21:28-33. [PMID: 30797442 DOI: 10.1016/j.jvc.2018.10.005] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 11/25/2022]
Abstract
A two-month-old Red Angus heifer calf presented to the University of Wisconsin Veterinary Care for evaluation of suspected severe bronchopneumonia. Pertinent physical exam findings included tachycardia, tachypnea, dyspnea with a significant abdominal component, and cyanotic mucous membranes. On thoracic auscultation, wheezes were present bilaterally, as well as a grade 2/6 right apical systolic murmur. Thoracic radiographs revealed cardiomegaly, most severely affecting the right side. Echocardiography showed tricuspid valve dysplasia, resulting in severe tricuspid regurgitation and right-heart dilation, as well as a patent foramen ovale. A postmortem examination confirmed the presence of the aforementioned cardiac abnormalities and revealed only mild pulmonary changes. This case report is the first to describe tricuspid dysplasia in the absence of multiple, complex congenital cardiac abnormalities in a calf, and it highlights the value of echocardiography for an antemortem diagnosis.
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Affiliation(s)
- A S Dias Moreira
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
| | - K Grint
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - R Stepien
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - G Shaw
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - S Peek
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
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Shaw G, Brisbois J, Pinheiro LBGL, Müller J, Blanco Alvarez S, Devillers T, Dempsey NM, Scheerder JE, Van de Vondel J, Melinte S, Vanderbemden P, Motta M, Ortiz WA, Hasselbach K, Kramer RBG, Silhanek AV. Quantitative magneto-optical investigation of superconductor/ferromagnet hybrid structures. Rev Sci Instrum 2018; 89:023705. [PMID: 29495853 DOI: 10.1063/1.5016293] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present a detailed quantitative magneto-optical imaging study of several superconductor/ferromagnet hybrid structures, including Nb deposited on top of thermomagnetically patterned NdFeB and permalloy/niobium with erasable and tailored magnetic landscapes imprinted in the permalloy layer. The magneto-optical imaging data are complemented with and compared to scanning Hall probe microscopy measurements. Comprehensive protocols have been developed for calibrating, testing, and converting Faraday rotation data to magnetic field maps. Applied to the acquired data, they reveal the comparatively weaker magnetic response of the superconductor from the background of larger fields and field gradients generated by the magnetic layer.
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Affiliation(s)
- G Shaw
- Experimental Physics of Nanostructured Materials, Q-MAT, CESAM, Université de Liège, B-4000 Sart Tilman, Belgium
| | - J Brisbois
- Experimental Physics of Nanostructured Materials, Q-MAT, CESAM, Université de Liège, B-4000 Sart Tilman, Belgium
| | - L B G L Pinheiro
- Departamento de Física, Universidade Federal de São Carlos, 13565-905 São Carlos, SP, Brazil
| | - J Müller
- Experimental Physics of Nanostructured Materials, Q-MAT, CESAM, Université de Liège, B-4000 Sart Tilman, Belgium
| | - S Blanco Alvarez
- Experimental Physics of Nanostructured Materials, Q-MAT, CESAM, Université de Liège, B-4000 Sart Tilman, Belgium
| | - T Devillers
- Univ. Grenoble Alpes, CNRS, Institut Néel, 38000, Grenoble, France
| | - N M Dempsey
- Univ. Grenoble Alpes, CNRS, Institut Néel, 38000, Grenoble, France
| | - J E Scheerder
- Laboratory of Solid-State Physics and Magnetism, KU Leuven, Celestijnenlaan 200 D, Box 2414, B-3001 Leuven, Belgium
| | - J Van de Vondel
- Laboratory of Solid-State Physics and Magnetism, KU Leuven, Celestijnenlaan 200 D, Box 2414, B-3001 Leuven, Belgium
| | - S Melinte
- Université catholique de Louvain, Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTM), Institut de la Matière Condensée et des Nanosciences (IMCN), 1348 Louvain-la-Neuve, Belgium
| | - P Vanderbemden
- Université de Liège, SUPRATECS and Department of Electrical Engineering and Computer Science, Sart Tilman B-4000, Belgium
| | - M Motta
- Departamento de Física, Universidade Federal de São Carlos, 13565-905 São Carlos, SP, Brazil
| | - W A Ortiz
- Departamento de Física, Universidade Federal de São Carlos, 13565-905 São Carlos, SP, Brazil
| | - K Hasselbach
- Univ. Grenoble Alpes, CNRS, Institut Néel, 38000, Grenoble, France
| | - R B G Kramer
- Univ. Grenoble Alpes, CNRS, Institut Néel, 38000, Grenoble, France
| | - A V Silhanek
- Experimental Physics of Nanostructured Materials, Q-MAT, CESAM, Université de Liège, B-4000 Sart Tilman, Belgium
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Bar K, Bauer A, Veazey R, Li H, Shaw G, Lee F, Watkins M. Novel SHIVs encoding transmitted/founder envs for latency and cure research. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30601-4] [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: 10/23/2022] Open
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Dutto L, Witt JH, Urbanova K, Wagner C, Schuette A, Addali M, Kelly JD, Nathan S, Briggs TP, Sridhar A, Gori S, Ahmad A, Shaw G. Development and external validation of a novel risk score to identify insignificant prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5073] [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: 11/20/2022] Open
Abstract
5073 Background: Active surveillance is increasingly used for insignificant prostate cancer (PCa). In order to identify suitable patients, risk scores have been developed which use pre-operative factors. We evaluated the accuracy of 9 separate tools developed to identify patients harbouring insignificant PCa in 2613 patients who underwent radical prostatectomy for Gleason 3+3 PCa. We have developed and validated a novel risk score to correctly identify insignificant PCa for use in unscreened patient cohorts using non-dichotomised clinical predictors. Methods: 2799 patients who would have been candidates for AS (Gleason score 6 only) patients underwent robotic radical prostatectomy between 2006 and 2016 at a tertiary referral center. The volume and grade of tumour in the resected prostate was analysed. Inignificant PCa was defined as Gleason 3+3 only, index tumour volume <1.3 cm3 , total tumour volume <2.5 cm3 (updated ERSPC definition). 2613 patients were included in the final analysis. We computed the accuracy (specificity, sensitivity and area under the curve (AUC) of the receiver operator characteristic) of 9 predictive tools. Multivariate logistic regression with elastic net regularisation was used to develop a novel tool to predict insignificant prostate cancer using age at diagnosis, baseline PSA, TRUS volume, clinical T-stage, number of positive cores and percentage of positive cores as predictors. This tool was validated in an external cohort of 441 unscreened patients undergoing surgery for Gleason 6 PCa. Results: All of the predefined tools rated poorly as predictors of insignificant disease as none of them reached the required AUC threshold of 0.7. The new tool performed well in training and validation cohorts. Conclusions: Pre-existing predictive tools to identify indolent PCa have a poor predictive value when applied to an unscreened cohort of patients. Our novel tool shows good predictive power for insignificant PCa in this population in training and validation cohorts. The inherent selection bias due to analysis of a surgical cohort is acknowledged. [Table: see text]
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Affiliation(s)
- Lorenzo Dutto
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Germany
| | | | - Katarina Urbanova
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Germany
| | - Christian Wagner
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Germany
| | - Andreas Schuette
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Germany
| | - Mustafa Addali
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Germany
| | - John D Kelly
- University College London, London, United Kingdom
| | - Senthil Nathan
- Department of Urology, University College London Hospital, London, United Kingdom
| | | | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, United Kingdom
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | - Amar Ahmad
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Gregory Shaw
- Department of Urology, University College London Hospital, London, United Kingdom
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Gaynard S, Shaw G, Mark B, Barry F, Murphy M. Novel macrocarrier system for the scalable 3D expansion of bone marrow derived MSCs isolated and expanded in a novel xeno-free medium. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.239] [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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Whitaker L, Murray A, Matthews R, Shaw G, Williams A, Saunders P, Critchley H. Selective progesterone receptor modulator (SPRM) ulipristal acetate (UPA) and its effects on the human endometrium. Hum Reprod 2017; 32:531-543. [PMID: 28130434 PMCID: PMC5400066 DOI: 10.1093/humrep/dew359] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/30/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION What is the impact of administration of the selective progesterone receptor modulator (SPRM), ulipristal acetate (UPA) on the endometrium of women with fibroids? SUMMARY ANSWER UPA administration altered expression of sex-steroid receptors and progesterone-regulated genes and was associated with low levels of glandular and stromal cell proliferation. WHAT IS KNOWN ALREADY Administration of all SPRM class members results in PAEC (progesterone receptor modulator associated endometrial changes). Data on the impact of the SPRM UPA administration on endometrial sex-steroid receptor expression, progesterone (P)-regulated genes and cell proliferation are currently lacking. STUDY DESIGN SIZE, DURATION Observational study with histological and molecular analyses to delineate impact of treatment with UPA on endometrium. Endometrial samples (n = 9) were collected at hysterectomy from women aged 39 to 49 with uterine fibroids treated with UPA (oral 5 mg daily) for 9-12 weeks. Control proliferative (n = 9) and secretory (n = 9) endometrium from women aged 38-52 with fibroids were derived from institutional tissue archives. PARTICIPANTS/MATERIALS, SETTING, METHODS Study setting was a University Research Institute. Endometrial biopsies were collected with institutional ethical approval and written informed consent. Concentrations of mRNAs encoded by steroid receptors, P-regulated genes and factors in decidualised endometrium were quantified with qRT-PCR. Immunohistochemistry was employed for localization of progesterone (PR, PRB), androgen (AR), estrogen (ERα) receptors and expression of FOXO1, HAND2, HOXA10, PTEN homologue. Endometrial glandular and stromal cell proliferation was objectively quantified using Ki67. MAIN RESULTS AND THE ROLE OF CHANCE UPA induced morphological changes in endometrial tissue consistent with PAEC. A striking change in expression patterns of PR and AR was detected compared with either proliferative or secretory phase samples. There were significant changes in pattern of expression of mRNAs encoded by IGFBP-1, FOXO1, IL-15, HAND2, IHH and HOXA10 compared with secretory phase samples consistent with low agonist activity in endometrium. Expression of mRNA encoded by FOXM1, a transcription factor implicated in cell cycle progression, was low in UPA-treated samples. Cell proliferation (Ki67 positive nuclei) was lower in samples from women treated with UPA compared with those in the proliferative phase. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION A small number of well-characterized patients were studied in-depth. The impacts on morphology, molecular and cellular changes with SPRM, UPA administration on symptom control remains to be determined. WIDER IMPLICATIONS OF THE FINDINGS P plays a pivotal role in endometrial function. P-action is mediated through interaction with the PR. These data provide support for onward development of the SPRM class of compounds as effective long-term medical therapy for heavy menstrual bleeding. STUDY FUNDING/COMPETING INTEREST(S) H.O.D.C. received has clinical research support for laboratory consumables and staff from Bayer Pharma Ag and provides consultancy advice (no personal remuneration) for Bayer Pharma Ag, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc.; A.R.W.W. has received consultancy payments from Bayer, Gedeon Richter, Preglem SA, HRA Pharma; L.H.R.W., A.A.M., R.M., G.S. and P.T.K.S. have no conflicts of interest. Study funded in part from each of: Medical Research Council (G1002033; G1100356/1; MR/N022556/1); National Health Institute for Health Research (12/206/520) and TENOVUS Scotland.
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Affiliation(s)
- L.H.R. Whitaker
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - A.A. Murray
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - R. Matthews
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - G. Shaw
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - A.R.W. Williams
- Division of Pathology, The University of Edinburgh, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - P.T.K. Saunders
- MRC Centre for Inflammation Research, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - H.O.D. Critchley
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
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Toedebusch CM, Bachrach MD, Garcia VB, Johnson GC, Katz ML, Shaw G, Coates JR, Garcia ML. Cerebrospinal Fluid Levels of Phosphorylated Neurofilament Heavy as a Diagnostic Marker of Canine Degenerative Myelopathy. J Vet Intern Med 2017; 31:513-520. [PMID: 28186658 PMCID: PMC5354061 DOI: 10.1111/jvim.14659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/23/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND No definitive, antemortem diagnostic test for canine degenerative myelopathy (DM) is available. Phosphorylated neurofilament heavy (pNF-H) is a promising biomarker for nervous system diseases. HYPOTHESIS/OBJECTIVE Cerebrospinal fluid (CSF) and serum pNF-H is a detectable biological marker for diagnosis of canine DM. ANIMALS Fifty-three DM-affected, 27 neurologically normal, 7 asymptomatic at-risk, and 12 DM mimic dogs. METHODS Archived CSF and serum pNF-H concentrations were determined by a commercially available ELISA. A receiver-operating characteristic (ROC) curve was generated with CSF values. RESULTS Compared with old control dogs, median CSF pNF-H concentration was increased in all stages of DM; old dogs 5.1 ng/mL (interquartile range [IQR] 1.4-9.3) versus DM stage 1 23.9 ng/mL (IQR 20.8-29.6; P < .05) versus DM stage 2 36.8 ng/mL (IQR 22.9-51.2; P < .0001) versus DM stage 3 25.2 ng/mL (IQR 20.2-61.8; P < .001) versus DM stage 4 38.0 ng/mL (IQR 11.6-59.9; P < .01). Degenerative myelopathy stage 1 dogs had increased median CSF pNF-H concentrations compared with asymptomatic, at-risk dogs (3.4 ng/mL [IQR 1.5-10.9; P < .01]) and DM mimics (6.6 ng/mL [IQR 3.0-12.3; P < .01]). CSF pNF-H concentration >20.25 ng/mL was 80.4% sensitive (confidence interval [CI] 66.09-90.64%) and 93.6% specific (CI 78.58-99.21%) for DM. Area under the ROC curve was 0.9467 (CI 0.92-0.9974). No differences in serum pNF-H concentration were found between control and DM-affected dogs. CONCLUSIONS AND CLINICAL IMPORTANCE pNF-H concentration in CSF is a sensitive biomarker for diagnosis of DM. Although there was high specificity for DM in this cohort, further study should focus on a larger cohort of DM mimics, particularly other central and peripheral axonopathies.
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Affiliation(s)
- C M Toedebusch
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO
| | - M D Bachrach
- Division of Biological Sciences, Bond Life Sciences Center, University of Missouri-Columbia, Columbia, MO
| | - V B Garcia
- Division of Biological Sciences, Bond Life Sciences Center, University of Missouri-Columbia, Columbia, MO
| | - G C Johnson
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO
| | - M L Katz
- Mason Eye Institute, School of Medicine, University of Missouri-Columbia, Columbia, MO
| | - G Shaw
- EnCor Biotechnology Inc, Gainesville, FL
| | - J R Coates
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO
| | - M L Garcia
- Division of Biological Sciences, Bond Life Sciences Center, University of Missouri-Columbia, Columbia, MO
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Shaw G, Lee-Barthel A, Ross MLR, Wang B, Baar K. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr 2017; 105:136-143. [PMID: 27852613 PMCID: PMC5183725 DOI: 10.3945/ajcn.116.138594] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/13/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries are the most common complaint in active populations. More than 50% of all injuries in sports can be classified as sprains, strains, ruptures, or breaks of musculoskeletal tissues. Nutritional and/or exercise interventions that increase collagen synthesis and strengthen these tissues could have an important effect on injury rates. OBJECTIVE This study was designed to determine whether gelatin supplementation could increase collagen synthesis. DESIGN Eight healthy male subjects completed a randomized, double-blinded, crossover-design study in which they consumed either 5 or 15 g of vitamin C-enriched gelatin or a placebo control. After the initial drink, blood was taken every 30 min to determine amino acid content in the blood. A larger blood sample was taken before and 1 h after consumption of gelatin for treatment of engineered ligaments. One hour after the initial supplement, the subjects completed 6 min of rope-skipping to stimulate collagen synthesis. This pattern of supplementation was repeated 3 times/d with ≥6 h between exercise bouts for 3 d. Blood was drawn before and 4, 24, 48, and 72 h after the first exercise bout for determination of amino-terminal propeptide of collagen I content. RESULTS Supplementation with increasing amounts of gelatin increased circulating glycine, proline, hydroxyproline, and hydroxylysine, peaking 1 h after the supplement was given. Engineered ligaments treated for 6 d with serum from samples collected before or 1 h after subjects consumed a placebo or 5 or 15 g gelatin showed increased collagen content and improved mechanics. Subjects who took 15 g gelatin 1 h before exercise showed double the amino-terminal propeptide of collagen I in their blood, indicating increased collagen synthesis. CONCLUSION These data suggest that adding gelatin to an intermittent exercise program improves collagen synthesis and could play a beneficial role in injury prevention and tissue repair. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12616001092482.
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Affiliation(s)
- Gregory Shaw
- Sport Nutrition, Australian Institute of Sport, Canberra, Australia
| | | | - Megan LR Ross
- Sport Nutrition, Australian Institute of Sport, Canberra, Australia;,Mary MacKillop Institute for Health Research, Centre for Exercise and Nutrition, Australian Catholic University, Melbourne, Australia; Departments of
| | - Bing Wang
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; and
| | - Keith Baar
- Neurobiology, Physiology, and Behavior and .,Physiology and Membrane Biology, University of California, Davis, Davis, CA.,VA Northern California Health Care System, Mather, CA
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Abstract
In a repeated measures experiment, twelve female typists performed typing and cursor positioning tasks using a chair-mounted split keyboard (FAK) and a conventional keyboard (CK) on an articulated tray. Results showed that the FAK significantly reduced ulnar deviation, but did not reduce wrist extension compared with the CK arrangement. Typing speed was slower for the FAK than the CK, but accuracy was unaffected. Videomotion analysis showed that more subjects sat fully back in their chair with their shoulders relaxed and their hands in less ulnar deviation when using the FAK to type. Other postural changes are described. Subjective comfort and strain ratings are described. Results are discussed within the limitations of a short-term laboratory study.
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Affiliation(s)
- Alan Hedge
- Dept. Design & Environmental Analysis Cornell University, Ithaca, NY 14853-4401
| | - Gregory Shaw
- Dept. Design & Environmental Analysis Cornell University, Ithaca, NY 14853-4401
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Biewer TM, Meitner S, Rapp J, Ray H, Shaw G. First results from the Thomson scattering diagnostic on proto-MPEX. Rev Sci Instrum 2016; 87:11E518. [PMID: 27910678 DOI: 10.1063/1.4959163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A Thomson scattering (TS) diagnostic has been successfully implemented on the prototype Material Plasma Exposure eXperiment (Proto-MPEX) at Oak Ridge National Laboratory. The diagnostic collects the light scattered by plasma electrons and spectroscopically resolves the Doppler shift imparted to the light by the velocity of the electrons. The spread in velocities is proportional to the electron temperature, while the total number of photons is proportional to the electron density. TS is a technique used on many devices to measure the electron temperature (Te) and electron density (ne) of the plasma. A challenging aspect of the technique is to discriminate the small number of Thomson scattered photons against the large peak of background photons from the high-power laser used to probe the plasma. A variety of methods are used to mitigate the background photons in Proto-MPEX, including Brewster angled windows, viewing dumps, and light baffles. With these methods, first results were measured from argon plasmas in Proto-MPEX, indicating Te ∼ 2 eV and ne ∼ 1 × 1019 m-3. The configuration of the Proto-MPEX TS diagnostic will be described and plans for improvement will be given.
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Affiliation(s)
- T M Biewer
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S Meitner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Rapp
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - H Ray
- Bredesen Center, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - G Shaw
- Bredesen Center, University of Tennessee, Knoxville, Tennessee 37996, USA
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