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Mahmood U, Carrier E, Khan K. Neoadjuvant management of locally advanced pancreatic ductal adenocarcinoma - Heading towards a promising change in treatment paradigm. Cancer Treat Rev 2024; 127:102750. [PMID: 38703592 DOI: 10.1016/j.ctrv.2024.102750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Traditional chemotherapy-based adjuvant therapies for locally advanced pancreatic ductal adenocarcinoma (PDAC) have been associated with poor clinical outcomes driven partly by its complex anatomy and molecular heterogeneity. Treatment for PDAC is challenged by presence of a dense tumour microenvironment involving an interplay of multiple tumoural and stromal components which promote metastatic oncogenic behaviour. PDAC also involves aberrations in multiple signalling pathways with paucity of treatment options against the most common mutations including KRAS, TP53, CDKN2A andSMAD4. However, recent discovery of new mechanisms implicated in pancreatic carcinogenesis have led to identification of promising mechanistic therapeutic targets such as NET1 and ULK1. Early evidence also suggests the utility of targeting multiple DNA repair processes, modulators of DNA replication and major DNA damage response regulators. We explore the clinical rationale behind a neoadjuvant therapeutic strategy and emerging predictors of survival benefit associated with this approach. We also discuss challenges and opportunities originating from recent clinical trials evaluating neoadjuvant treatments composed of various combinations of radiotherapy, chemotherapy and immunotherapeutic regimens that have aimed to address some of these biological challenges. Selective treatment of patients harbouring specific genomic aberrations with targeted agents and immunotherapy can translate into optimum survival outcomes in PDAC. We also share perspectives on emerging prospective clinical evidence regarding stromal modifying agents, such as Tumour Growth Factor-Beta and Connective Tissue Growth Factor inhibitors along with novel vaccination-based approaches in improving PDAC outcomes.
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Affiliation(s)
- Umair Mahmood
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
| | - Ewa Carrier
- Department of Clinical Development, FibroGen, Inc., San Francisco, CA, USA
| | - Khurum Khan
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK; University College London Cancer Institute, London WC1E 6DD, UK.
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Li Y, Wong M, Zhan L, Corke L, Brown MC, Cheng S, Khan K, Balatnaram K, Chowdhury M, Sabouhanian A, Herman J, Walia P, Strom E, Patel D, García-Pardo M, Schmid S, Eng L, Sacher AG, Leighl N, Bradbury PA, Shepherd FA, Shultz D, Liu G. Single organ metastatic sites in non-small cell lung cancer: Patient characteristics, treatment patterns and outcomes from a large retrospective Canadian cohort. Lung Cancer 2024; 192:107823. [PMID: 38763103 DOI: 10.1016/j.lungcan.2024.107823] [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] [Received: 03/10/2024] [Revised: 04/17/2024] [Accepted: 05/12/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND There is a paucity of information about the characteristics, treatment patterns, and outcomes of non-small cell lung cancer (NSCLC) patients with single organ metastasis (SOM). METHODS This retrospective cohort study includes all patients with a diagnosis of stage IV NSCLC diagnosed from 2014 to 2016 and treated at Princess Margaret Cancer Centre. We compared baseline characteristics and patterns of metastatic sites between patients with SOM versus multiple (M)OM. Additionally, we identified treatment modalities and outcomes for patients with SOM. Cox multivariable models (MVA) were utilized to evaluate differences in overall survival (OS) between the SOM and MOM cohorts. RESULTS Of 893 pts analyzed, 457 (51 %) had SOM, while 436 (49 %) had MOM at initial diagnosis. Demographics were comparable between the two groups. Brain was the most common site of metastasis for SOM patients. When compared to the MOM group, the SOM group had lower percentages of liver and adrenal metastases. Amongst SOM patients, 54 % received single modality treatment, and 20 % did not receive any treatment for their SOM. In MVA, patients with liver (HR 2.4), bone (HR 1.8), and pleural (HR 1.7) metastasis as their SOM site had the worst outcomes, with median OS of 6.8 months, 12.1 months, and 13.0 months respectively. Patients with SOM had a significantly improved median OS compared to those with MOM (15.9 months vs. 10.6 months; HR 0.56, 95 % CI 0.47-0.66, p < 0.001). CONCLUSION In NSCLC patients who presented with SOM, survival correlated with the initial organ involved and was better overall compared to patients with MOM. SOM NSCLC may benefit from specific management strategies and SOM patients could be considered as a specific subgroup for survival analyses in observational and non-randomized interventional studies. In clinical trials, SOM can be considered as a stratification factor in the future.
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Affiliation(s)
- Y Li
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - M Wong
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Zhan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Corke
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M C Brown
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Cheng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - K Khan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - K Balatnaram
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Chowdhury
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - A Sabouhanian
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - J Herman
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - P Walia
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - E Strom
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Patel
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M García-Pardo
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Schmid
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Eng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - A G Sacher
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - N Leighl
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - P A Bradbury
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - F A Shepherd
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Shultz
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - G Liu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medical Biophysics, Pharmacology and Toxicology, Institute of Medical Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Hedayat S, Cascione L, Cunningham D, Schirripa M, Lampis A, Hahne JC, Tunariu N, Hong SP, Marchetti S, Khan K, Fontana E, Angerilli V, Delrieux M, Nava Rodrigues D, Procaccio L, Rao S, Watkins D, Starling N, Chau I, Braconi C, Fotiadis N, Begum R, Guppy N, Howell L, Valenti M, Cribbes S, Kolozsvari B, Kirkin V, Lonardi S, Ghidini M, Passalacqua R, Elghadi R, Magnani L, Pinato DJ, Di Maggio F, Ghelardi F, Sottotetti E, Vetere G, Ciracì P, Vlachogiannis G, Pietrantonio F, Cremolini C, Cortellini A, Loupakis F, Fassan M, Valeri N. Circulating microRNA Analysis in a Prospective Co-clinical Trial Identifies MIR652-3p as a Response Biomarker and Driver of Regorafenib Resistance Mechanisms in Colorectal Cancer. Clin Cancer Res 2024; 30:2140-2159. [PMID: 38376926 DOI: 10.1158/1078-0432.ccr-23-2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE The multi-kinase inhibitor (mKi) regorafenib has demonstrated efficacy in chemorefractory patients with metastatic colorectal cancer (mCRC). However, lack of predictive biomarkers and concerns over significant toxicities hamper the use of regorafenib in clinical practice. EXPERIMENTAL DESIGN Serial liquid biopsies were obtained at baseline and monthly until disease progression in chemorefractory patients with mCRC treated with regorafenib in a phase II clinical trial (PROSPECT-R n = 40; NCT03010722) and in a multicentric validation cohort (n = 241). Tissue biopsies collected at baseline, after 2 months and at progression in the PROSPECT-R trial were used to establish patient-derived organoids (PDO) and for molecular analyses. MicroRNA profiling was performed on baseline bloods using the NanoString nCounter platform and results were validated by digital-droplet PCR and/or ISH in paired liquid and tissue biopsies. PDOs co-cultures and PDO-xenotransplants were generated for functional analyses. RESULTS Large-scale microRNA expression analysis in longitudinal matched liquid and tissue biopsies from the PROSPECT-R trial identified MIR652-3p as a biomarker of clinical benefit to regorafenib. These findings were confirmed in an independent validation cohort and in a "control" group of 100 patients treated with lonsurf. Using ex vivo co-culture assays paired with single-cell RNA-sequencing of PDO established pre- and post-treatment, we modeled regorafenib response observed in vivo and in patients, and showed that MIR652-3p controls resistance to regorafenib by impairing regorafenib-induced lethal autophagy and by orchestrating the switch from neo-angiogenesis to vessel co-option. CONCLUSIONS Our results identify MIR652-3p as a potential biomarker and as a driver of cell and non-cell-autonomous mechanisms of resistance to regorafenib.
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Affiliation(s)
- Somaieh Hedayat
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Luciano Cascione
- Bioinformatics Core Unit, Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Bellinzona, Switzerland
- Swiss Institute of Bioinformatics, Bellinzona, Switzerland
| | - David Cunningham
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Marta Schirripa
- Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Andrea Lampis
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Jens C Hahne
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Department of Radiology, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Sung Pil Hong
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Silvia Marchetti
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Khurum Khan
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Elisa Fontana
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Valentina Angerilli
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Department of Medicine, Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Mia Delrieux
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Daniel Nava Rodrigues
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Letizia Procaccio
- Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Sheela Rao
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - David Watkins
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Naureen Starling
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Ian Chau
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Chiara Braconi
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nicos Fotiadis
- Department of Interventional Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Ruwaida Begum
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
| | - Naomy Guppy
- Breast Cancer Now Nina Barough Pathology Core Facility, The Institute of Cancer Research, London, United Kingdom
| | - Louise Howell
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Melanie Valenti
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Vladimir Kirkin
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Sara Lonardi
- Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Raghad Elghadi
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Luca Magnani
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David J Pinato
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Federica Di Maggio
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate Francesco Salvatore, Via Gaetano Salvatore, Naples, Italy
| | - Filippo Ghelardi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Sottotetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Guglielmo Vetere
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Ciracì
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Georgios Vlachogiannis
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessio Cortellini
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fotios Loupakis
- Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Matteo Fassan
- Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
- Department of Medicine, Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Nicola Valeri
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Department of Medicine, The Royal Marsden Hospital, London and Sutton, United Kingdom
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
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Khan K, Hall CL, Babbage C, Dodzo S, Greenhalgh C, Lucassen M, Merry S, Sayal K, Sprange K, Stasiak K, Tench CR, Townsend E, Stallard P, Hollis C. Precision computerised cognitive behavioural therapy (cCBT) for adolescents with depression: a pilot and feasibility randomised controlled trial protocol for SPARX-UK. Pilot Feasibility Stud 2024; 10:53. [PMID: 38532490 DOI: 10.1186/s40814-024-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND A serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context. AIMS To conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable. METHODS Following consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11-19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8-10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention. DISCUSSION The findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK's health services if delivered en masse. TRIAL REGISTRATION ISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804 .
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Affiliation(s)
- K Khan
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK.
| | - C L Hall
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - C Babbage
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - S Dodzo
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - C Greenhalgh
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - M Lucassen
- School of Health and Psychological Sciences, University of London, London, UK
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - S Merry
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - K Sayal
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - K Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - K Stasiak
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - C R Tench
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Precision Imaging Beacon, Queen's Medical Centre, Nottingham, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - P Stallard
- Department for Health, University of Bath, Bath, UK
| | - C Hollis
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Mahmood U, Muhamad Faizul E, Howlett S, Amin Z, Hochhauser D, Shiu KK, Bridgewater J, Khan K. Comprehensive Examination of Cholangiocarcinoma Patients Treated with Novel Targeted Therapies after Extended Molecular Profiling on Liquid Biopsies. Cancers (Basel) 2024; 16:697. [PMID: 38398088 PMCID: PMC10886944 DOI: 10.3390/cancers16040697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cholangiocarcinoma (CCA) is associated with poor outcomes and limited treatment options, leading to increased use of targeted therapies for its management. Here, we performed one of the largest single-centre reviews evaluating outcomes following personalised targeted agents in CCA patients. METHODS All consecutive CCA patients receiving systemic therapy between January 2010 and April 2023 at UCLH were included. The primary objective of this study was to evaluate treatment response, survival outcomes and predictors of clinical benefit in CCA patients treated with molecularly guided therapies. Patient demographic factors, disease characteristics and survival outcomes were evaluated using the Kaplan-Meier method and Cox proportional-hazards models. RESULTS Of the 227 consecutive CCA patients, 162 (71%) had molecular profiling, of whom 56 (35%) were eligible and 55 received molecular-targeted treatment. CCA histological classifications comprised intrahepatic (N = 32), extrahepatic (N = 11), hilar (N = 4) and unknown (N = 9) subtypes. Most patients received targeted agents based on genomic profiling in a second treatment line setting (N = 34). Frequently observed genomic alterations occurred in the FGFR2 (N = 21), IDH1 (N = 7) and BRCA2 (N = 6) genes. Median progression-free survival (PFS) following first-, second- and third-line systemic therapy and overall survival (OS) were 8.44 (95% CI, 7.49-12.78), 5.65 (95% CI, 3.71-7.13), 5.55 (2.79-12.58) and 29.01 (24.21-42.91) months, respectively. CCA subtype and FGFR/BRCA molecular aberration status were not associated with PFS or OS. However, a prior CCA-related surgical history was predictive of OS (p = 0.02). Stratification by best overall response to second-line targeted agents demonstrated an association with PFS (p = 0.002) and OS (p = 0.02). Duration of treatment with second-line targeted therapy was associated with OS (p < 0.001). CONCLUSIONS Patients receiving targeted therapeutics achieved promising outcomes, especially those attaining a favourable treatment response and those receiving targeted agents for longer periods. Liquid biopsies can reliably provide information on extended molecular profiling to aid patient selection for personalised therapies.
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Affiliation(s)
- Umair Mahmood
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
| | | | - Sarah Howlett
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
| | - Zahir Amin
- Department of Radiology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
| | - Daniel Hochhauser
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
- University College London Cancer Institute, London WC1E 6DD, UK
| | - Kai-Keen Shiu
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
- University College London Cancer Institute, London WC1E 6DD, UK
| | - John Bridgewater
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
- University College London Cancer Institute, London WC1E 6DD, UK
| | - Khurum Khan
- Department of Gastrointestinal Oncology, University College Hospital NHS Foundation Trust (UCLH), London NW1 2BU, UK
- University College London Cancer Institute, London WC1E 6DD, UK
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Nooreen N, Zahid M, Jawad M, Ullah SA, Khan MI, Khan K, Shah M, Wahab A, Ahmad R, Sajid M, Jawad SM, Khan S. Studying biodiversity of spiders species in seven different localities of Charsadda District, Khyber Pakhtunkhwa, Pakistan. BRAZ J BIOL 2024; 84:e260515. [DOI: 10.1590/1519-6984.260515] [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] [Received: 01/29/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract The current research work aims to provide knowledge about the diversity of spiders’ fauna and their occurrence throughout the year from District Charsadda Khyber Pakhtunkhwa, Pakistan. Research data were collected from March-2015 to January-2017 from seven different localities of Charsadda District by using the camera, bottle, plastic bags, paraffin films, field book and 70% of ethylene alcohol and 20% of glycerine were used as chemicals. By using special identification keys, spiders were differentiated into families, genera and species. During the study time, a total of 2734 specimens of spiders were collected belonging from 35 genera, 15 families and 44 species were identified. Salticidae was the dominant family according to genera studied plus spiders samples numbers collected with 10 genera and 616 species specimens count. The high occurrence of spiders was studied during July. The result of the current study also shows a reduction of spider’s species in December due to lowering the temperature. The current study shows that Salticidae were the dominant family as capered to other species. The occurrence of spiders species greatly depends on changing the weather condition. The present study also shows great fluctuation in spider’s occurrence with changing of hot climate to colder during the study duration. Moreover, the wet season plays a great role in spiders’ population increase and growth.
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Affiliation(s)
| | - M. Zahid
- Islamia College Peshawar, Pakistan
| | - M. Jawad
- Islamia College Peshawar, Pakistan
| | | | | | - K. Khan
- Islamia College Peshawar, Pakistan
| | - M. Shah
- Government College Peshawar, Pakistan
| | - A. Wahab
- Islamia College Peshawar, Pakistan
| | - R. Ahmad
- Islamia College Peshawar, Pakistan
| | - M. Sajid
- Islamia College Peshawar, Pakistan
| | | | - S. Khan
- Islamia College Peshawar, Pakistan
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7
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Michelet F, Smyth M, Lall R, Noordali H, Starr K, Berridge L, Yeung J, Fuller G, Petrou S, Walker A, Mark J, Canaway A, Khan K, Perkins GD. Randomised controlled trial of analgesia for the management of acute severe pain from traumatic injury: study protocol for the paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN). Scand J Trauma Resusc Emerg Med 2023; 31:84. [PMID: 38001541 PMCID: PMC10668487 DOI: 10.1186/s13049-023-01146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital analgesia is often required after traumatic injury, currently morphine is the strongest parenteral analgesia routinely available for use by paramedics in the United Kingdom (UK) when treating patients with severe pain. This protocol describes a multi-centre, randomised, double blinded trial comparing the clinical and cost-effectiveness of ketamine and morphine for severe pain following acute traumatic injury. METHODS A two arm pragmatic, phase III trial working with two large NHS ambulance services, with an internal pilot. Participants will be randomised in equal numbers to either (1) morphine or (2) ketamine by IV/IO injection. We aim to recruit 446 participants over the age of 16 years old, with a self-reported pain score of 7 or above out of 10. Randomised participants will receive a maximum of 20 mg of morphine, or a maximum of 30 mg of ketamine, to manage their pain. The primary outcome will be the sum of pain intensity difference. Secondary outcomes measure the effectiveness of pain relief and overall patient experience from randomisation to arrival at hospital as well as monitoring the adverse events, resource use and cost-effectiveness outcomes. DISCUSSION The PACKMAN study is the first UK clinical trial addressing the clinical and cost-effectiveness of ketamine and morphine in treating acute severe pain from traumatic injury treated by NHS paramedics. The findings will inform future clinical practice and provide insights into the effectiveness of ketamine as a prehospital analgesia. TRIAL REGISTRATION ISRCTN, ISRCTN14124474. Registered 22 October 2020, https://www.isrctn.com/ISRCTN14124474.
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Affiliation(s)
- F Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Noordali
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Starr
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Berridge
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Yeung
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Walker
- West Midlands Ambulance Services NHS Trust, Brierley Hill, Dudley, UK
| | - J Mark
- Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - A Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Khan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Almarashi AM, Khan K. HESITANCY viz-a-viz COVID-19 VACCINE: A CASE STUDY OF SAUDI ARABIA. JPJB 2023. [DOI: 10.17654/0973514323002] [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: 01/09/2023]
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9
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Asherson P, Johansson L, Holland R, Bedding M, Forrester A, Giannulli L, Ginsberg Y, Howitt S, Kretzschmar I, Lawrie SM, Marsh C, Kelly C, Mansfield M, McCafferty C, Khan K, Muller-Sedgwick U, Strang J, Williamson G, Wilson L, Young S, Landau S, Thomson L. Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study. Br J Psychiatry 2023; 222:7-17. [PMID: 35657651 PMCID: PMC7613969 DOI: 10.1192/bjp.2022.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Research has shown that 20-30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. AIMS To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. METHOD We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16-25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. RESULTS In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI -2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. CONCLUSIONS ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
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10
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Almarashi AM, Khan K. PATIENTS SATISFACTION WITH OPD SERVICES: A CASE STUDY OF SAUDI ARABIA. JPJB 2022. [DOI: 10.17654/0973514322028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Khan K, Abdulelah Z, Murad S, Hsu YUKAI, Leung J, Shahid F, Khan S. Intracoronary Imaging in left main stent percutaneous coronary intervention has a clear survival benefit particularly in more complex patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Main Stem Disease (LMS) is prognostically important coronary artery disease that is managed either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). Use of intracoronary imaging (ICI) modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve outcomes with PCI revascularization.
The primary objective of this study was to evaluate the impact of ICI on outcomes following LMS PCI.
Methods
Retrospective observation study of 498 (5.1% of all PCI cases) patients who had undergone LMS PCI at our tertiary primary PCI centre hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records. Follow-up was also obtained through linkage with the Office of National Statistics.
Results
The mean age at the time of enrolment was 70.7±11.5 years. Majority of the patients were male 351 (70.5%). 353 (70.9%) of cases had acute coronary syndrome (ACS) presentation while the remainder were elective procedures. Mean follow-up duration was 3.75±3.06 years. Survival calculated by Kaplan-Meier was 70%. 87 patients (17.5%) deceased during first year of enrolment. 344 (69.1%) patients had ICI, with IVUS in 316 (63.5%) and OCT in 28 (5.6%) patients. IVUS comprised 91.9% of ICI procedures. Protected LMS (OR 0.175, 95% CI: 0.037–0.833, P-value=0.029) and the use of left ventricular mechanical support device (OR 0.324, 95% CI: 0.122–0.859, P-value=0.024) were associated with decreased odds of undergoing an ICI.
Patients undergoing ICI had significantly better survival compared to those without ICI (HR: 0.54, P<0.001). Moreover, OCT showed significantly better survival compared with IVUS (HR: 0.181, P=0.017). Use of ICI was associated with better survival in patients who had Rotablation (HR: 0.455, 95% CI: 0.232–0.892, P=0.022), ACS (HR: 0.523, 95% CI: 0.383–0.714, P<0.001) or comorbidities of diabetes and stroke (HR: 0.551, 95% CI: 0.337–0.807, P=0.002).
Conclusion
ICI in LMS PCI has a significant survival benefit in our dataset. This is especially the case in patients presenting with ACS, those with comorbidities of Diabetes mellitus and stroke and those undergoing rotablation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Khan
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - Z Abdulelah
- King hussein medical center , Amman , Jordan
| | - S Murad
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - Y U K A I Hsu
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - J Leung
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - F Shahid
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - S Khan
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
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12
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Murad S, Khan K, Abdulelah Z, Leung J, Hsu YK, Shahid F, Ludman PF, Khan SQ. The 11-year outcome of PCI for treatment of left main stem disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Main Stem Disease (LMS) has historically been treated with coronary artery bypass surgery (CABG). However, not all patents with LMS are candidates for CABG due to co-morbidities. There is limited long-term follow-up of patients undergoing PCI in the real world. The primary objective of this study was to investigate the long-term mortality following LMS PCI.
Methods
We conducted a retrospective study of patients who had undergone PCI for LMS disease at our hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records and analyzed using Kaplain-Meier survival analysis. Follow-up was obtained through linkage with the Office of National Statistics.
Results
498 patients underwent LMS PCI (5.1% of the total PCI cases). The overall survival rate was 70%. Median survival following PCI was 1,196 days (IQR = 1,796). The mean age of the patients was 70.7 years; 70.5% were males. 70.9% of patients underwent PCI for Acute Coronary Syndrome (ACS), and 15.3% had STEMI. 33.7% of patients had a history of diabetes, 8% had stroke, 8.2% had COPD, and 8.8% had PVD. 51 patients went into cardiogenic shock, and 25 died prior to discharge.
Survival of the ACS group was significantly lower than the stable group (67% vs 77%, p<0.01); the STEMI group did not significantly differ from rest of the ACS group (62% vs 66%, p=0.87). Survival in those <60 years of age was significantly higher than in those >60 years (80% vs 68%; p<0.01). The presence of one or more co-morbidities was associated with higher survival compared to zero co-morbidities (74% vs 65%, p<0.01). Patients with a history of diabetes had a significantly lower survival rate than those without diabetes (63% vs 73%, p<0.01). Patients with an LV ejection fraction ≤35% had a significantly lower survival than those with an ejection fraction >35% (22% vs 29%, p<0.01); only 259 patients had data on LV function. Patients who developed cardiogenic shock had a significantly lower survival rate than those who did not develop shock (38% vs 70%; p<0.01). When these patients were excluded from the data set, the overall survival rate increased from 70% to 74%. Lastly, a multinomial analysis showed that the only independent predictors of mortality were age (p<0.01) and cardiogenic shock (p<0.01).
Conclusion
Our results show that the real world 10-year mortality rate following LMS PCI is influenced by multiple factors including age, shock, and LV function. The high mortality rate was potentially due to the significant number of acute cases (70.1%) in non-operable patients. While factors such as age and past medical history are considered in the decision-making process regarding CABG vs PCI, we saw that specific subgroups within these factors may have decreased the effectiveness of PCI as a treatment for LMS disease, suggesting that deeper analysis into these risk factors is required when deciding between CABG and PCI for LMS disease management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Murad
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - K Khan
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - Z Abdulelah
- King hussein medical center , Amman , Jordan
| | - J Leung
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - Y K Hsu
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - F Shahid
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - P F Ludman
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - S Q Khan
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
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Hoxha T, Pienkowski M, Khan K, Moore A, Balaratnam K, Chowdhury M, Walia P, Sabouhanian A, Herman J, Strom E, Hueniken K, Corke L, Leighl N, Shepherd F, Bradbury P, Sacher A, Cheng S, Brown M, Mai V, Garcia M, Zhan L, Xu W, Liu G. EP02.04-009 Real World Survival Outcome Analysis of Adjuvant Therapies in Non-EGFR, Non-ALK Early Stage Resected NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.394] [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: 10/14/2022]
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14
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Rodriguez E, Olazagasti C, Khan K, Kareff S, Torres T, Torrents S, Fernandez-Vega Martinez G, MacIntyre J, Lopes G. EP04.01-010 Addressing Barriers to Lung Cancer Care for Diverse Populations through Patient Navigation: The University of Miami Experience. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.422] [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: 10/14/2022]
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15
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Lee J, Mai V, Garcia M, Cheng S, Khan K, Balaratnam K, Thakral A, Brown M, Zhan L, Corke L, Leighl N, Shepherd F, Bradbury P, Sacher A, Liu G. EP08.02-082 Treatment Patterns and Outcomes of First-line Osimertinib-treated Advanced EGFR Mutated NSCLC Patients: A Real-world Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schmid S, Zhan L, Garcia M, Cheng S, Khan K, Chowdhury M, Sabouhanian A, Herman J, Walia P, Strom E, Brown M, Patel D, Xu W, Shepherd F, Sacher A, Leighl N, Bradbury P, Shultz D, Liu G. 1144P Clinical outcomes of NSCLC patients (pts) who had brain-only metastasis at time of stage IV diagnosis, by presence versus absence of EGFR/ALK mutations. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1268] [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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Moore S, Zhan L, Liu G, Rittberg R, Patel D, Chowdhury D, Leung B, Cheng S, Mckinnon M, Khan K, Agulnik J, Cheung W, Dawe D, Fung A, Snow S, Cohen V, Yan M, Lok B, Wheatley-Price P, Ho C. EP14.05-020 Population-based Outcomes for Patients with Extensive-Stage Small-cell Lung Cancer from the Canadian SCLC Database (CASCADE). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.995] [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: 10/14/2022]
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18
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Moore S, Zhan L, Liu G, Rittberg R, Patel D, Chowdhury D, Leung B, Cheng S, Mckinnon M, Khan K, Snow S, Fung A, Dawe D, Cheung W, Agulnik J, Yan M, Cohen V, Wheatley-Price P, Ho C, Lok B. EP14.04-001 Treatment and Outcomes of Patients with Limited-Stage Small-cell Lung Cancer in the Canadian SCLC Database (CASCADE). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.974] [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: 10/14/2022]
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19
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Moore S, Zhan L, Liu G, Rittberg R, Patel D, Chowdhury D, Leung B, Cheng S, Mckinnon M, Khan K, Agulnik J, Fung A, Cheung W, Snow S, Dawe D, Cohen V, Yan M, Ho C, Lok B, Wheatley-Price P. EP03.01-016 The Canadian Small Cell Lung Cancer Database (CASCADE): Results from a Multi-Institutional Real-World Evidence Collaboration. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.411] [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: 10/14/2022]
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20
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Wysocki O, Zhou C, Rogado J, Huddar P, Shotton R, Tivey A, Albiges L, Angelakas A, Arnold D, Aung T, Banfill K, Baxter M, Barlesi F, Bayle A, Besse B, Bhogal T, Boyce H, Britton F, Calles A, Castelo-Branco L, Copson E, Croitoru A, Dani SS, Dickens E, Eastlake L, Fitzpatrick P, Foulon S, Frederiksen H, Ganatra S, Gennatas S, Glenthøj A, Gomes F, Graham DM, Hague C, Harrington K, Harrison M, Horsley L, Hoskins R, Hudson Z, Jakobsen LH, Joharatnam-Hogan N, Khan S, Khan UT, Khan K, Lewis A, Massard C, Maynard A, McKenzie H, Michielin O, Mosenthal AC, Obispo B, Palmieri C, Patel R, Pentheroudakis G, Peters S, Rieger-Christ K, Robinson T, Romano E, Rowe M, Sekacheva M, Sheehan R, Stockdale A, Thomas A, Turtle L, Viñal D, Weaver J, Williams S, Wilson C, Dive C, Landers D, Cooksley T, Freitas A, Armstrong AC, Lee RJ. An International Comparison of Presentation, Outcomes and CORONET Predictive Score Performance in Patients with Cancer Presenting with COVID-19 across Different Pandemic Waves. Cancers (Basel) 2022; 14:3931. [PMID: 36010932 PMCID: PMC9406013 DOI: 10.3390/cancers14163931] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with cancer have been shown to have increased risk of COVID-19 severity. We previously built and validated the COVID-19 Risk in Oncology Evaluation Tool (CORONET) to predict the likely severity of COVID-19 in patients with active cancer who present to hospital. We assessed the differences in presentation and outcomes of patients with cancer and COVID-19, depending on the wave of the pandemic. We examined differences in features at presentation and outcomes in patients worldwide, depending on the waves of the pandemic: wave 1 D614G (n = 1430), wave 2 Alpha (n = 475), and wave 4 Omicron variant (n = 63, UK and Spain only). The performance of CORONET was evaluated on 258, 48, and 54 patients for each wave, respectively. We found that mortality rates were reduced in subsequent waves. The majority of patients were vaccinated in wave 4, and 94% were treated with steroids if they required oxygen. The stages of cancer and the median ages of patients significantly differed, but features associated with worse COVID-19 outcomes remained predictive and did not differ between waves. The CORONET tool performed well in all waves, with scores in an area under the curve (AUC) of >0.72. We concluded that patients with cancer who present to hospital with COVID-19 have similar features of severity, which remain discriminatory despite differences in variants and vaccination status. Survival improved following the first wave of the pandemic, which may be associated with vaccination and the increased steroid use in those patients requiring oxygen. The CORONET model demonstrated good performance, independent of the SARS-CoV-2 variants.
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Affiliation(s)
- Oskar Wysocki
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
| | - Cong Zhou
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
| | - Jacobo Rogado
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Al-derley Park, Macclesfield SK10 4TG, UK; (C.Z.); (C.D.)
| | - Prerana Huddar
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Rohan Shotton
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Ann Tivey
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Laurence Albiges
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (P.H.); (R.S.); (A.T.); (A.A.); (K.B.); (F.B.); (F.G.); (D.M.G.); (C.H.); (L.H.); (A.L.); (J.W.); (T.C.); (A.C.A.)
| | - Angelos Angelakas
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Dirk Arnold
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.)
| | - Theingi Aung
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Kathryn Banfill
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Mark Baxter
- Department of Oncology, Haematology and Palliative Care, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763 Hamburg, Germany;
| | - Fabrice Barlesi
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (P.H.); (R.S.); (A.T.); (A.A.); (K.B.); (F.B.); (F.G.); (D.M.G.); (C.H.); (L.H.); (A.L.); (J.W.); (T.C.); (A.C.A.)
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (T.A.); (H.B.); (A.M.); (R.S.); (S.W.); (C.W.)
| | - Arnaud Bayle
- Division of Molecular and Clinical Medicine, Ninewells School of Medicine, University of Dundee, Dundee DD2 1SY, UK;
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, 13015 Marseille, France
| | - Benjamin Besse
- Division of Molecular and Clinical Medicine, Ninewells School of Medicine, University of Dundee, Dundee DD2 1SY, UK;
| | - Talvinder Bhogal
- Drug Development Department (DITEP), Gustave Roussy—Cancer Campus, 94805 Villejuif, France; (A.B.); (B.B.); (C.M.)
| | - Hayley Boyce
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Fiona Britton
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Antonio Calles
- Oncostat (CESP U1018 INSERM), Labeled Ligue Contre le Cancer, University Paris-Saclay, 94805 Villejuif, France;
| | - Luis Castelo-Branco
- Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK; (T.B.); (U.T.K.); (C.P.)
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain;
- ESMO-CoCARE Steering Committee, European Society for Medical Oncology, Via Ginevra 4, 6900 Lugano, Switzerland; (L.C.-B.); (G.P.); (S.P.)
| | - Ellen Copson
- NOVA National School of Public Health, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Adina Croitoru
- Department of Medical Oncology, University Hospital Center of Algarve, R. Leao Penedo, 8000-386 Faro, Portugal
| | - Sourbha S. Dani
- Cancer Sciences Academic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; (E.C.); (H.M.)
| | - Elena Dickens
- Medical Oncology Department, Fundeni Clinical Institute, 258, Fundeni Str., 022238 București, Romania;
| | - Leonie Eastlake
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.S.D.); (S.G.); (A.C.M.); (R.P.); (K.R.-C.)
| | - Paul Fitzpatrick
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
| | - Stephanie Foulon
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, 13015 Marseille, France
- Oncology Department, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (E.D.); (S.K.); (A.T.)
| | - Henrik Frederiksen
- Department of Medical Oncology, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, Devon, UK;
| | - Sarju Ganatra
- Cancer Sciences Academic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; (E.C.); (H.M.)
| | - Spyridon Gennatas
- Biostatistics and Epidemiology Office, Gustave Roussy, University Paris-Saclay, 94805 Villejuif, France
| | - Andreas Glenthøj
- Department of Haematology, Odense University Hospital, 5000 Odense, Denmark;
| | - Fabio Gomes
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Donna M. Graham
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Christina Hague
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Kevin Harrington
- Biostatistics and Epidemiology Office, Gustave Roussy, University Paris-Saclay, 94805 Villejuif, France
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (S.G.); (K.H.)
| | - Michelle Harrison
- Department of Haematology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Laura Horsley
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Richard Hoskins
- The Institute of Cancer Research NIHR Biomedical Research Centre, London SW3 6JB, UK
| | - Zoe Hudson
- Ninewells Hospital and Medical School, Dundee DD2 1SG, UK;
| | - Lasse H. Jakobsen
- Research IT, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Nalinie Joharatnam-Hogan
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK; (Z.H.); (T.R.)
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Sam Khan
- Medical Oncology Department, Fundeni Clinical Institute, 258, Fundeni Str., 022238 București, Romania;
| | - Umair T. Khan
- Drug Development Department (DITEP), Gustave Roussy—Cancer Campus, 94805 Villejuif, France; (A.B.); (B.B.); (C.M.)
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (N.J.-H.); (K.K.)
| | - Khurum Khan
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK; (Z.H.); (T.R.)
| | - Alexandra Lewis
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Christophe Massard
- Division of Molecular and Clinical Medicine, Ninewells School of Medicine, University of Dundee, Dundee DD2 1SY, UK;
| | - Alec Maynard
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Hayley McKenzie
- NOVA National School of Public Health, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Olivier Michielin
- MRC Clinical Trials Unit, University College London, Gower St., London WC1E 6BT, UK
| | - Anne C. Mosenthal
- Cancer Sciences Academic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; (E.C.); (H.M.)
| | - Berta Obispo
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Al-derley Park, Macclesfield SK10 4TG, UK; (C.Z.); (C.D.)
| | - Carlo Palmieri
- Drug Development Department (DITEP), Gustave Roussy—Cancer Campus, 94805 Villejuif, France; (A.B.); (B.B.); (C.M.)
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; (N.J.-H.); (K.K.)
| | - Rushin Patel
- Cancer Sciences Academic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; (E.C.); (H.M.)
| | - George Pentheroudakis
- Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK; (T.B.); (U.T.K.); (C.P.)
| | - Solange Peters
- Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK; (T.B.); (U.T.K.); (C.P.)
- Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L69 3BX, UK
| | - Kimberly Rieger-Christ
- Cancer Sciences Academic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; (E.C.); (H.M.)
| | - Timothy Robinson
- Ninewells Hospital and Medical School, Dundee DD2 1SG, UK;
- Department of Oncology, Melanoma Clinic, Swiss Institute of Bioinformatics, Quartier Sorge—Batiment Amphipole, 1015 Lausanne, Switzerland;
| | - Emanuela Romano
- Medical Oncology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Michael Rowe
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Marina Sekacheva
- Department of Oncology, Institut Curie, PSL Research University, Office 2A-5, 26, Rue d’Ulm, 75005 Paris, France;
| | - Roseleen Sheehan
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Alexander Stockdale
- Sunrise Centre, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK;
| | - Anne Thomas
- Medical Oncology Department, Fundeni Clinical Institute, 258, Fundeni Str., 022238 București, Romania;
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Lance Turtle
- Sunrise Centre, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK;
| | - David Viñal
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, 3Z Link, Prescot Street, Liverpool L7 8XP, UK; (A.S.); (L.T.)
| | - Jamie Weaver
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Sophie Williams
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Caroline Wilson
- Department of Medical Oncology, Gustave Roussy, 94805 Villejuif, France; (L.A.); (F.B.)
| | - Caroline Dive
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
| | - Donal Landers
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
| | - Timothy Cooksley
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - André Freitas
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Digital Experimental Cancer Medicine Team, Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield SK10 4TG, UK; (P.F.)
- Leicester Cancer Research Centre, The University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Anne C. Armstrong
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
| | - Rebecca J. Lee
- Department of Computer Science, University of Manchester, Oxford Road, Manchester M13 9PL, UK; (O.W.); (A.F.)
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.R.); (B.O.)
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21
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Popay J, Kaloudis H, Heaton L, Barr B, Halliday E, Holt V, Khan K, Porroche-Escudero A, Ring A, Sadler G, Simpson G, Ward F, Wheeler P. System resilience and neighbourhood action on social determinants of health inequalities: an English Case Study. Perspect Public Health 2022; 142:213-223. [PMID: 35801904 PMCID: PMC9284076 DOI: 10.1177/17579139221106899] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This article seeks to make the case for a new approach to understanding and nurturing resilience as a foundation for effective place-based co-produced local action on social and health inequalities. METHODS A narrative review of literature on community resilience from a public health perspective was conducted and a new concept of neighbourhood system resilience was developed. This then shaped the development of a practical programme of action research implemented in nine socio-economically disadvantaged neighbourhoods in North West England between 2014 and 2019. This Neighbourhood Resilience Programme (NRP) was evaluated using a mixed-method design comprising: (1) a longitudinal household survey, conducted in each of the Neighbourhoods For Learning (NFLs) and in nine comparator areas in two waves (2015/2016 and 2018/2019) and completed in each phase by approximately 3000 households; (2) reflexive journals kept by the academic team; and (3) semi-structured interviews on perceptions about the impacts of the programme with 41 participants in 2019. RESULTS A difference-in-difference analysis of household survey data showed a statistically significant increase of 7.5% (95% confidence interval (CI), 1.6 to 13.5) in the percentage of residents reporting that they felt able to influence local decision-making in the NFLs relative to the residents in comparator areas, but no effect attributable to the NRP in other evaluative measures. The analysis of participant interviews identified beneficial impacts of the NRP in five resilience domains: social connectivity, cultural coherence, local decision-making, economic activity, and the local environment. CONCLUSION Our findings support the need for a shift away from interventions that seek solely to enhance the resilience of lay communities to interventions that recognise resilience as a whole systems phenomenon. Systemic approaches to resilience can provide the underpinning foundation for effective co-produced local action on social and health inequalities, but they require intensive relational work by all participating system players.
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Affiliation(s)
- J Popay
- Professor, Division of Health Research, Lancaster University, Lancaster, UK
| | - H Kaloudis
- Senior Research Associate, Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YE, UK
| | - L Heaton
- Senior Manager CLAHRC Legacy Project, Division of Health Research, Lancaster University, Lancaster, UK
| | - B Barr
- Professor, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - E Halliday
- Senior Research Fellow, Division of Health Research, Lancaster University, Lancaster, UK
| | - V Holt
- Senior Research Associate, Division of Health Research, Lancaster University, Lancaster, UK
| | - K Khan
- Senior Research Associate, Division of Health Research, Lancaster University, Lancaster, UK
| | - A Porroche-Escudero
- Senior Research Associate, Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - A Ring
- Research Associate, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - G Sadler
- Senior Research Associate, Division of Health Research, Lancaster University, Lancaster, UK
| | - G Simpson
- Research Fellow, Faculty of Medicine, University of Southampton, Southampton, UK
| | - F Ward
- Senior Research Associate, Division of Health Research, Lancaster University, Lancaster, UK
| | - P Wheeler
- EPBHC Theme Manager, Division of Health Research, Lancaster University, Lancaster, UK
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22
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Derish I, Zwaig J, Khan K, Derish D, To J, Young P, Cecere R. A preliminary study of patient-specific differences in induced pluripotent stem cell-derived cardiomyocytes following hypoxia-induced injury. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Courtois Cardiovascular Signature Program
The increasing rate of cardiovascular disease (CVD) contributes to a worsening morbidity in the general population and a socioeconomic burden on the healthcare system. Newly approved therapies present unforeseen side effects and occasionally entail adverse cardiovascular responses in patients - this issue significantly stalls efficacious pharmacological development. Indeed, modern cardiovascular treatments do not account for the variability of individual patient reactions, due to a lack of a representative in vitro cardiac model. While the use of induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) has gained traction as a superior model for drug screening when compared to cardiac biopsies and immortalized cell lines, cardiovascular patient-specific differences remain poorly understood and understudied.
We hypothesized that 1) cardiomyopathic patient-derived iPSC-CMs have differing baselines of beating rate, contractility, viability, metabolic activity and protein expression, when compared to healthy controls, and that 2) cell lines have patient-specific responses to hypoxia-induced injury. As such, the purpose of this preliminary study was two-fold: 1) to perform a characterization of patient iPSC-CM function, and 2) to study patient-specific cellular responses to hypoxia.
First, we generated iPSC-CMs from the peripheral blood of donors (n=6 patients with cardiomyopathies, n=2 healthy donors). We then confirmed the expression of prominent cardiac markers connexin 43 (CXN43), sarcoendoplasmic reticulum Ca2+ ATPase (SERCA2a), GATA4 and cardiac Troponin T, as well as a lack of pluripotency markers Octamer-binding transcription factor 4 (OCT4), Nanog, Stage-specific embryonic antigen-4 (SSEA-4) and TRA-1-60 in the iPSC-CM lines, via immunocytochemistry. Preliminary assessment of iPSC-CMs (days 1-30 post-differentiation) revealed significant baseline differences in beating rate (p<0.01) and contractility amplitude (p<0.01) between iPSC-CMs derived from cardiomyopathic patients and healthy donors.
We then subjected iPSC-CM lines to hypoxic conditions (24 hours), to mimic ischaemic injury. Diseased patient-derived lines had significantly decreased viability and metabolic activity when compared to the controls, under normoxic (p<0.01) and hypoxic conditions (p<0.001). Immunoblotting revealed differential expression of cardiac markers and factors implicated in cardiac function, cardioprotection and pathology. Taken together, these results suggest that the detected differences at the cellular level after hypoxia-induced injury might be translatable to the inter-individual variability currently observed in the CVD patient population. The data gathered will prove to be instrumental in future studies of iPSC-CM responses to treatment. With this preliminary study, we hope to shift the focus towards these patient-specific differences at the cellular level, in the search for tailored therapies and a higher standard of care for CVD patients.
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Affiliation(s)
- I Derish
- McGill University Health Centre , Montreal , Canada
| | - J Zwaig
- McGill University Health Centre , Montreal , Canada
| | - K Khan
- McGill University Health Centre , Montreal , Canada
| | - D Derish
- McGill University Health Centre , Montreal , Canada
| | - J To
- McGill University Health Centre , Montreal , Canada
| | - P Young
- McGill University Health Centre , Montreal , Canada
| | - R Cecere
- McGill University Health Centre , Montreal , Canada
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23
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Tamm A, Jones HJ, Perry W, Campbell D, Carten R, Davies J, Galdikas A, English L, Garbett A, Glampson B, Harris S, Khan K, Little S, Malcomson L, Matharu S, Mayer E, Mercuri L, Morris EJ, Muirhead R, Norris R, O'Hara C, Papadimitriou D, Peek N, Renehan A, Roadknight G, Starling N, Teare M, Turner R, Várnai KA, Wasan H, Woods K, Cunningham C. Establishing a colorectal cancer research database from routinely collected health data: the process and potential from a pilot study. BMJ Health Care Inform 2022; 29:bmjhci-2021-100535. [PMID: 35738723 PMCID: PMC9226931 DOI: 10.1136/bmjhci-2021-100535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveColorectal cancer is a common cause of death and morbidity. A significant amount of data are routinely collected during patient treatment, but they are not generally available for research. The National Institute for Health Research Health Informatics Collaborative in the UK is developing infrastructure to enable routinely collected data to be used for collaborative, cross-centre research. This paper presents an overview of the process for collating colorectal cancer data and explores the potential of using this data source.MethodsClinical data were collected from three pilot Trusts, standardised and collated. Not all data were collected in a readily extractable format for research. Natural language processing (NLP) was used to extract relevant information from pseudonymised imaging and histopathology reports. Combining data from many sources allowed reconstruction of longitudinal histories for each patient that could be presented graphically.ResultsThree pilot Trusts submitted data, covering 12 903 patients with a diagnosis of colorectal cancer since 2012, with NLP implemented for 4150 patients. Timelines showing individual patient longitudinal history can be grouped into common treatment patterns, visually presenting clusters and outliers for analysis. Difficulties and gaps in data sources have been identified and addressed.DiscussionAlgorithms for analysing routinely collected data from a wide range of sites and sources have been developed and refined to provide a rich data set that will be used to better understand the natural history, treatment variation and optimal management of colorectal cancer.ConclusionThe data set has great potential to facilitate research into colorectal cancer.
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Affiliation(s)
- Andres Tamm
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Js Jones
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Perry
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Des Campbell
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Carten
- Royal Marsden NHS Foundation Trust, London, UK
- Croydon University Hospital, Croydon, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Algirdas Galdikas
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Louise English
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Alex Garbett
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Ben Glampson
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Steve Harris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Khurum Khan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephanie Little
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lee Malcomson
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Sheila Matharu
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Erik Mayer
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College London, London, London, UK
| | - Luca Mercuri
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Eva Ja Morris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rebecca Muirhead
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Norris
- NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Catherine O'Hara
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Niels Peek
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - Andrew Renehan
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Gail Roadknight
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Marion Teare
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Turner
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Kinga A Várnai
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harpreet Wasan
- NIHR Imperial Biomedical Research Centre, London, UK
- iCare & Imperial College Healthcare NHS Trust, London, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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24
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Lee RJ, Wysocki O, Zhou C, Shotton R, Tivey A, Lever L, Woodcock J, Albiges L, Angelakas A, Arnold D, Aung T, Banfill K, Baxter M, Barlesi F, Bayle A, Besse B, Bhogal T, Boyce H, Britton F, Calles A, Castelo-Branco L, Copson E, Croitoru AE, Dani SS, Dickens E, Eastlake L, Fitzpatrick P, Foulon S, Frederiksen H, Frost H, Ganatra S, Gennatas S, Glenthøj A, Gomes F, Graham DM, Hague C, Harrington K, Harrison M, Horsley L, Hoskins R, Huddar P, Hudson Z, Jakobsen LH, Joharatnam-Hogan N, Khan S, Khan UT, Khan K, Massard C, Maynard A, McKenzie H, Michielin O, Mosenthal AC, Obispo B, Patel R, Pentheroudakis G, Peters S, Rieger-Christ K, Robinson T, Rogado J, Romano E, Rowe M, Sekacheva M, Sheehan R, Stevenson J, Stockdale A, Thomas A, Turtle L, Viñal D, Weaver J, Williams S, Wilson C, Palmieri C, Landers D, Cooksley T, Dive C, Freitas A, Armstrong AC. Establishment of CORONET, COVID-19 Risk in Oncology Evaluation Tool, to Identify Patients With Cancer at Low Versus High Risk of Severe Complications of COVID-19 Disease On Presentation to Hospital. JCO Clin Cancer Inform 2022; 6:e2100177. [PMID: 35609228 PMCID: PMC9173569 DOI: 10.1200/cci.21.00177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/26/2022] [Accepted: 04/11/2022] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Patients with cancer are at increased risk of severe COVID-19 disease, but have heterogeneous presentations and outcomes. Decision-making tools for hospital admission, severity prediction, and increased monitoring for early intervention are critical. We sought to identify features of COVID-19 disease in patients with cancer predicting severe disease and build a decision support online tool, COVID-19 Risk in Oncology Evaluation Tool (CORONET). METHODS Patients with active cancer (stage I-IV) and laboratory-confirmed COVID-19 disease presenting to hospitals worldwide were included. Discharge (within 24 hours), admission (≥ 24 hours inpatient), oxygen (O2) requirement, and death were combined in a 0-3 point severity scale. Association of features with outcomes were investigated using Lasso regression and Random Forest combined with Shapley Additive Explanations. The CORONET model was then examined in the entire cohort to build an online CORONET decision support tool. Admission and severe disease thresholds were established through pragmatically defined cost functions. Finally, the CORONET model was validated on an external cohort. RESULTS The model development data set comprised 920 patients, with median age 70 (range 5-99) years, 56% males, 44% females, and 81% solid versus 19% hematologic cancers. In derivation, Random Forest demonstrated superior performance over Lasso with lower mean squared error (0.801 v 0.807) and was selected for development. During validation (n = 282 patients), the performance of CORONET varied depending on the country cohort. CORONET cutoffs for admission and mortality of 1.0 and 2.3 were established. The CORONET decision support tool recommended admission for 95% of patients eventually requiring oxygen and 97% of those who died (94% and 98% in validation, respectively). The specificity for mortality prediction was 92% and 83% in derivation and validation, respectively. Shapley Additive Explanations revealed that National Early Warning Score 2, C-reactive protein, and albumin were the most important features contributing to COVID-19 severity prediction in patients with cancer at time of hospital presentation. CONCLUSION CORONET, a decision support tool validated in health care systems worldwide, can aid admission decisions and predict COVID-19 severity in patients with cancer.
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Affiliation(s)
- Rebecca J. Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Oskar Wysocki
- The University of Manchester, Manchester, United Kingdom
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | - Cong Zhou
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | - Rohan Shotton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ann Tivey
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Louise Lever
- The University of Manchester, Manchester, United Kingdom
| | | | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Dirk Arnold
- Department of Oncology, Haematology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany
| | - Theingi Aung
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Kathryn Banfill
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Mark Baxter
- Division of Molecular and Clinical Medicine, Ninewells School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Arnaud Bayle
- Drug Development Department (DITEP) Gustave Roussy—Cancer Campus, Villejuif, France
- Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Benjamin Besse
- Drug Development Department (DITEP) Gustave Roussy—Cancer Campus, Villejuif, France
| | - Talvinder Bhogal
- The Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
| | - Hayley Boyce
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Fiona Britton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Antonio Calles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Castelo-Branco
- ESMO-CoCARE Steering Committee, European Society for Medical Oncology, Lugano, Switzerland
- NOVA National School of Public Health, Lisboa, Portugal
- Department of Medical Oncology, University Hospital Center of Algarve, Faro, Portugal
| | - Ellen Copson
- Cancer Sciences Academic Unit, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Adina E. Croitoru
- Medical Oncology Department, Fundeni Clinical Institute, Bucureşti, Romania
| | | | - Elena Dickens
- Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Leonie Eastlake
- University Hospitals Plymouth NHS Trust, Crownhill, Plymouth, Devon, United Kingdom
| | - Paul Fitzpatrick
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | - Stephanie Foulon
- Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
- Biostatistics and Epidemiology Office, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Hannah Frost
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | | | | | - Andreas Glenthøj
- Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Donna M. Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Christina Hague
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- The Institute of Cancer Research NIHR Biomedical Research Center, London, United Kingdom
| | | | - Laura Horsley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Hoskins
- Research IT, University of Manchester, Manchester, United Kingdom
| | - Prerana Huddar
- Royal Preston Hospital, Lancashire Teaching Hospitals, Fulwood, Preston, United Kingdom
| | - Zoe Hudson
- Bristol Haematology and Oncology Center, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Lasse H. Jakobsen
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Nalinie Joharatnam-Hogan
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Sam Khan
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Umair T. Khan
- The Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
- The University of Liverpool, Liverpool, United Kingdom
| | - Khurum Khan
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Christophe Massard
- Drug Development Department (DITEP) Gustave Roussy—Cancer Campus, Villejuif, France
| | - Alec Maynard
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Hayley McKenzie
- Cancer Sciences Academic Unit, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Olivier Michielin
- Department of Oncology, Melanoma Clinic, Swiss Institute of Bioinformatics, Quartier Sorge—Batiment Amphipole, Lausanne, Switzerland
| | | | - Berta Obispo
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rushin Patel
- Lahey Hospital and Medical Center, Burlington, MA
| | - George Pentheroudakis
- ESMO-CoCARE Steering Committee, European Society for Medical Oncology, Lugano, Switzerland
| | - Solange Peters
- ESMO-CoCARE Steering Committee, European Society for Medical Oncology, Lugano, Switzerland
- Medical Oncology, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Timothy Robinson
- Bristol Haematology and Oncology Center, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom
| | - Jacobo Rogado
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Emanuela Romano
- Department of Oncology, Institut Curie, PSL Research University, Paris, France
| | - Michael Rowe
- Sunrise Center, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
| | - Marina Sekacheva
- World-Class Research Center Digital Biodesign and Personalized Healthcare, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Roseleen Sheehan
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Julie Stevenson
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | - Alexander Stockdale
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Anne Thomas
- Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Leicester Cancer Research Centre, The University of Leicester, Leicester, United Kingdom
| | - Lance Turtle
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - David Viñal
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Jamie Weaver
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Sophie Williams
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Caroline Wilson
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Carlo Palmieri
- The Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
- The University of Liverpool, Liverpool, United Kingdom
| | - Donal Landers
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | | | - ESMO Co-Care
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Department of Oncology, Haematology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany
- Weston Park Cancer Center, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Division of Molecular and Clinical Medicine, Ninewells School of Medicine, University of Dundee, Dundee, United Kingdom
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
- Drug Development Department (DITEP) Gustave Roussy—Cancer Campus, Villejuif, France
- Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
- The Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ESMO-CoCARE Steering Committee, European Society for Medical Oncology, Lugano, Switzerland
- NOVA National School of Public Health, Lisboa, Portugal
- Department of Medical Oncology, University Hospital Center of Algarve, Faro, Portugal
- Cancer Sciences Academic Unit, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Medical Oncology Department, Fundeni Clinical Institute, Bucureşti, Romania
- Lahey Hospital and Medical Center, Burlington, MA
- Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- University Hospitals Plymouth NHS Trust, Crownhill, Plymouth, Devon, United Kingdom
- Biostatistics and Epidemiology Office, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Department of Haematology, Odense University Hospital, Odense, Denmark
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- The Institute of Cancer Research NIHR Biomedical Research Center, London, United Kingdom
- Ninewells Hospital and Medical School, Dundee, United Kingdom
- Research IT, University of Manchester, Manchester, United Kingdom
- Royal Preston Hospital, Lancashire Teaching Hospitals, Fulwood, Preston, United Kingdom
- Bristol Haematology and Oncology Center, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Clinical Trials Unit, University College London, London, United Kingdom
- The University of Liverpool, Liverpool, United Kingdom
- Department of Oncology, Melanoma Clinic, Swiss Institute of Bioinformatics, Quartier Sorge—Batiment Amphipole, Lausanne, Switzerland
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Medical Oncology, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom
- Department of Oncology, Institut Curie, PSL Research University, Paris, France
- Sunrise Center, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
- World-Class Research Center Digital Biodesign and Personalized Healthcare, Sechenov First Moscow State Medical University, Moscow, Russia
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- Leicester Cancer Research Centre, The University of Leicester, Leicester, United Kingdom
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
- Idiap Research Institute, Martigny, Switzerland
| | - Caroline Dive
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
| | - André Freitas
- The University of Manchester, Manchester, United Kingdom
- Cancer Research UK Manchester Institute Cancer Biomarker Center, The University of Manchester, Alderley Park, United Kingdom
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Anne C. Armstrong
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
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25
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Sukumar A, Khan K, Khalid W, Singh-Ranger D. 207 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of Treatment with Oral/ IV Iron. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.128] [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
Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay, recurrence, and requirement for blood transfusions.
Method
Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia and non- Iron Deficiency anaemia. IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, length of stay, recurrence and requirement for blood transfusions were collected plus treatment for anaemia. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P <0.05.
Results
150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron).
IDA oral and IV treatment versus non-IDA:
Median age 74, 80 and 78 years (P = 0.814),
Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant),
Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596)
Length of Stay (days) 6, 5; 7 (P 0.113),
Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P >0.1), and
Recurrence P >0.1.
Conclusions
In our series, iron treatment does not influence recurrence, length of stay, requirement for blood transfusions. Tumour location is not significantly different between IDA and non-IDA group. Patients treated with oral iron therapy are seen to have a larger drop in haemoglobin post operatively than the other groups.
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Affiliation(s)
- A. Sukumar
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K. Khan
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - W. Khalid
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - D. Singh-Ranger
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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26
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Almarashi AM, Khan K. JOB SATISFACTION AND ORGANIZATIONAL COMMITMENT OF DOCTORS: A CASE STUDY OF SAUDI ARABIA. JPJB 2022. [DOI: 10.17654/0973514322002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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27
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Walker NF, Karim F, Moosa MYS, Moodley S, Mazibuko M, Khan K, Sterling TR, van der Heijden YF, Grant AD, Elkington PT, Pym A, Leslie A. OUP accepted manuscript. J Infect Dis 2022; 226:928-932. [PMID: 35510939 PMCID: PMC9470104 DOI: 10.1093/infdis/jiac160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
Current methods for tuberculosis treatment monitoring are suboptimal. We evaluated plasma matrix metalloproteinase (MMP) and procollagen III N-terminal propeptide concentrations before and during tuberculosis treatment as biomarkers. Plasma MMP-1, MMP-8, and MMP-10 concentrations significantly decreased during treatment. Plasma MMP-8 was increased in sputum Mycobacterium tuberculosis culture–positive relative to culture-negative participants, before (median, 4993 pg/mL [interquartile range, 2542–9188] vs 698 [218–4060] pg/mL, respectively; P = .004) and after (3650 [1214–3888] vs 720 [551–1321] pg/mL; P = .008) 6 months of tuberculosis treatment. Consequently, plasma MMP-8 is a potential biomarker to enhance tuberculosis treatment monitoring and screen for possible culture positivity.
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Affiliation(s)
- N F Walker
- Correspondence: N. F. Walker, Senior Clinical Lecturer, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom ()
| | - F Karim
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - M Y S Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - S Moodley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - M Mazibuko
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - K Khan
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - T R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Y F van der Heijden
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- The Aurum Institute, Johannesburg, South Africa
| | - A D Grant
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - P T Elkington
- NIHR Biomedical Research Centre, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - A Pym
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - A Leslie
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
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28
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Rata M, Khan K, Collins DJ, Koh DM, Tunariu N, Bali MA, d'Arcy J, Winfield JM, Picchia S, Valeri N, Chau I, Cunningham D, Fassan M, Leach MO, Orton MR. DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases. Cancer Imaging 2021; 21:67. [PMID: 34924031 PMCID: PMC8684660 DOI: 10.1186/s40644-021-00436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diffusion weighted imaging (DWI) with intravoxel incoherent motion (IVIM) modelling can inform on tissue perfusion without exogenous contrast administration. Dynamic-contrast-enhanced (DCE) MRI can also characterise tissue perfusion, but requires a bolus injection of a Gadolinium-based contrast agent. This study compares the use of DCE-MRI and IVIM-DWI methods in assessing response to anti-angiogenic treatment in patients with colorectal liver metastases in a cohort with confirmed treatment response. METHODS This prospective imaging study enrolled 25 participants with colorectal liver metastases to receive Regorafenib treatment. A target metastasis > 2 cm in each patient was imaged before and at 15 days after treatment on a 1.5T MR scanner using slice-matched IVIM-DWI and DCE-MRI protocols. MRI data were motion-corrected and tumour volumes of interest drawn on b=900 s/mm2 diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10-3 mm2/s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10-3 mm2/s), and their product fD* (mm2/s)] and three DCE-MRI parameters [volume transfer constant Ktrans (min-1), enhancement fraction EF (%), and their product KEF (min-1)] were recorded at each visit, before and after treatment. Changes in pre- and post-treatment measurements of all MR parameters were assessed using Wilcoxon signed-rank tests (P<0.05 was considered significant). DCE-MRI and IVIM-DWI parameter correlations were evaluated with Spearman rank tests. Functional MR parameters were also compared against Response Evaluation Criteria In Solid Tumours v.1.1 (RECIST) evaluations. RESULTS Significant treatment-induced reductions of DCE-MRI parameters across the cohort were observed for EF (91.2 to 50.8%, P<0.001), KEF (0.095 to 0.045 min-1, P<0.001) and Ktrans (0.109 to 0.078 min-1, P=0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10-3 mm2/s, P<0.001), while perfusion-related parameters showed no change. No strong correlations were found between DCE-MRI and IVIM-DWI parameters. A moderate correlation was found, after treatment, between Ktrans and D* (r=0.60; P=0.002) and fD* (r=0.67; P<0.001). When compared to RECIST v.1.1 evaluations, KEF and D correctly identified most clinical responders, whilst non-responders were incorrectly identified. CONCLUSION IVIM-DWI perfusion-related parameters showed limited sensitivity to the anti-angiogenic effects of Regorafenib treatment in colorectal liver metastases and showed low correlation with DCE-MRI parameters, despite profound and significant post-treatment reductions in DCE-MRI measurements. TRIAL REGISTRATION NCT03010722 clinicaltrials.gov; registration date 6th January 2015.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.
- Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Khurum Khan
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David J Collins
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Maria Antonietta Bali
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Cancer Research UK National Cancer Imaging Translational Accelerator (NCITA), London, United Kingdom
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicola Valeri
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
- Centre for Evolution and Cancer, The Institute of Cancer Research, London and Sutton, United Kingdom
- Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ian Chau
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David Cunningham
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Martin O Leach
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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29
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Goldthorpe J, Khan K. What data is currently collected on social prescribing outcomes?Case studies of two sites in England. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Whilst a considerable amount of social prescribing activity is taking place across the North West of England, little is known about how different models are being implemented, how data is being collected to support evidence of impact and outcomes, and how these models could be positively or negatively influencing health inequalities. Our study aims to investigate the reach and impact of two social prescribing services by using a mixed-methods approach which will include analysing secondary data from social prescribing management databases held by participating organisations, workshops, focus groups and interviews. Participants will include professionals involved in commissioning, delivery and monitoring and evaluation roles related to social prescribing link workers and members of the public who have accessed social prescribing services. Observational data will also be collected during meetings and informal conversations with those involved in the project. The findings will be reviewed with participants to support the development of a larger research project to explore the effects of social prescribing on health inequalities in ways that are meaningful to stakeholders. In this presentation the findings will be presented and discussed loosely around the following questions: 1. What routinely collected outcome data is currently available to social prescribing researchers (locally, nationally and internationally)?; 2.What is missing from that data regarding meaningful outcomes in relation to health inequalities?; 3. How might social prescribing reduce or exacerbate health inequalities?
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Affiliation(s)
- J Goldthorpe
- Lancaster University, Equitable Place-Based Health and Care theme, Applied Research Collaboration North West Coast, Lancaster, UK
| | - K Khan
- Lancaster University, Equitable Place-Based Health and Care theme, Applied Research Collaboration North West Coast, Lancaster, UK
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30
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Kumar D, Yasin U, Saghir T, Akbar Sial J, Khatti S, Khan K, Khan N, Naeem Mengal M, Qamar N. Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High intensity statins are recommended in patients with acute coronary syndrome. Statins inhibit atherosclerotic plaque formation in the coronary arteries and reducing the burden of ischemic heart disease, therefore decreasing the morbidity and mortality. Muscle symptoms are most common adverse effect of statins. Hence, the aim of this study is to determine the statin induced myalgia by the statin myalgia clinical score.
Purpose
To monitor the Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome
Methods
This was an prospective observational study comprised of 418 patients with acute coronary syndrome who were commenced on high intensity statins (Rosuvastatin 20–40mg & Atorvastatin 40–80). These patients were followed at 4 weeks, 8 weeks and 12 weeks subsequently and the clinical myalgia score (SAMS-CI) was calculated at each visit to determine the statin induced myalgia. SAMS-CI was categorized as unlikely (2–6), possible (7–8) and probable (9–11)
Results
From 418 patients, 327 were males and 91 were females. Mean age was 55.6±11.14. Only 19 (7.63±1.8) patients developed muscle symptoms on high intensity statins (Rosuvastatin 20 mg and Atorvastatin 40 mg) on SAMS-CI Score. 5 patients were unlikely to develop myalgia on SAMS-CI and continued with the same dosage without any new symptoms. 6 patients were possible on SAMS-CI, therefore the dosage of these patients were decreased to moderate intensity statin (Rosuvastatin 10mg, Atorvastatin 20 mg), their symptoms were resolved and continued with the moderate intensity statins. Furthermore, Statin was hold in 8 patients in the probable category for 4 weeks until the resolution of symptoms followed by moderate intensity statins.
Conclusion
Statin induced myalgia is more reported in old aged and female patients. Most of the patients can better tolerate the lower range of high intensity statins with the similar benefits and should be prescribed in every patient
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - U Yasin
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - T Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - J Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - S Khatti
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - K Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - N Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - M Naeem Mengal
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - N Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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31
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Saluja S, Contractor H, Wiltshire R, Mannan F, Hussain N, Abidin N, Tin L, Ali S, Saluja S, Khan K, Sobolewska J, Sood P, Anderson S. An evaluation of patient outcomes following transcatheter pulmonary valve implantation: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter pulmonary valve implantation has emerged as an effective alternative to surgery in patients with congenital Right Ventricular Outflow Tract Dysfunction (RVOT). There is demonstrable evidence that Percutaneous Pulmonary Valve Implantation (PPVI) effectively restores conduit graft viability with a consequent improvement in right ventricular pressures.
Aim
The objective of this study was to perform a meta-analysis of all previously published studies examining the outcome of PPVI and the associated early and late peri-procedural factors in patients with RVOT dysfunction. Data from procedures performed within our own centre have also been included.
Methodology
We performed a meta-analysis of all observational studies investigating early and late outcomes following PPVI. Risk ratios and risk differences were pooled in a random-effects model. The I2 statistic was used to quantify heterogeneity between studies. We searched EMBASE, MEDLINE, CINAHL, PsychInfo and Cochrane databases from their inception until 2021. Studies were included if they reported any comparative data regarding study endpoints. Primary endpoint was mean RVOT gradient. Secondary end points include pulmonary regurgitation fraction, left and right ventricular end-diastolic and systolic volume indexes, and left ventricular ejection fraction. Complication rates were considered a safety endpoint.
Results
A total of 23 studies with 1501 participants enrolled were included in the final meta-analysis. The RVOT gradient decreased significantly [weighted mean difference (WMD) = −20.32 mmHg; 95% confidence interval (CI): −22.15, −19.11; p<0.001]. Mean right ventricular (RV) systolic pressures fell significantly [(WMD)= −18.4 mmHg; 95% CI: −16.4, −20.2; p<0.001) and RV diastolic pressures decreased significantly [(WMD) = −6.3 mmHg, 95% CI: −4.3, −8.9; p<0.001). Pulmonary regurgitation fraction (PRF) also decreased notably (WMD = −24.38%, 95% CI: −28.27, −17.32; p<0.001).The incidence of infective endocarditis was 1.8% (95% CI: 0.7–3.8).
Conclusion
PPVI is an effective and safe strategy in relieving right ventricular remodelling and improving haemodynamic and clinical outcomes in patients with RVOT dysfunction. Multi-centre collaborations are essential to further determine the long-term effects of PPVI on cardiac function, exercise tolerance and quality of life in RVOT dysfunction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Saluja
- University of Manchester, 1 Manchester Heart Centre, Central Manchester Foundation Trust, University of Manchester, Manchester, Manchester, United Kingdom
| | - H Contractor
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - R Wiltshire
- Salford Primary Care Trust, Cardiology, Manchester, United Kingdom
| | - F Mannan
- Salford Primary Care Trust, Cardiology, Manchester, United Kingdom
| | - N Hussain
- Salford Primary Care Trust, Cardiology, Manchester, United Kingdom
| | - N Abidin
- Salford Primary Care Trust, Cardiology, Manchester, United Kingdom
| | - L Tin
- Salford Primary Care Trust, Cardiology, Manchester, United Kingdom
| | - S Ali
- The Pennine Acute Hospital, Manchester, United Kingdom
| | - S Saluja
- University of Manchester, 1 Manchester Heart Centre, Central Manchester Foundation Trust, University of Manchester, Manchester, Manchester, United Kingdom
| | - K Khan
- The Pennine Acute Hospital, Manchester, United Kingdom
| | - J Sobolewska
- The Pennine Acute Hospital, Manchester, United Kingdom
| | - P Sood
- The Pennine Acute Hospital, Manchester, United Kingdom
| | - S Anderson
- The Pennine Acute Hospital, Manchester, United Kingdom
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Khan K, Fisher R. 1133 Long Term Survival After Standard EVAR: Have We Started to Treat The EVAR-2 Patient? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Abdominal aortic aneurysm repair was traditionally preformed with open surgical repair (OSR). Recently endovascular aneurysm repair (EVAR) has increased in popularity due to its less invasive nature particularly in those deemed unfit for OSR. The EVAR-2 trial found no significant difference between BMT and EVAR in the 30 days all-cause mortality. This questioned whether EVAR was the best option in those medically unfit for OSR.
Method
Elective EVAR procedures from the 1st April 2012 to 1st September 2017 were analysed with Kaplan-Meier graphs. The patient data was stratified by year, age group and EVAR risk scoring.
Results
The all-cause mortality at 30 days was 1.8%, at 6 months it was 7%, and at 4 years it was 19.8%. There was no significant difference with log rank analysis of the year of EVAR operation and consultant (P > 0.05). The log rank analysis found a significant difference between the stratified age groups (P < 0.001) and the EVAR scoring (P = 0.032). At all time-points the RLUH EVAR patients had a lower all-cause mortality compared to the EVAR-2. At the 4-year time point, the RLUH EVAR group had lower all- cause mortality than both EVAR-1 and EVAR-2 trials.
Conclusions
The retrospective audit data from 2012-2017, suggest the RLUH EVAR treatment practice is not falling into the EVAR-2 trial findings. At all time-points the RLUH EVAR patients had a lower all-cause mortality compared to the EVAR-2. Therefore, it can be concluded the RLUH is not treating EVAR-2 patients.
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Affiliation(s)
- K Khan
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - R Fisher
- Royal Liverpool University Hospital, Liverpool, United Kingdom
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Sahni D, Khan K. 1034 A Survey to Assess the Confidence and Knowledge of Foundation Year One Doctors to Perform A Digital Rectal Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patient, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE.
Method
FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings, and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study.
Results
There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderately confident in performing and appreciating DRE findings. 63% respondents though that a chaperone is not mandatory if the gender of the doctor and patient was same. 58% respondents thought that hematuria is not an indication to preform DRE. Interpretation of DRE findings - approximately 80% respondents correctly interpreted the findings, however only 45% could formulate the correct initial management plan.
Conclusions
This study illustrates that FY1 doctors receive inadequate exposure to performing and interpreting DRE. Their teaching should be enhanced by providing them with more opportunities through simulation and dedicated teaching sessions.
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Affiliation(s)
- D Sahni
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - K Khan
- Glasgow Royal Infirmary, Glasgow, United Kingdom
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Khan K, Chuntamongkol R, McCollum C, Gall L, Forshaw M. 964 Stage Migration in Newly Diagnosed Oesophago-Gastric Cancer During the First Wave Of COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.674] [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
Aim
Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.
Method
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.
Results
349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p < 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).
Conclusions
The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
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Affiliation(s)
- K Khan
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | | | - C McCollum
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - L Gall
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - M Forshaw
- Glasgow Royal infirmary, Glasgow, United Kingdom
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Khan K. 1120 Clinical Applications of Local Field Potentials in Deep Brain Stimulation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.656] [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
Local field potentials (LFP) are gathered when deep brain stimulation (DBS) electrodes are inserted into subcortical structures; however, the clinical application of these findings are unclear.
Method
A literature search was conducted using PRISMA guidelines, 231 papers were analysed for the literature review.
Results
The lack of dopamine in Parkinson’s disease (PD), is thought to increase the sensitivity of the basal ganglia-thalamo-cortical network to rhythmic oscillatory inputs causing pathological oscillations. Beta band frequency oscillations have been strongly linked to bradykinesia and rigidity in Parkinson’s disease patients. Whereas gamma oscillations were found to be prokinetic and possibly related to normal physiology. There has been varying views on LFP findings and tremor pathology, recent research has suggested a link between the ratio of slow and fast oscillations increasing resulting in a tremor. Studies found contradicting results with pathological oscillations, reasons for the variation include the time of the LFP recordings and the placement of the electrodes. The use of LFP presents a promising new technology namely adaptive deep brain stimulation (aDBS). aDBS has not been tested long-term in human patients, the safety and effectiveness long-term is unknown.
Conclusions
aDBS provide an exciting new technology however, the current evidence base provides a proof-of- principle, there are still many issues which need to be addressed before this can become an established treatment. With technological advances aDBS could revolutionise PD treatment and if perfected could potentially abolish patient’s symptoms completely.
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Affiliation(s)
- K Khan
- Kings College London, London, United Kingdom
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Khan K, Gall L, Forshaw M. 973 Why Are Curative Treatment Rates So Low for Stage I/II Oesophago-Gastric Cancer in The West of Scotland? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment in the West of Scotland.
Method
The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed.
Results
81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months.
Conclusions
Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.
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Affiliation(s)
- K Khan
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - L Gall
- Glasgow Royal infirmary, Glasgow, United Kingdom
| | - M Forshaw
- Glasgow Royal infirmary, Glasgow, United Kingdom
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O'Sullivan S, Macfarlane R, Khan K, Horwitz M. 377 Expanding the Use of Wide-Awake Local Anaesthesia Non-Tourniquet (WALANT) Technique in The Management of Hand Trauma Patients During the COVID 19 Pandemic. Br J Surg 2021. [PMCID: PMC8524476 DOI: 10.1093/bjs/znab259.988] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim COVID19 produced a unique challenge to the management of hand trauma. There was reduced theatre capacity and inpatient beds as staff and resources were lost to make way for the critically unwell1, however the burden of patients (albeit reduced) requiring emergency procedures remained2. During 1stUK peak we adopted a one-stop hand trauma clinic where patients were assessed by senior surgeons and immediately operated on under local anaesthesia with Adrenalin, a model mirrored by other units across the UK during this time3,4. Subsequent to surgery they were either seen on the same day for advice with a hand therapist or booked for immediate hand therapy follow up. Method A retrospective review of 158 cases operated on over a 4-month COVID19 period compared to the same 4-month period 1 year previously. Indications for surgery and type of anaesthesia were recorded. Follow up and complication rates were reviewed for the COVID19 patients. Results There were similarities in the demographic of patients across both cohorts and in mechanism of injury, with trauma the highest indication for surgery. The comparable data sets showed only 21% of patients treated used WALANT pre-COVID19 versus 100% of patient during COVID19. Conclusions WALANT is a viable model by which to perform emergency hand trauma surgery in a low cost and low resource setting. Previously this model was not utilised to full effect in our hospital. The results demonstrate the adaptability of WALANT in an adverse and dynamic situation, such as COVID19, thus highlighting benefits to patient care and service provision.
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Affiliation(s)
- S O'Sullivan
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | - K Khan
- Chelsea and Westminster, London, United Kingdom
| | - M Horwitz
- Chelsea and Westminster, London, United Kingdom
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Khan S, Mohideen R, Khan K, Helbren C. 1385 “Pre-Op Fasting Times Audit in Colorectal Surgery at A University Teaching Hospital”. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.152] [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
Hull University teaching hospitals NHS trust has guidelines for patient fasting times prior to major elective surgery. We aimed to assess the compliance of pre-op fasting times for patients undergoing elective colorectal surgery.
Method
An initial and later re-audit was undertaken, prospectively, of 20 consecutive patients admitted for elective colorectal surgery at Castle Hill Hospital. Data was collected on a structured proforma and was completed following patient’s interview, ORMIS (operation room system) and Lorenzo (hospital intranet).
Results
Initial audit demonstrated 10% (2 out of 20) and 5% (1 out of 20) compliance with liquid and solid fasting times, respectively. Following implementation of changes, re-audit demonstrated 60% (12 out of 20) and 0% (0 out of 20) compliance with liquid and solid fasting times respectively
Conclusions
We concluded that liquid fasting times can be improved further by communication between theatre staff and ward. Whilst solid fasting times can be improved but at an expense of losing a theatre space. A further re-audit [planned in a month period.
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Affiliation(s)
- S Khan
- Hull University Teaching Hospital, Hull, United Kingdom
| | - R Mohideen
- Hull University Teaching Hospital, Hull, United Kingdom
| | - K Khan
- Hull University Teaching Hospital, Hull, United Kingdom
| | - C Helbren
- Hull University Teaching Hospital, Hull, United Kingdom
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Nassar A, Qandeel H, Khan K, Ng H, Hasanat S, Ashour H. 1282 Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones.
Method
Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.
Results
741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.
Conclusions
The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
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Affiliation(s)
- A Nassar
- University Hospital Monklands, Airdrie, United Kingdom
| | | | - K Khan
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - H Ng
- Royal Alexandra Hospital, Paisley, United Kingdom
| | | | - H Ashour
- Hashemite University, Zarqa, Jordan
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40
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Khan K, Torpiano G, Galbraith N, McLellan M, Lannigan A. 982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.884] [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
The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.
Method
All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared.
Results
Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).
Conclusions
The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.
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Affiliation(s)
- K Khan
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - G Torpiano
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - N Galbraith
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - M McLellan
- University Hospital Hairmyres, East Kilbride, United Kingdom
| | - A Lannigan
- University Hospital Wishaw, Wishaw, United Kingdom
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Herman J, Schmid S, Zhan L, Garcia M, Brown M, Khan K, Chowdhury M, Sabouhanian A, Walia P, Strom E, Sacher A, Bradbury P, Shepherd F, Leighl N, Cheng S, Patel D, Shultz D, Liu G. FP12.07 Clinico-demographic Factors, EGFR status and their association with Stage at Diagnosis in Lung Adenocarcinoma Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.247] [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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42
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Pizzamiglio C, Mahroo O, Khan K, Patasin M, Quinlivan R. METABOLIC MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.233] [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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43
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Schmid S, Chotai S, Cheng S, Zhan L, Balaratnam K, Khan K, Patel D, Brown M, Xu W, Moriarty P, Kaidanovich-Beilin O, Shepherd F, Sacher A, Leighl N, Bradbury P, Liu G. MA08.02 Outcomes of Early Stage ALK-positive NSCLC patients in a Real-World Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.147] [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] [Indexed: 11/24/2022]
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Chotai S, Schmid S, Cheng S, Zhan L, Balaratnam K, Khan K, Patel D, Brown M, Xu W, Moriarty P, Kaidanovich-Beilin O, Shepherd F, Sacher A, Leighl N, Bradbury P, Liu G. P45.09 Real-World Sequencing of ALK-TKIs in Advanced Stage ALK-positive NSCLC patients in Canada. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.477] [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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45
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Garcia M, Schmid S, Hueniken K, Zhan L, Balaratnam K, Khan K, Fares A, Chan S, Smith E, Aggarwal R, Brown M, Patel D, Sacher A, Bradbury P, Shepherd F, Leighl N, Liu G. P48.05 Is Relapse-Free Survival at 2-Years an Appropriate Surrogate for Overall Survival at 5-Years in EGFR-mutated Resected NSCLC? J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Rao S, Guren MG, Khan K, Brown G, Renehan AG, Steigen SE, Deutsch E, Martinelli E, Arnold D. Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:1087-1100. [PMID: 34175386 DOI: 10.1016/j.annonc.2021.06.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- S Rao
- GI Unit, Royal Marsden Hospital, London, UK
| | - M G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - K Khan
- University College London Hospitals NHS Foundation Trust/UCL Cancer Institute, London, UK; Royal Marsden Hospital, London, UK
| | - G Brown
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - S E Steigen
- University Hospital of North Norway, Tromsø, Norway
| | - E Deutsch
- INSERM 1030, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - E Martinelli
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - D Arnold
- Department of Hematology, Oncology, Palliative Care Medicine and Rheumatology, Asklepios Hospital Altona, Hamburg, Germany
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Nawaz Z, Shafique M, Zahoor MA, Siddique AB, Ali S, Arshad R, Kausar S, Khan K, Asad M, Rehman AU, Masih I. Sero-epidemiology and risk factor analysis of human brucellosis in Punjab, Pakistan: a cross sectional study. Trop Biomed 2021; 38:413-419. [PMID: 34608115 DOI: 10.47665/tb.38.3.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Human brucellosis is a neglected zoonotic problem worldwide with a high degree of morbidity in humans and is mostly overlooked due to other febrile conditions. The aim of this study was to evaluate the sero-prevalence and risk factors of human brucellosis among subjects living in Punjab, Pakistan. In this cross-sectional study, human blood samples were collected from seven districts of Punjab, Pakistan. Information regarding personal data, demographic data and potential risk factors was collected through a structured questionnaire. Detection of anti-Brucella antibodies was done through Rose Bengal Plate Test (RBPT) and Enzyme Linked Immunosorbent Assay (ELISA). Descriptive analysis, Chi square test and Odds ratio was applied using STATA software version 12. The sero-prevalence of human brucellosis was 13.13% with significantly higher percentage in males 17.23% and age group 25-40 years 16.50% (P=< 0.001). The demographic factors positively associated with human brucellosis were lack of education (P = 0.003; OR = 1.85) and farming as an occupation (P =<0.001; OR = 2.50) Similarly, among the risk factors studied, keeping animals at home (P =<0.001; OR = 2.03), slaughtering of animals (P =<0.001; OR = 15.87) and consuming raw milk (P =<0.001; OR = 5.42) were the factors strongly connected with human brucellosis. A massive awareness should be given to livestock farmers and individuals directly linked to animals regarding risk factors and transmission of brucellosis. Consumption of unpasteurized milk and its products should be condemned to curtail this neglected disease.
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Affiliation(s)
- Z Nawaz
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M Shafique
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M A Zahoor
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - A B Siddique
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - S Ali
- Veterinary Research Institute, Lahore, Punjab, Pakistan
| | - R Arshad
- University College of Conventional Medicine, The Islamia University of Bahawalpur, Punjab, Pakistan
| | - S Kausar
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - K Khan
- DHQ Hospital, Bhakkar, Punjab Pakistan
| | - M Asad
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - A U Rehman
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - I Masih
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
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Kuruvilla M, Syed I, Gwadry-Sridhar F, Sachdeva R, Pencz A, Zhan L, Hueniken K, Patel D, Balaratnam K, Khan K, Grant B, Sheffield B, Noy S, Singh K, Liu L, Ralibuz-Zaman M, Davis B, Moldaver D, Shanahan M, Cheema P. 1152P Real-world outcomes in resected stage IB-IIIA EGFR mutated NSCLC in Canada: Analysis from the POTENT study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1755] [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] Open
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49
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Raperport C, Chronopoulou E, Homburg R, Khan K, Bhide P. P–625 Does endogenous progesterone play a role in unexplained infertility? A systematic review. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does endogenous progesterone play a role in unexplained infertility? A systematic review investigating the possibility of altered progesterone-mediated change leading to reduced endometrial receptivity in women with unexplained infertility.
Summary answer
The evidence suggests that many of the measurable actions of endogenous progesterone are reduced in women with unexplained infertility when compared with controls.
What is known already
Unexplained infertility is the diagnosis given to heterosexual couples who fail to conceive despite normal semen analysis, regular ovulation and patent tubes. The underlying pathology is likely to relate to embryonic failure to implant. Endometrial receptivity is largely mediated by luteal phase progesterone which controls many different molecular pathways involved in secretory transformation. It is possible that defective actions of progesterone could contribute to this condition. To date however, there is minimal published literature on the role of progesterone in unexplained infertility. We therefore felt it important to combine the results of all trials measuring progesterone-related outcomes in unexplained infertility.
Study design, size, duration
A systematic review was performed using standard Cochrane methodology. We searched Medline, Embase and CINAHL databases from inception to December 2020 and additionally hand-searched. The study was prospectively registered on Prospero (CRD42020141041). The search strategy was designed to identify all types of primary research published in English that investigated women with unexplained infertility and reported outcomes that relate to progesterone. Newcastle Ottawa Scoring and NHLBI assessment of bias scoring was performed.
Participants/materials, setting, methods
The study population was women with unexplained infertility. Included studies had no controls, fertile controls or controls with other diagnoses associated with subfertility. Outcomes were either upstream affecting progesterone production/release or receptor expression or downstream measuring results of progesterone-mediated processes. The results were summarised in a narrative review. Meta-analysis was not possible due to varying methodological heterogeneity.
Main results and the role of chance
36 studies were included. No difference was found in 18 studies in progesterone levels (serum, peritoneal and salivary) between women with unexplained infertility and control groups. Despite this, 32 of the 36 included studies demonstrated a significant difference between progesterone-mediated outcomes in the unexplained infertile and control groups.
5 ultrasound studies all reported increased resistance and decreased flow on doppler studies of uterine, ovarian and spiral arteries and reduced endometrial and sub-endometrial perfusion. No significant difference was found in luteal phase endometrial thickness in 2 studies.
Endometrial dating was reported by 11 studies. 8/11 studies reported significantly higher numbers (20–38%) of ‘out-of-phase’ endometrium in women with unexplained infertility compared with controls.
Endometrial biopsy results measuring different cell adhesion molecules, monoclonal antibodies and other molecules involved in endometrial transformation as well as expression of responsible genes and steroid hormone receptors were included. All the progesterone-mediated outcome measures listed above were reduced in unexplained infertile women except β3 integrin which reported contradictory results and SGK1 expression which was reported in 1 study. This trend towards support for the hypothesis may be more important than any individual finding. The quality of the included studies was variable and hence the strength of the recommendations moderate.
Limitations, reasons for caution
The number of studies measuring each outcome was limited. The study quality varied from good to poor. Methodological heterogeneity between studies prevented meta-analysis. The strength of the study however comes from the originality of the research, the variety of included outcomes and that 32/36 papers reported results supporting the hypothesis.
Wider implications of the findings: The findings of this systematic review support the need for larger, well designed research on this topic. If altered progesterone-mediated receptivity is implicated in unexplained infertility, it may be possible to offer other therapeutic interventions to improve outcomes as an alternative or adjunct to standard fertility treatment.
Trial registration number
NA
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Affiliation(s)
- C Raperport
- Homerton University Hospital NHS Trust, Fertility Unit, London, United Kingdom
| | - E Chronopoulou
- Homerton University Hospital NHS Trust, Fertility Unit, London, United Kingdom
| | - R Homburg
- Homerton University Hospital NHS Trust, Fertility Unit, London, United Kingdom
| | - K Khan
- University of Granada, Department of Preventive Medicine and Public Health, Granada, Spain
| | - P Bhide
- Homerton University Hospital NHS Trust, Fertility Unit, London, United Kingdom
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50
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Lee R, Wysocki O, Zhou C, Calles A, Eastlake L, Ganatra S, Harrison M, Horsley L, Huddar P, Khan K, Mckenzie H, Palmieri C, Rogado Revuelta J, Thomas A, Wilson C, Cooksley T, Dive C, Freitas A, Armstrong AC. CORONET; COVID-19 in Oncology evaluatiON Tool: Use of machine learning to inform management of COVID-19 in patients with cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1505] [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
1505 Background: Patients (pts) with cancer are at increased risk of severe COVID-19 infection and death. Due to COVID-19 outcome heterogeneity, accurate assessment of pts is crucial. Early identification of pts who are likely to deteriorate allows timely discussions regarding escalation of care. Likewise, safe home management will reduce risk of nosocomial infection. To aid clinical decision-making, we developed a model to help determine which pts should be admitted vs. managed as an outpatient and which pts are likely to have severe COVID-19. Methods: Pts with active solid or haematological cancer presenting with symptoms/asymptomatic and testing positive for SARS-CoV-2 in Europe and USA were identified following institutional board approval. Clinical and laboratory data were extracted from pt records. Clinical outcome measures were discharge within 24 hours, requirement for oxygen at any stage during admission and death. Random Forest (RF) algorithm was used for model derivation as it compared favourably vs. lasso regression. Relevant clinical features were identified using recursive feature elimination based on SHAP. Internal validation (bootstrapping) with multiple imputations for missing data (maximum ≤2) were used for performance evaluation. Cost function determined cut-offs were defined for admission/death. The final CORONET model was trained on the entire cohort. Results: Model derivation set comprised 672 pts (393 male, 279 female, median age 71). 83% had solid cancers, 17% haematological. Predictive features were selected based on clinical relevance and data availability, supported by recursive feature elimination based on SHAP. RF model using haematological cancer, solid cancer stage, no of comorbidities, National Early Warning Score 2 (NEWS2), neutrophil:lymphocyte ratio, platelets, CRP and albumin achieved AUROC for admission 0.79 (+/-0.03) and death 0.75 (+/-0.02). RF explanation using SHAP revealed NEWS2 and C-reactive protein as the most important features predicting COVID-19 severity. In the entire cohort, CORONET recommended admission of 96% of patients requiring oxygen and 99% of patients who died. We then built a decision support tool using the model, which aids clinical decisions by presenting model predictions and explaining key contributing features. Conclusions: We have developed a model and tool available at https://coronet.manchester.ac.uk/ to predict which pts with cancer and COVID-19 require hospital admission and are likely to have a severe disease course. CORONET is being continuously refined and validated over time.
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Affiliation(s)
- Rebecca Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Oskar Wysocki
- The University of Manchester, Manchester, United Kingdom
| | - Cong Zhou
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Manchester, United Kingdom
| | | | - Leonie Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | | | | | - Laura Horsley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Khurum Khan
- University College Hospital London, London, United Kingdom
| | - Hayley Mckenzie
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Anne Thomas
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Caroline Wilson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Caroline Dive
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Manchester, United Kingdom
| | - Andre Freitas
- University of Manchester, Manchester, United Kingdom
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