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Reddy D, Peters M, Shah T, Van Son M, Bertoncelli Tanaka M, Huber P, Lomas D, Rakauskas A, Miah S, Eldred-Evans D, Hosking-Jervis F, Engle R, Dudderidge T, Mccracken S, Greene D, Nigam R, Mccartan N, Valerio M, Orczyk C, Virdi J, Arya M, Ahmed H. Primary focal cryotherapy for non-metastatic prostate cancer: Update from the UK ICE registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharun K, Jambagi K, Arya M, Aakanksha, Chaithra SN, Patel PK, Dixit SK, Dhama K. Clinical Applications of Substance P (Neurokinin-1 Receptor) Antagonist in Canine Medicine. Arch Razi Inst 2021; 76:1175-1182. [PMID: 35355772 PMCID: PMC8934081 DOI: 10.22092/ari.2021.356171.1797] [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] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 01/24/2023]
Abstract
Substance P binds to the Neurokinin-1 (NK-1) receptors found in the emetic center of the central nervous system (CNS) to induce emesis. Maropitant is a selective NK-1 receptor antagonist that inhibits the binding of substance P to NK-1 receptors and is commonly used to prevent and treat vomiting in dogs. This review study aimed to discuss and analyze the therapeutic potential of substance P (Neurokinin-1 receptor) antagonist with a particular focus on the drug maropitant in canine medicine. A systematic literature review was performed to identify the existing literature on the subject during the past 20 years (2001-2021) using such databases as ScienceDirect, PubMed, Scopus, and Google Scholar. The initial search identified 173 articles; however, 41 articles were selected for further analysis, based on the specific inclusion and exclusion criteria. Studies have already confirmed the role of substance P and NK-1 receptors in central pain processing, intestinal smooth muscle contraction, vasodilation, and neurogenic inflammation. Maropitant is one of the most effective veterinary antiemetic drugs that work well against peripheral and central stimuli that trigger the vomiting center. It has been already demonstrated that the therapeutic efficacy of maropitant for managing acute vomiting in dogs is associated with pancreatitis, gastritis, and parvoviral enteritis. It can also prevent and treat chemotherapy-induced emesis and delay the signs of nausea and adverse gastrointestinal effects. Regarding the broad-spectrum antiemetic activity of maropitant, it can be recommended for managing uremic vomiting in dogs. In addition, it has also exhibited an anesthetic sparing effect since the dogs treated with maropitant require a slightly lower percentage of isoflurane as an inhalational anesthetic. The NK-1 receptors are also identified in different areas of the pain pathways. Therefore, NK-1 receptor antagonists might be effective for managing visceral pain. However, further studies are required to establish the broad therapeutic potential of NK-1 receptor antagonist drugs, such as maropitant in canine medicine. It has been shown that the pain associated with the subcutaneous administration of maropitant is due to metacresol, a preservative used in some formulations. Therefore, the side effects can be eliminated by developing novel maropitant formulations specifically for dogs.
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Affiliation(s)
- K Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - K Jambagi
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - M Arya
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Aakanksha
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - S. N Chaithra
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - P. K Patel
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - S. K Dixit
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - K Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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Shah T, Kanthabalan A, Pavlou M, Adeleke S, Giganti F, Brew-Graves C, Williams N, Haroon A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Virdi J, Arya M, Mitra A, Payne H, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed H. MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: Primary outcomes of the FORECAST trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kanthabalan A, Arya M, Freeman A, Mitra AV, Payne H, Peters M, Shah TT, Emberton M, Ahmed HU. Intraprostatic Cancer Recurrence following Radical Radiotherapy on Transperineal Template Mapping Biopsy: Implications for Focal Ablative Salvage Therapy. J Urol 2020; 204:950-955. [PMID: 32602770 DOI: 10.1097/ju.0000000000001201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Men in whom external beam radiotherapy fails are usually placed on delayed hormone therapy. Some of these men have localized recurrence that might be suitable for further local therapy. We describe patterns of recurrence and suitability for focal ablative therapy in those undergoing transperineal template prostate mapping biopsies. MATERIALS AND METHODS The study included 145 consecutive patients (December 2007 to May 2014) referred with suspicion of recurrence due to rising prostate specific antigen after external beam radiotherapy or brachytherapy who underwent transperineal template prostate mapping biopsies. Suitability for focal ablative therapy required the cancer to be unifocal or unilateral, or bilateral/multifocal with 1 dominant index lesion and secondary lesions with Gleason score 3+3=6 with no more than 3 mm cancer core involvement. RESULTS Mean patient age was 70.7 (SD 5.8) years. Median prostate specific antigen at time of transperineal template prostate mapping biopsy was 4.5 ng/ml (IQR 2.5-7.7). Overall 75.9% (110) were suitable for a form of focal salvage treatment, 40.7% (59) were suitable for quadrant ablation, 14.5% (21) hemiablation, 14.5% (21) bilateral focal ablation and 6.2% (9) for index lesion ablation. CONCLUSIONS Three-quarters of patients who have localized radiorecurrent prostate cancer may be suitable for focal ablative therapy to the prostate based on transperineal template prostate mapping biopsies.
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Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, United Kingdom
| | - A V Mitra
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H Payne
- Department of Clinical Oncology, UCLH NHS Foundation Trust, London, United Kingdom
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - T T Shah
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom
| | - H U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Mehta N, Braun PX, Gendelman I, Alibhai AY, Arya M, Duker JS, Waheed NK. Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification. Sci Rep 2020; 10:15368. [PMID: 32958813 PMCID: PMC7505834 DOI: 10.1038/s41598-020-72358-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.
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Affiliation(s)
- Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Phillip X Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Isaac Gendelman
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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Cathcart P, Moore C, Ahmed H, Leslie T, Arya M, Hindley R, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Sooriakumaran P, Emberton M. Functional outcomes from the Robotic surgery After Focal Therapy (RAFT) clinical trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Kadner G, Valerio M, Giannakis I, Arya M, Lumen N, Ho B, Alonso S, Schulman C, Barber N, Amparore D, Porpigila F. Second generation of temporary implantable nitinol device (iTind) in men with lower urinary tract symptoms (LUTS): Who profit most from treatment? 2 year results of the MT-02-study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Arya M, Filho MB, Rebhun CB, Moult EM, Lee B, Alibhai Y, Witkin AJ, Baumal CR, Duker JS, Fujimoto JG, Waheed NK. Analyzing Relative Flow Speeds in Diabetic Retinopathy Using Variable Interscan Time Analysis OCT Angiography. Ophthalmol Retina 2020; 5:49-59. [PMID: 32585373 DOI: 10.1016/j.oret.2020.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Further insight into the flow characteristics of the vascular features associated with diabetic retinopathy (DR) may improve assessment and treatment of disease progression. The variable interscan time analysis (VISTA) algorithm is an extension of OCT angiography (OCTA) that detects relative blood flow speeds, which then can be depicted on a color-coded map. This study used VISTA to analyze relative blood flow speeds in the microvascular changes associated with DR. DESIGN Cross-sectional study. PARTICIPANTS Thirteen patients with varying severities of DR treated at New England Eye Center, Boston, Massachusetts. METHODS OCT angiography images centered at the fovea were obtained on a prototype swept-source OCT device, and the VISTA algorithm was applied to visualize relative blood flow speeds. MAIN OUTCOME MEASURES Descriptive flow analysis of the retinal vascular features of DR was conducted on the VISTA-generated images. RESULTS Twenty-six eyes were included in this study. Of these, 3 eyes had mild nonproliferative DR (NPDR), 6 eyes had moderate NPDR, 4 eyes had severe NPDR, 9 eyes had proliferative DR, and 4 eyes were normal controls. Microaneurysms, intraretinal microvascular abnormalities (IRMAs), and neovascularization appeared to originate from areas of relatively slow blood flow speeds. Microaneurysms showed relatively slower flow, IRMAs showed turbulent, intermediate to slow flow, and venous beading and looping presented with relatively high flow speeds that tapered progressively. Neovascularization of venous origin demonstrated slower flow speeds, whereas that of arterial origin showed relatively high flow speeds. Additionally, increased disease severity was associated with globally slower flow speeds, with particularly slower flow around the foveal avascular zone. CONCLUSIONS The VISTA algorithm seems to be a useful extension of OCTA that overcomes some of the limitations of normal gray-scale OCTA. It seems to have some potential in providing relevant insight into the pathogenesis of the microvascular changes associated with DR. These findings may assist in improving our understanding of the pathogenic changes that take place in DR.
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Affiliation(s)
- Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Marco Bonini Filho
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; Department of Ophthalmology, Sao Juliao Hospital, Campo Grande, MS, Brazil
| | - Carl B Rebhun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Byungkung Lee
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
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10
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Sorour OA, Mehta N, Baumal CR, Ishibazawa A, Liu K, Konstantinou EK, Martin S, Braun P, Alibhai AY, Arya M, Witkin AJ, Duker JS, Waheed NK. Morphological changes in intraretinal microvascular abnormalities after anti-VEGF therapy visualized on optical coherence tomography angiography. Eye Vis (Lond) 2020; 7:29. [PMID: 32514410 PMCID: PMC7262762 DOI: 10.1186/s40662-020-00195-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/09/2020] [Indexed: 11/10/2022]
Abstract
Background To examine the baseline morphological characteristics and alterations in intraretinal microvascular abnormalities (IRMAs) in response to anti-vascular endothelial growth factor (anti-VEGF) treatment, documented by optical coherence tomography angiography (OCTA) in diabetic eyes. Methods In this retrospective study, IRMAs were evaluated with multimodal imaging (fundus photography, fluorescein angiography, OCTA) in treatment-naïve diabetic eyes before and after anti-VEGF treatment for diabetic macular edema (DME) and/or proliferative diabetic retinopathy (PDR) and compared to diabetic control eyes with similar diabetic retinopathy (DR) severity that did not receive anti-VEGF therapy. The morphological characteristics of IRMAs on enface OCTA imaging were graded by masked readers at baseline, then after anti-VEGF therapy in treated eyes or after observation in control eyes. Characterization of interval changes in an IRMA were based on the following parameters: branching, vessel caliber and area of adjacent capillary non-perfusion. Results The treated group included 45 IRMA foci from 15 eyes of 11 patients, while the control group included 27 IRMA foci from 15 eyes of 14 patients. Following anti-VEGF treatment, enface OCTA demonstrated that 14 foci of IRMA (31%) demonstrated regression with normalization of appearance of the capillary bed, 20 IRMAs (44%) remained unchanged, six IRMAs (13%) progressed with enlargement or development of new IRMAs and five IRMAs (11%) demonstrated complete obliteration defined as IRMA disappearance with advancing capillary drop-out. In the control group, 17 IRMA (63%) remained stable, 8 IRMAs (29.6%) progressed and 2 experienced total obliteration (7.4%). The difference in rank order between the two groups was statistically significant (p = 0.022). Conclusions In eyes with DR status post anti-VEGF therapy, foci of IRMAs have a variable course demonstrating one of four possible outcomes: regression, stability, progression or complete obliteration. In contrast, none of the untreated control diabetic eyes demonstrated regression of IRMAs, consistent with known progression of DR severity in high risk eyes. Morphologic evaluation of IRMAs with OCTA may help to monitor changes in retinal blood flow as well as the response to anti-VEGF treatment.
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Affiliation(s)
- Osama A Sorour
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,The Warren Alpert Medical School of Brown University, Providence, Rhode Island USA
| | - Caroline R Baumal
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Akihiro Ishibazawa
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | - Keke Liu
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,University of Hawai'i John A. Burns School of Medicine, Honolulu, HI USA
| | - Eleni K Konstantinou
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Sarah Martin
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Phillip Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Yale School of Medicine, New Haven, Connecticut USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Andre J Witkin
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Ricardo CP, Evie I, Henry M, Sanchez-Nieto J, Jayawardena M, Soula A, Daldoul K, Arya M, O'Grady C, Dewhirst O, Smart M, Munye M, Hasan J. Development of process analytical technology to monitor the cell secretome during differentiation of pluripotent stem cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Liu K, Mehta N, Alibhai AY, Arya M, Sorour O, Ishibazawa A, Byon I, Baumal CR, Witkin AJ, Duker JS, Sadda SR, Waheed NK. Effects of enhanced depth imaging and en face averaging on optical coherence tomography angiography image quantification. Graefes Arch Clin Exp Ophthalmol 2020; 258:979-986. [PMID: 32020294 DOI: 10.1007/s00417-020-04610-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/11/2020] [Accepted: 01/23/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To examine the effects of enhanced depth imaging (EDI) and en face averaging on global vascular measurements of optical coherence tomography angiography (OCTA) images. METHODS All eyes were imaged with 3 mm × 3 mm fields centered at the fovea using the Carl Zeiss Cirrus 5000 spectral-domain OCTA, with and without EDI, and the Zeiss PLEX Elite 9000 swept-source OCTA. Vessel area density (VAD), vessel length (VL), and vessel diameter index (VDI) were calculated for the superficial capillary plexus (SCP) en face angiograms. For the choriocapillaris (CC), VAD and the number, total area, and average size of flow voids were calculated. These metrics were compared between SD- and SS-OCTA images, with and without en face averaging and EDI. RESULTS Both averaging and EDI had a significant effect on quantitative metrics. EDI images trended toward a decrease in SCP VAD. In the CC, EDI decreased average flow void size. Averaging increased CC VAD while decreasing number of flow voids, total flow void area, and average flow void size. With both averaging and EDI, SD-OCTA was not able to visualize as many CC flow voids, particularly of a smaller size, compared with SS-OCTA. CONCLUSIONS Averaging and EDI affect quantitative metrics from SCP and CC OCTA images. EDI resulted in a trend toward decreased VAD in SCP images. Averaging had a major effect on CC imaging. Even with the combination of EDI and en face averaging, SD-OCTA images do not appear to approximate SS-OCTA images in terms of quantitative metrics. This has implications for clinical and research use of SD-OCTA for retinal imaging.
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Affiliation(s)
- Keke Liu
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Iksoo Byon
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA. .,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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13
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Ishibazawa A, De Pretto LR, Alibhai AY, Moult EM, Arya M, Sorour O, Mehta N, Baumal CR, Witkin AJ, Yoshida A, Duker JS, Fujimoto JG, Waheed NK. Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2020; 60:4310-4318. [PMID: 31622467 PMCID: PMC6996665 DOI: 10.1167/iovs.19-26653] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate whether retinal capillary nonperfusion is found predominantly adjacent to arteries or veins in eyes with diabetic retinopathy (DR). Methods Sixty-three eyes from 44 patients with proliferative DR (PDR) or non-PDR (NPDR) were included. Images (12 × 12-mm) foveal-centered optical coherence tomography (OCT) angiography (OCTA) images were taken using the Zeiss Plex Elite 9000. In 37 eyes, widefield montages with five fixation points were also obtained. A semiautomatic algorithm that detects nonperfusion in full-retina OCT slabs was developed, and the percentages of capillary nonperfusion within the total image area were calculated. Retinal arteries and veins were manually traced. Based on the shortest distance, nonperfusion pixels were labeled as either arterial-side or venous-side. Arterial-adjacent and venous-adjacent nonperfusion and the A/V ratio (arterial-adjacent nonperfusion divided by venous-adjacent nonperfusion) were quantified. Results Twenty-two eyes with moderate NPDR, 16 eyes with severe NPDR, and 25 eyes with PDR were scanned. Total nonperfusion area in PDR (median: 8.93%) was greater than in moderate NPDR (3.49%, P < 0.01). Arterial-adjacent nonperfusion was greater than venous-adjacent nonperfusion for all stages of DR (P < 0.001). The median A/V ratios were 1.93 in moderate NPDR, 1.84 in severe NPDR, and 1.78 in PDR. The A/V ratio was negatively correlated with the total nonperfusion area (r = −0.600, P < 0.0001). The results from the widefield montages showed similar patterns. Conclusions OCTA images with arteries and veins traced allowed us to estimate the nonperfusion distribution. In DR, smaller nonperfusion tends to be arterial-adjacent, while larger nonperfusion tends toward veins.
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Affiliation(s)
- Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Lucas R De Pretto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States.,Nuclear and Energy Research Institute, Sao Paulo, Sao Paulo, Brazil
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
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Au A, Hou K, Dávila JP, Gunnemann F, Fragiotta S, Arya M, Sacconi R, Pauleikhoff D, Querques G, Waheed N, Freund KB, Sadda S, Sarraf D. Volumetric Analysis of Vascularized Serous Pigment Epithelial Detachment Progression in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography. ACTA ACUST UNITED AC 2019; 60:3310-3319. [DOI: 10.1167/iovs.18-26478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adrian Au
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Kirk Hou
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Juan Pablo Dávila
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | | | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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15
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Ishibazawa A, Mehta N, Sorour O, Braun P, Martin S, Alibhai AY, Saifuddin A, Arya M, Baumal CR, Duker JS, Waheed NK. Accuracy and Reliability in Differentiating Retinal Arteries and Veins Using Widefield En Face OCT Angiography. Transl Vis Sci Technol 2019; 8:60. [PMID: 31316862 PMCID: PMC6602142 DOI: 10.1167/tvst.8.3.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the accuracy and reliability in differentiating retinal arteries from veins using widefield optical coherence tomography angiography (OCTA). Methods Ten healthy eyes and 12 eyes from diabetic patients were included. Foveal-centered swept-source OCTA images (12 × 12 mm) were obtained using the PLEX Elite 9000. Vessels were graded as arteries or veins by two independent, masked readers. Arteriovenous crossings were also evaluated in healthy eyes. The vessel identification gold standard was defined using color fundus photographs (CFP) for normal eyes and both CFP and fluorescein angiography for diabetic eyes. Grading accuracy was compared to the gold standard and reliability between readers assessed. Results The study evaluated 538 vessels (119 first order, 110 second, 309 third) in healthy eyes and 645 vessels (184 first order, 159 second, 302 third). In healthy eyes, the average accuracies identifying all, first-, second-, and third-order vessels were 98.61%, 99.16%, 100%, and 98.06%, respectively. Cohen's κ between graders in all vessels was 0.948. In diabetic eyes, the average accuracies identifying vessels were 96.90%, 99.46%, 97.77%, and 94.85%, respectively. Cohen's κ between graders for all vessels was 0.888. For crossing identification, the average accuracy and Cohen's κ were low (60.71% and 0.659, respectively). Conclusions En face OCTA allows for accurate and reliable artery and vein identification; for small branches and crossings, identification by en face OCTA alone may be less accurate and reliable. Translational Relevance Arteries and veins can be differentiated on OCTA, assisting in clinically identifying pathology as arterial or venous side.
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Affiliation(s)
- Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Phillip Braun
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Sarah Martin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Adnan Saifuddin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
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Sorour OA, Sabrosa AS, Yasin Alibhai A, Arya M, Ishibazawa A, Witkin AJ, Baumal CR, Duker JS, Waheed NK. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy. Int Ophthalmol 2019; 39:2361-2371. [PMID: 31119505 DOI: 10.1007/s10792-019-01076-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate changes in macular vessel density following intravitreal anti-VEGF injection in patients with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). METHODS In this retrospective case series, optical coherence tomography angiography (OCTA) images from 55 eyes of 35 patients with either DME (46 eyes) or PDR (9 eyes) were included. Macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP) before and after anti-VEGF treatment was calculated. Longitudinal changes in vessel density following serial anti-VEGF treatment were analyzed in a subset of eyes. RESULTS Vessel density in the SCP, DCP or TCP was not found to be significantly different after one, two or three intravitreal injections (p > 0.05 for all time points). Subgroup analysis revealed no significant change in the DME and PDR subgroups (all p > 0.05). Multivariate analysis revealed no effect of type of injected anti-VEGF agent or presence of previous treatment on VD measurements (all p > 0.05). There was no correlation between the anatomic response of DME to treatment and VD measurements. CONCLUSIONS In this study, macular vessel density remained statistically unchanged following up to three intravitreal injections of any anti-VEGF agent. This indicates that there may not be an early effect of anti-VEGF treatment on macular vessel density and its effect on macular perfusion may not be a direct change in microvascular flow.
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Affiliation(s)
- Osama A Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Ophthalmology Department, Tanta University, Tanta, Egypt
| | - Almyr S Sabrosa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Institute Ophthalmology Rio de Janeiro/Hospital da Gamboa, Rio de Janeiro, Brazil
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.
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17
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Arya M, Rebhun CB, Alibhai AY, Chen X, Moreira-Neto C, Baumal CR, Reichel E, Witkin AJ, Duker JS, Sadda SR, Waheed NK. Parafoveal Retinal Vessel Density Assessment by Optical Coherence Tomography Angiography in Healthy Eyes. Ophthalmic Surg Lasers Imaging Retina 2019; 49:S5-S17. [PMID: 30339262 DOI: 10.3928/23258160-20180814-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess variability in vessel density (VD) measurements across three optical coherence tomography angiography (OCTA) devices to identify a methodology that offers the least amount of variation in VD, and to assess the effect of averaging of multiple scans on VD variability. PATIENTS AND METHODS Fifteen eyes of eight healthy individuals were imaged consecutively on three OCTA devices. Segmentations at the superficial, deep, and full retinal layers were generated. Repeat scans for each retinal layer were registered and averaged to generate one OCTA image. Two different automated thresholding techniques were used to calculate vessel area density (VAD) from binarized images and vessel skeleton density (VSD) from skeletonized images. Vessel length, a linear measure of the combined lengths of vessels, was calculated. Foveal avascular zone (FAZ) area was measured. RESULTS All three OCTA devices were significantly different (P < .0001). This finding remained after averaging images (P < .0001). VSD was more repeatable within a device but less reproducible across devices. Conversely, VAD demonstrated less repeatability but greater reproducibility. Differences in VSD between devices were systematic and attributable to differences in resolution. Vessel length, unaffected by resolution, demonstrated no significant differences between the devices (P > .107). There was no significant difference in FAZ area across devices (P = .51). After averaging images, VD was significantly different from the single images for each device and plexus (P < .05) but remained within 1% of the value of a single scan. CONCLUSIONS OCTA devices show variability in VD for healthy individuals. With greater repeatability, VSD appeared useful for following a patient on one device. VAD and vessel length seemed ideal for comparing vessel parameters between OCTA devices. After averaging multiple scans, VSD remained within 1% of a single scan, for which clinical significance remains to be determined. Caution is advised when comparing quantitative analyses across OCTA devices. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S5-S17.].
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18
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Khoo C, Eldred-Evans D, Jaenicke J, Bertoncelli Tanaka M, Shah T, Miah S, Connor M, Reddy D, Sethi J, Forde A, Bhola-Stewart H, Smith A, Carton J, Lloyd J, Mannion E, Hosking-Jervis F, Cullen E, Cartwright R, Clark M, Arya M, Hrouda D, Winkler M, Tam H, Ahmed H. Likert vs. PI-RADS v2: A comparison of two radiological scoring systems for detection of clinically significant prostate cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Garrity ST, Jung JY, Zambrowski O, Pichi F, Su D, Arya M, Waheed NK, Duker JS, Chetrit Y, Miserocchi E, Giuffrè C, Kaden TR, Querques G, Souied EH, Freund KB, Sarraf D. Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects. Br J Ophthalmol 2019; 103:1600-1604. [DOI: 10.1136/bjophthalmol-2018-313350] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 11/04/2022]
Abstract
Background/AimsHydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.MethodsData from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.ResultsSeventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.ConclusionPatients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.
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20
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Arya M, Duker JS. Vinorelbine-induced regression of a choroidal metastasis from primary breast carcinoma. Int J Retina Vitreous 2018; 4:17. [PMID: 29785284 PMCID: PMC5950186 DOI: 10.1186/s40942-018-0121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Various therapeutic options exist to treat choroidal metastatic lesions. However, they are all associated with potential long-term adverse effects. This case report discusses a case of choroidal metastasis from primary breast carcinoma that regressed after single-agent chemotherapy. Case presentation We report a case of choroidal metastasis from estrogen receptor (ER) positive breast carcinoma that became resistant to endocrine therapy. The primary malignancy was treated with surgical resection and adjuvant chemoradiation, followed by hormone therapy with various agents in combination with kinase inhibitors for ER resistance. The choroidal metastatic lesion regressed after the initiation of vinorelbine. Vinorelbine is a cytotoxic vinca alkaloid with tolerable systemic adverse effects. Conclusions This case report highlights the possible role of vinorelbine as a single chemotherapeutic agent for the conservative therapy of uveal metastasis from advanced breast carcinoma, irrespective of responsiveness to hormone therapy.
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21
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Arya M, Rashad R, Sorour O, Moult EM, Fujimoto JG, Waheed NK. Optical coherence tomography angiography (OCTA) flow speed mapping technology for retinal diseases. Expert Rev Med Devices 2018; 15:875-882. [PMID: 30460869 DOI: 10.1080/17434440.2018.1548932] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality for depth-resolved visualization of retinal vasculature. Angiographic data couples with structural data to generate a cube scan, from which en-face images of vasculature can be obtained at various axial positions. OCTA has expanded understanding of retinal vascular disorders and has primarily been used for qualitative analysis. AREAS COVERED Recent studies have explored the quantitative properties of OCTA, which would allow for objective assessment and follow-up of retinal pathologies. Various quantitative metrics have been developed, such as foveal avascular zone area and vessel density. However, quantitative assessment of the characteristics of retinal blood flow remains limited, as OCTA provides an image depicting either the presence or absence of flow at a particular region without information of relative velocities. The development of variable interscan time analysis (VISTA) overcomes this limitation. The VISTA algorithm generates a color-coded map of relative blood flow speeds. VISTA has already demonstrated utility in furthering our understanding of various retinal pathologies, such as geographic atrophy, choroidal neovascularization, aneurysmal type 1 neovascularization, and diabetic retinopathy. EXPERT COMMENTARY VISTA, an OCTA flow speed mapping technique, may have a role in developing the utility of OCTA as a screening tool.
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Affiliation(s)
- Malvika Arya
- a Department of Ophthalmology , New England Eye Center, Tufts Medical Center , Boston , MA , USA
| | - Ramy Rashad
- a Department of Ophthalmology , New England Eye Center, Tufts Medical Center , Boston , MA , USA
| | - Osama Sorour
- a Department of Ophthalmology , New England Eye Center, Tufts Medical Center , Boston , MA , USA.,b Department of Ophthalmology , Tanta University , Tanta , Egypt
| | - Eric M Moult
- c Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics , Massachusetts Institute of Technology , Cambridge , MA , USA
| | - James G Fujimoto
- c Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics , Massachusetts Institute of Technology , Cambridge , MA , USA
| | - Nadia K Waheed
- a Department of Ophthalmology , New England Eye Center, Tufts Medical Center , Boston , MA , USA
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Arya M, Sabrosa AS, Duker JS, Waheed NK. Choriocapillaris changes in dry age-related macular degeneration and geographic atrophy: a review. Eye Vis (Lond) 2018; 5:22. [PMID: 30238015 PMCID: PMC6138930 DOI: 10.1186/s40662-018-0118-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/29/2018] [Indexed: 01/16/2023]
Abstract
Age-related macular degeneration (AMD) is a leading cause of central vision loss worldwide. The progression of dry AMD from early to intermediate stages is primarily characterized by increasing drusen formation and adverse impact on outer retinal cells. Late stage AMD consists of either geographic atrophy (GA), the non-exudative (dry) AMD subtype, or choroidal neovascularization, the exudative (wet) AMD subtype. GA is characterized by outer retinal and choroidal atrophy, specifically the photoreceptor layer, RPE, and choriocapillaris. Much remains to be discovered regarding the pathogenesis of AMD progression and subsequent development of GA. As the functionality of all three layers is closely linked, the temporal sequence of events that end up in atrophy is important in the understanding of the pathogenic pathway of the disease. The advent of OCTA, and particularly of swept-source technology, has allowed for depth-resolved imaging of retinal vasculature and the choriocapillaris. With the use of OCTA, recent studies demonstrate that choriocapillaris flow alterations are closely associated with the development and progression of AMD. Such changes may even possibly offer predictive value in determining progression of GA. This article reviews studies demonstrating choriocapillaris changes in dry AMD and summarizes the existing literature on the potential role of the choriocapillaris as a key factor in the pathogenesis of AMD.
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Affiliation(s)
- Malvika Arya
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA.,Institude of Ophthalmology, Rio de Janeiro, Brazil
| | - Almyr S Sabrosa
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA.,Institude of Ophthalmology, Rio de Janeiro, Brazil
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Nadia K Waheed
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
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Abstract
SummaryAntithrombin III activity and thrombin times were assayed in maturity onset diabetics, atherosclerotic patients and normal subjects. There was a close correlation between the Antithrombin III activity and thrombin times in all three groups. Reductions in these measurements in diabetes mellitus and atherosclerosis, independent of thromboembolic phenomena, support the theory of Antithrombin III deficiency in these diseases.
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Huber P, Afzal N, Arya M, Boxler S, Charman S, Cornaby A, Dudderidge T, Emberton M, Guillaumier S, Hindley R, Leemann L, Lewi H, Mc Cartan N, Moore C, Nigam R, Ogden C, Persad R, Shah K, Thalmann G, Virdi J, Winkler M, Ahmed H. Focal HIFU: Higher recurrence rate in treatment of anterior compared to posterior lesions in prostate cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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25
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26
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Or C, Sabrosa AS, Sorour O, Arya M, Waheed N. Use of OCTA, FA, and Ultra-Widefield Imaging in Quantifying Retinal Ischemia: A Review. Asia Pac J Ophthalmol (Phila) 2018; 7:46-51. [PMID: 29436208 DOI: 10.22608/apo.201812] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
As ischemia remains a key prognostic factor in the management of various diseases including diabetic retinopathy, an increasing amount of research has been dedicated to its quantification as a potential biomarker. Advancements in the quantification of retinal ischemia have been made with the imaging modalities of fluorescein angiography (FA), ultra-widefield imaging (UWF), and optical coherence tomography angiography (OCTA), with each imaging modality offering certain benefits over the others. FA remains the gold standard in assessing the extent of ischemia. UWF imaging has allowed for the assessment of peripheral ischemia via FA. It is, however, OCTA that offers the best visualization of retinal vasculature with its noninvasive depth-resolved imaging and therefore has the potential to become a mainstay in the assessment of retinal ischemia. The primary purpose of this article is to review the use of FA, UWF, and OCTA to quantify retinal ischemia and the various methods described in the literature by which this is achieved.
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Affiliation(s)
- Chris Or
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Almyr S Sabrosa
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Institute Ophthalmology Rio de Janeiro/Hospital da Gamboa, Rio de Janeiro, Brazil
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
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27
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Affiliation(s)
- M Harper
- Institute of Urology, 48 Riding House Street, London W1W 7EY, UK
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28
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Affiliation(s)
- J S Kalsi
- Institute of Urology and Nephrology, 48 Riding House Street, London W1P 7NN, UK.
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29
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Davda R, Prentice M, Sarova A, Nei W, Orczyk C, Arya M, Moore C, Ahmed H, Emberton M, Mitra A, Payne H. Late Toxicity and Patient Reported Outcomes in Patients Treated With Salvage Radiation Following Primary High Intensity Focal Ultrasound for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1144] [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: 10/18/2022]
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Linch M, Goh G, Hiley C, Shanmugabavan Y, McGranahan N, Rowan A, Wong YNS, King H, Furness A, Freeman A, Linares J, Akarca A, Herrero J, Rosenthal R, Harder N, Schmidt G, Wilson GA, Birkbak NJ, Mitter R, Dentro S, Cathcart P, Arya M, Johnston E, Scott R, Hung M, Emberton M, Attard G, Szallasi Z, Punwani S, Quezada SA, Marafioti T, Gerlinger M, Ahmed HU, Swanton C. Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters. Ann Oncol 2017; 28:2472-2480. [PMID: 28961847 PMCID: PMC5815564 DOI: 10.1093/annonc/mdx355] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies. PATIENTS AND METHODS Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification. RESULTS We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion. CONCLUSIONS The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies. CLINICAL TRIALS.GOV IDENTIFIER NCT02022371.
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Affiliation(s)
- M Linch
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Goh
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - C Hiley
- Division of Cancer Studies, King's College London, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y Shanmugabavan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N McGranahan
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - A Rowan
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y N S Wong
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - H King
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK
| | - A Furness
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Linares
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Akarca
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - R Rosenthal
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | | | | | - G A Wilson
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - N J Birkbak
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - R Mitter
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - S Dentro
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK;; Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, UK
| | - P Cathcart
- The Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - E Johnston
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - R Scott
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Hung
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - G Attard
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - Z Szallasi
- Centre for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark;; Computational Health Informatics Program (CHIP), Harvard Medical School, Boston, USA;; MTA-SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
| | - S Punwani
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - S A Quezada
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - T Marafioti
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Gerlinger
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK;; Division of Surgery, Department of Surgery and Cancer, Imperial College London, UK;; Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - C Swanton
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK;.
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Bass EJ, Donaldson IA, Freeman A, Jameson C, Punwani S, Moore C, Arya M, Emberton M, Ahmed HU. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic Dis 2017; 20:311-317. [PMID: 28485391 DOI: 10.1038/pcan.2017.13] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 11/21/2016] [Revised: 01/29/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique. METHODS Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05). RESULTS One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0-2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater (irrespective of cancer length). Any cancer was detected in 142/181 (78%). Significant disease was more likely in higher MRI-scoring lesions and in men with PSAs ⩾10 ng ml-1. CONCLUSIONS This approach to prostate biopsy is feasible, tolerable and can be performed in ambulatory settings.
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Affiliation(s)
- E J Bass
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - I A Donaldson
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - C Jameson
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - C Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
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Louzada RN, de Carlo TE, Adhi M, Novais EA, Durbin MK, Cole E, Lane M, Moghimi O, Arya M, Filho MB, Witkin AJ, Baumal CR, Ávila M, Duker JS, Waheed NK. Optical coherence tomography angiography artifacts in retinal pigment epithelial detachment. Can J Ophthalmol 2017; 52:419-424. [PMID: 28774527 DOI: 10.1016/j.jcjo.2016.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe optical coherence tomography angiography (OCTA) reflectance artifacts secondary to retinal pigment epithelial detachment (RPED). DESIGN Retrospective review. METHODS Four eyes from 4 subjects were included. Three presented with RPED and 1 eye was a normal control. Two eyes diagnosed with RPED and the normal eye were evaluated using en face OCTA centred at the fovea acquired using the RTVue XR Avanti (Optovue Inc). In the third eye with RPED, OCTA imaging was performed using a CIRRUS 5000 prototype modified to do OCTA imaging on a spectral domain OCT platform provided by Carl Zeiss Meditec, Inc. The segmented OCTA angiograms were overlaid to determine if the flow patterns seen at the edge of the RPEDs were due to reflectance from the inner retinal vessels, also known as "decorrelation tails." RESULTS OCTA projection artifacts were noted when segmentation lines intersected with the boundary of the RPED. The overlaid segmented OCTA from the 3 RPED eyes imaged using each system revealed the same vasculature pattern at the edges of the RPED as that of the inner retina, demonstrating the "decorrelation tails" artifact, which caused the RPED to appear as a bright ring on the segmented OCTA. CONCLUSIONS OCTA images are susceptible to various known artifacts. This series describes the impact of the projection artifact seen at the edges of an RPED that simulates appearance of flow but is actually due to reflectance of the inner retinal vasculature on the RPED.
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Affiliation(s)
- Ricardo N Louzada
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Federal University of Goiás, Goiás, Brazil
| | - Talisa E de Carlo
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Mehreen Adhi
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Eduardo A Novais
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Emily Cole
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Mark Lane
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Omid Moghimi
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | - Malvika Arya
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | - Marco Bonini Filho
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | - Andre J Witkin
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | - Caroline R Baumal
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | | | - Jay S Duker
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts
| | - Nadia K Waheed
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts.
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Kanthabalan A, Abd-Alazeez M, Arya M, Allen C, Freeman A, Jameson C, Kirkham A, Mitra A, Payne H, Punwani S, Ramachandran N, Walkden M, Emberton M, Ahmed H. Transperineal Magnetic Resonance Imaging-targeted Biopsy versus Transperineal Template Prostate Mapping Biopsy in the Detection of Localised Radio-recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 28:568-76. [DOI: 10.1016/j.clon.2016.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/19/2016] [Accepted: 03/08/2016] [Indexed: 12/14/2022]
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Shah TT, Peters M, Kanthabalan A, McCartan N, Fatola Y, van der Voort van Zyp J, van Vulpen M, Freeman A, Moore CM, Arya M, Emberton M, Ahmed HU. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Prostate Cancer Prostatic Dis 2016; 19:311-6. [PMID: 27431499 PMCID: PMC4983180 DOI: 10.1038/pcan.2016.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 12/03/2022]
Abstract
Background: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. Methods: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA>nadir+2 ng ml−1)), start of systemic therapies or metastases. Results: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml−1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgen-deprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir <0.5 ng ml−1, 15/50 (30%) had a nadir ⩾0.5 ng ml−1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir <0.5 ng ml−1, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (P<0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). Conclusions: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
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Affiliation(s)
- T T Shah
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, Whittington Hospital NHS Trust, London, UK
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kanthabalan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - N McCartan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Y Fatola
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - J van der Voort van Zyp
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - C M Moore
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
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Hamid S, Guillaumier S, Shah T, Arya M, Ahmed HU. Prostate cancer recurrence after Focal Therapy: Treatment options. ARCH ESP UROL 2016; 69:375-383. [PMID: 27416641] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Focal therapy is a novel treatment option in localised prostate cancer with or without a visible lesion on MRI. Treatment for low to intermediate risk prostate cancer with focal therapy has demonstrated good short to medium term outcomes with fewer undesirable genitourinary side effects. This has made focal therapy more appealing to men who find the implications of radical treatment unacceptable or are unable to tolerate active surveillance. In this paper we review the literature for treatment options in prostate cancer recurrence post focal therapy. We also cover the different definitions of failure agreed upon in previous consensus meetings, as well as their implications on future management focal therapy patients.
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Affiliation(s)
- S Hamid
- Division of Surgery and Interventional Science. Urology Research Group, UCL. London. UK. Department of Urology. UCLH NHS Foundation Trust. London. UK
| | - S Guillaumier
- Division of Surgery and Interventional Science. Urology Research Group, UCL. London. UK. Department of Urology. UCLH NHS Foundation Trust. London. UK
| | - T Shah
- Division of Surgery and Interventional Science. Urology Research Group, UCL. London. UK. Department of Urology. Whittington Hospital NHS Trust. London. UK
| | - M Arya
- Department of Urology. Whittington Hospital NHS Trust. London. UK
| | - H U Ahmed
- Division of Surgery and Interventional Science. Urology Research Group, UCL. London. UK. Department of Urology. UCLH NHS Foundation Trust. London. UK
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Orczyk C, Punwani S, Kirkham A, Ramachandran N, Walkden M, Freeman A, Jameson C, Shehada M, Moore C, Arya M, Emberton M, Ahmed H. [Not Available]. Prog Urol 2015; 25:829-30. [PMID: 26544420 DOI: 10.1016/j.purol.2015.08.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C Orczyk
- University College London, Londres, Royaume-Uni
| | - S Punwani
- University College London, Londres, Royaume-Uni
| | - A Kirkham
- University College London, Londres, Royaume-Uni
| | | | - M Walkden
- University College London, Londres, Royaume-Uni
| | - A Freeman
- University College London, Londres, Royaume-Uni
| | - C Jameson
- University College London, Londres, Royaume-Uni
| | - M Shehada
- University College London, Londres, Royaume-Uni
| | - C Moore
- University College London, Londres, Royaume-Uni
| | - M Arya
- University College London, Londres, Royaume-Uni
| | - M Emberton
- University College London, Londres, Royaume-Uni
| | - H Ahmed
- University College London, Londres, Royaume-Uni
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Kanthabalan A, Shah T, Arya M, Punwani S, Bomanji J, Haroon A, Illing RO, Latifoltojar A, Freeman A, Jameson C, van der Meulen J, Charman S, Emberton M, Ahmed HU. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. Contemp Clin Trials 2015; 44:175-186. [PMID: 26184343 DOI: 10.1016/j.cct.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. AIM FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. METHODS Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. RESULTS Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. CONCLUSION Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
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Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
| | - T Shah
- Division of Surgery and Interventional Science, University College London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, UK
| | - S Punwani
- Department of Radiology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - J Bomanji
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, UK
| | - A Haroon
- Centre for Medical Imaging and Computing, University College London, UK
| | - R O Illing
- Department of Radiology, UCLH NHS Foundation Trust, UK
| | - A Latifoltojar
- Department of Urology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - A Freeman
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | - C Jameson
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | | | - S Charman
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
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38
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Abd-Alazeez M, Ramachandran N, Dikaios N, Ahmed HU, Emberton M, Kirkham A, Arya M, Taylor S, Halligan S, Punwani S. Multiparametric MRI for detection of radiorecurrent prostate cancer: added value of apparent diffusion coefficient maps and dynamic contrast-enhanced images. Prostate Cancer Prostatic Dis 2015; 18:128-36. [PMID: 25644248 DOI: 10.1038/pcan.2014.55] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 10/16/2014] [Revised: 11/16/2014] [Accepted: 12/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mp-MRI) is increasingly advocated for prostate cancer detection. There are limited reports of its use in the setting of radiorecurrent disease. Our aim was to assess mp-MRI for detection of radiorecurrent prostate cancer and examine the added value of its functional sequences. METHODS Thirty-seven men with mean age of 69.7 (interquartile range, 66-74) with biochemical failure after external beam radiotherapy underwent mp-MRI (T2-weighted, high b-value, multi-b-value apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) imaging); then transperineal systematic template prostate mapping (TPM) biopsy. Using a locked sequential read paradigm (with the sequence order above), two experienced radiologists independently reported mp-MRI studies using score 1-5. Radiologist scores were matched with TPM histopathology at the hemigland level (n=74). Accuracy statistics were derived for each reader. Interobserver agreement was evaluated using kappa statistics. RESULTS Receiver-operator characteristic area under curve (AUC) for readers 1 and 2 increased from 0.67 (95% confidence interval (CI), 0.55-0.80) to 0.80 (95% CI, 0.69-0.91) and from 0.67 (95% CI, 0.55-0.80) to 0.84 (95% CI, 0.76-0.93), respectively, between T2-weighted imaging alone and full mp-MRI reads. Addition of ADC maps and DCE imaging to the examination did not significantly improve AUC for either reader (P=0.08 and 0.47 after adding ADC, P=0.90 and 0.27 after adding DCE imaging) compared with T2+high b-value review. Inter-reader agreement increased from k=0.39 to k=0.65 between T2 and full mp-MRI review. CONCLUSIONS mp-MRI can detect radiorecurrent prostate cancer. The optimal examination included T2-weighted imaging and high b-value DWI; adding ADC maps and DCE imaging did not significantly improve the diagnostic accuracy.
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Affiliation(s)
- M Abd-Alazeez
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - N Ramachandran
- Department of Radiology, University College London Hospital, London, UK
| | - N Dikaios
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - H U Ahmed
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Division of Surgery and Interventional Science, University College London, London, UK
| | - A Kirkham
- Department of Radiology, University College London Hospital, London, UK
| | - M Arya
- 1] Department of Urology, University College Hospital NHS Foundation Trust, London, UK [2] Barts Cancer Institute, Queen Mary University of London, London, UK
| | - S Taylor
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Halligan
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
| | - S Punwani
- 1] Department of Radiology, University College London Hospital, London, UK [2] Centre for Medical Imaging, University College London, London, UK
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El-Shater Bosaily A, Arya M, Punwani S, Emberton M, Kirkham A, Freeman A, Ahmed H. Re: Multiparametric Magnetic Resonance Imaging Guided Diagnostic Biopsy Detects Significant Prostate Cancer and could Reduce Unnecessary Biopsies and Over Detection: A Prospective Study. J Urol 2015; 193:735-6; discussion 736. [DOI: 10.1016/j.juro.2014.08.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 11/16/2022]
Affiliation(s)
- A. El-Shater Bosaily
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - M. Arya
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S. Punwani
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - M. Emberton
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A. Kirkham
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A. Freeman
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - H.U. Ahmed
- Research Department of Urology, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Center for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Gera S, Dali JS, Sharma KR, Garg R, Arya M. Evaluation of intubating conditions in children after sevoflurane induction using propofol or rocuronium bromide--a randomised, prospective, double blind study. Acta Anaesthesiol Belg 2015; 66:25-30. [PMID: 27108466 DOI: pmid/27108466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of sevoflurane without muscle relaxant for tracheal intubation has been widely investigated in children. Non-depolarizing neuromuscular blockers have long duration of action and do not provide rapid return of spontaneous ventilation. Use of suc-cinylcholine has been found to be associated with various side-effects especially in children. Therefore, we aim to evaluate the effect of propofol 1.5 mg/kg without muscle relaxant, on intubating conditions in children 2-8 yrs of age and we compare them with those achieved with rocuronium 0.6 mg/kg, at moderate sevoflurane concentration. METHODS Fifty children between 2-8 yrs, ASA I or II scheduled for elective surgery were randomly allocated to either Group P (propofol) or group R (rocuronium). After premedication with oral midazolam 0.5 mg/kg 30 min before surgery, anaesthesia was induced with 8% sevoflurane in oxygen. Intravenous fentanyl 1 µg/kg was administered after securing intravenous access and dial concentration of sevoflurane was reduced to 4%. At one minute with regards to time T₀, the patients received the drug which was either intravenous rocuronium 0.6 mg/kg or an equal volume of 0.9% saline (D) and at three minutes (two minutes after D₁), second drug (D₂) was given, which was either propofol 1.5 mg/kg or an equal volume of 0.9% saline according to the group allocated. At four minutes, laryngoscopy was done and intubation performed with appropriate sized uncuffed endotracheal tube. Incidence of acceptable and excellent intubating conditions, time to intubation and hemodynamic parameters were recorded. RESULTS Incidence of acceptable or excellent intubating conditions was similar in both groups (p = 1.00). The difference in time to intubation was statistically not significant (25.03 ± 6.05s in Group P and 24.38 ?5.58s in Group R, p = 0.694), at similar end-tidal concentration of sevoflurane (3.2 ± 0.20% in Group P and 3.1 ± 0.20% in Group R, p = 0.12). CONCLUSION Propofol (1.5 mg/kg) and rocuronium (0.6 mg/kg) produced similar intubating conditions in children induced with sevoflurane.
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Kanthabalan A, Abl-Azzeez M, Arya M, Freeman A, Punwani S, Ahmed H. Transperineal MRI-targeted Biopsy Versus Transperineal Template Prostate Mapping Biopsy in the Detection of Radio-recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2013.11.012] [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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Wallace AS, Xiang D, Hockman L, Arya M, Jeffress J, Wang Z, Dale PS. Abstract P6-06-35: Invasive lobular cancer versus mixed invasive lobular cancer with invasive ductal cancer: 20 year outcomes at one institution. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-06-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Conflicting reports exist regarding characteristics and outcomes of patients with only invasive lobular carcinoma (ILC) and mixed invasive lobular and ductal carcinoma (ILC/IDC). The purpose of this project is to report experience of 20 year cohort at one institution.
Methods: Patients diagnosed with ILC between 1990 and 2010 were divided into two groups: ILC alone and ILC/IDC. Patient demographics, history, diagnosis and treatment modalities, and outcomes were captured. Chi-square, log-rank, and Wilcoxon rank sums tests were utilized for statistical analysis. P < 0.05 was considered significant.
Results: In 189 AJCC Stage I-III patients, ILC was identified in 149 (79%) and ILC/IDC in 39 (21%). ILC stage was I, II, III in 46 (31%), 57 (41%), 32 (21%) ILC, and ILC/IDC was 17 (44%), 16 (41%), 4 (10%). Median age (range) at diagnosis was 64 (31-88) for ILC and 64 (35-84) years for ILC/IDC (p = 0.78). Median largest tumor diameter was 22 (range 1-100) in ILC, and 20 (range 2-110) mm in ILC/IDC (p = 0.97). Seventy-eight (52%) and 20 (51%) were diagnosed with ILC and ILC/IDC clinically, and 58 (39%) and 15 (38%) were diagnosed with ILC and ILC/IDC radiographically (p = 0.96). Treatment modalities were mastectomy and breast conservation therapy in 82(55%) and 67(45%) of patients with ILC, 18 (46%) and 21 (54%) of patients with ILC/IDC (p = 0.32). In 136 (91%) ILC and 33 (85%) ILC/IDC patients who had nodal evaluation/excision, 59 (43%) ILC and 12 (36%) ILC/IDC patients presented with positive nodal status. ER, PR, and HER2 status were positive in 132 (89%), 104 (70%), 7 (5%) ILC, and 29 (74%), 26 (67%), 3 (8%) ILC/IDC patients respectively (p = 0.02, p = 0.85, p = 0.17).
Median (range) follow-up for ILC was 6.1 (< 1-22.3), and 8.0 (1.72-17.7) years for ILC/IDC (p = 0.03). At the time of analysis, 43(29%) patients with ILC, and 11(28%) patients with ILC/IDC had expired (p = 0.94). Median (range) follow-up for patients who were alive at time of analysis was 6.8 (<1-20.7) years for ILC, and10.1 (2.3-17.7) years for ILC/IDC (p = 0.06). Time to first recurrence was 3.23 (0.8-17.0) years in ILC, and 5.2 (2.9-9.3) years in ILC/IDC (p = 0.20). Recurrence was identified in 33(22%) ILC: 15(46%) locoregional and18 (54%) distant disease. Similarly, recurrence was found in 7 (20%) ILC/IDC patients: 4 locoregional and 3 distant. Most locoregional recurrences, 12/15 (80%), occurred in the ipsilateral breast in ILC, and 3/4 (75%) in ILC/IDC (p = 0.82). Five years disease free survival rates were 76% ILC and 85% for ILC/IDC, and 10 years rates were 63% for ILC and 67% for ILC/IDC (p = 0.4941). Overall survival estimates at 5 years were 84% for ILC and 92% for ILC/IDC, and at 10 years were 65% for ILC and 74% for ILC/IDC (p = 0.52).
Conclusion: While basic demographics and survival patterns did not differ statistically between ILC and ILC/IDC, pure ILC histology tends to carry a higher risk of recurrence, as well as worse disease free and overall survival compared to ILC/IDC. ILC histology was more likely to be ER positive, present with advanced stage, and recur in the ipsilateral breast than the contralateral breast.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-35.
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Affiliation(s)
- AS Wallace
- University of Missouri, Columbia; Creighton University
| | - D Xiang
- University of Missouri, Columbia; Creighton University
| | - L Hockman
- University of Missouri, Columbia; Creighton University
| | - M Arya
- University of Missouri, Columbia; Creighton University
| | - J Jeffress
- University of Missouri, Columbia; Creighton University
| | - Z Wang
- University of Missouri, Columbia; Creighton University
| | - PS Dale
- University of Missouri, Columbia; Creighton University
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Kanthabalan A, Abl-Azzeez M, Arya M, Freeman A, Allen C, Kirkham A, Punwani S, Emberton M, Ahmed H. 717 Transperineal MRI-targeted biopsy versus transperineal template prostate mapping biopsy in the detection of localised radio-recurrent prostate cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)61199-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION Priapism is a urological emergency which is commonly classified into low-flow and high-flow priapism. Immediate intervention is required for low-flow cases as the development of ischaemia ultimately leads to long-term erectile dysfunction. Stuttering or recurrent priapism is less well understood. This subtype is characterised by short-lived painful erections and is commonly encountered in patients with sickle cell disease. METHODS A systematic review of the treatment options available for stuttering priapism is presented combined with our own experience in managing this condition over a period of 25 years. RESULTS Although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. CONCLUSIONS Stuttering priapism is a condition which is still not well understood and there is no standardised algorithm for the management of this condition. A multicentre randomised trial is required to evaluate the treatment options.
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Affiliation(s)
- A Muneer
- University College London Hospitals, London, UK.
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Garg R, Bhalotra A, Arya M, Bhadoria P, Manchanda G. Congenital cystic adenomatoid malformation of lung--differential diagnosis and management. Anaesth Intensive Care 2008; 36:464-5. [PMID: 18564819 DOI: pmid/18564819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
MESH Headings
- Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis
- Cystic Adenomatoid Malformation of Lung, Congenital/diagnostic imaging
- Cystic Adenomatoid Malformation of Lung, Congenital/surgery
- Diagnosis, Differential
- Hernia, Diaphragmatic/diagnosis
- Hernias, Diaphragmatic, Congenital
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Intubation, Gastrointestinal
- Laparotomy
- Lung/surgery
- Male
- Radiography
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Ahmed H, Tsiouris A, Arya M, Kaisary A, Morgan R, Young M. POS-02.87: Is the correct diagnosis being assigned to adult chromophobe renal cell carcinoma: An immunocytochemical verification? Urology 2007. [DOI: 10.1016/j.urology.2007.06.728] [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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Ahmed HU, Calleary J, Arya M, Emberton M, Illing RO, Allen C. Re: Dynamic Contrast Enhanced, Pelvic Phased Array Magnetic Resonance Imaging of Localized Prostate Cancer for Predicting Tumor Volume: Correlation With Radical Prostatectomy Findings. J Urol 2007; 177:2395; author reply 2395-6. [PMID: 17509366 DOI: 10.1016/j.juro.2007.01.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Indexed: 11/29/2022]
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Al-Singary W, Shergill IS, Allen SE, John JA, Arya M, Patel HRH. Trans-Obturator Tape for Incontinence: A 3-Year Follow-Up. Urol Int 2007; 78:198-201. [PMID: 17406126 DOI: 10.1159/000099337] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 09/26/2006] [Indexed: 11/19/2022]
Abstract
AIM To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. PATIENTS AND METHODS The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40-83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. RESULTS All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15-38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. CONCLUSIONS The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.
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Affiliation(s)
- W Al-Singary
- Urology Department, Worthing Hospital, Worthing, UK
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Ahmed HU, Arya M, Tsiouris A, Sellaturay SV, Shergill IS, Duffy PG, Mushtaq I. An update on the management of Wilms' tumour. Eur J Surg Oncol 2007; 33:824-31. [PMID: 17317082 DOI: 10.1016/j.ejso.2006.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 06/04/2006] [Accepted: 12/11/2006] [Indexed: 11/24/2022] Open
Abstract
AIMS To review the management of Wilms' tumour. METHODS A search of the literature was performed using the PubMed database (1966 to May 2006) with the search terms 'Wilms' and either 'tumour/tumor' or 'cancer' or 'carcinoma'. This was augmented by manual searches of publications. FINDINGS The success of clinical trials in Wilms' tumour patients over the past 30 years has led to an overall survival of 85% and the introduction of less aggressive chemotherapeutic regimes for patients. Large randomised controlled trials have been published on the management of Wilms' tumour by various collaborative groups, including the National Wilms' Tumour Study Group (NWTSG) in North America and the Société Internationale d'Oncologie Pédiatrique (SIOP) plus the United Kingdom Children's Cancer Study Group (UKCCSG) in Europe. CONCLUSIONS Controversy exists as to the best approach to the management of these children with regard to neoadjuvant chemotherapy. Challenges remain in the identification of histological and molecular risk factors for the stratification of treatment intensity.
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Affiliation(s)
- H U Ahmed
- Great Ormond Street Hospital for Sick Children, Great Ormond Street, London, United Kingdom
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