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Ahmed T, Rahman N, Tasfia R, Farhana J, Hasan T, Sarwar N. Effects of Non-Thermal Processing Methods on Physicochemical, Bioactive, and Microbiological Properties of Fresh Pineapple (Ananas comosus L. Merr.) Juice. JFQHC 2022. [DOI: 10.18502/jfqhc.9.3.11150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Pineapple juice processing is an art of preservation, and the processing technologies play important role in pineapple juice quality. Therefore, this study aimed to explore the potential impacts of non-thermal processing methods on the physicochemical, bioactive, and microbiological properties of fresh pineapple juice.
Methods: Extracted juices were subjected to several non-thermal processes including microwave processing, vacuum evaporation, mild pasteurization, pulsed electric field, and ultra-sonication. Physicochemical properties including Total Soluble Solids (TSS), pH, titratable acidity, and color; Total Phenolic Content (TPC); Total Anthocyanin Content (TAC); antioxidant capacity; and microbiological properties were evaluated. Data were statistically analyzed by Minitab statistical software (version: 18.1).
Results: TSS, pH, acidity (%) of processed juices ranged from 11.03-12.03, 4.07-4.27, and 0.42-0.49, respectively. In terms of color properties both ultra-sonication and microwave processing showed the highest values of L (luminosity), a* (redness), and b* (yellow). The highest TPC was reported in ultra-sonication treatment 11.996±0.002 mg Gallic Acid Equivalents (GAE)/100 ml. The TAC varied from 0.179-0.235 mg Total Anthocyanin (TA)/100 ml, where ultra-sonication and mild pasteurization treatment yielded the highest and lowest contents, respectively.
Conclusion: Perfect phenolic content, antioxidant capacity, retention of anthocyanin content, and attractive color in pineapple juices when treated with non-thermal techniques.
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Clark J, Suyanto S, Hennah L, Winter M, Joneborg U, Wallin E, Harry A, Naban N, Kaur B, Aguiar X, Tin T, Sarwar N, Gonzalez M, Seckl M. 807P Multi-centre study of escalated etoposide/cisplatin (Esc-EP) as a novel salvage regimen in advanced/refractory gestational trophoblastic neoplasia. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Choueiri T, Tomczak P, Park S, Venugopal B, Symeonides S, Hajek J, Ferguson T, Chang YH, Lee J, Haas N, Sawrycki P, Sarwar N, Gross-Goupil M, Thiery-Vuillemin A, Mahave M, Saretsky T, Zhang P, Willemann-Rogerio J, Quinn D, Powles T. 653O Pembrolizumab (pembro) vs placebo as adjuvant therapy for patients (pts) with renal cell carcinoma (RCC): Patient-reported outcomes (PRO) in KEYNOTE-564. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.049] [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: 10/20/2022] Open
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Connor M, Genie M, Gonzalez M, Hosking-Jervis F, Thippu Jayaprakash K, Sarwar N, Horan G, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Rai B, Robinson A, Beresford M, Mangar S, Falconer A, Dudderidge T, Khoo V, Winkler M, Watson V, Ahmed H. Metastatic prostate cancer patients’ Attitudes towards Treatment of the local Tumour and metastasis Evaluative Research (IP5-MATTER): A multicentre, discrete choice experiment trial-in-progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cortés-Charry R, Hennah L, Froeling FEM, Short D, Aguiar X, Tin T, Harvey R, Unsworth N, Kaur B, Savage P, Sarwar N, Seckl MJ. Increasing the human chorionic gonadotrophin cut-off to ≤1000 IU/l for starting actinomycin D in post-molar gestational trophoblastic neoplasia developing resistance to methotrexate spares more women multi-agent chemotherapy. ESMO Open 2021; 6:100110. [PMID: 33845362 PMCID: PMC8044379 DOI: 10.1016/j.esmoop.2021.100110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background A human chorionic gonadotropin (hCG) cut-off of ≤300 IU/l for starting actinomycin D (ActD) in post-molar gestational trophoblastic neoplasia (GTN) patients developing methotrexate resistance (MTX-R) reduced the number of women needing toxic multi-agent chemotherapy (etoposide, MTX and ActD alternating weekly with cyclophosphamide and vincristine; EMA/CO) without affecting survival. Here we assess whether an increased hCG cut-off of ≤1000 IU/l spares more women EMA/CO. Patients and methods All post-molar GTN patients treated with first-line methotrexate and folinic acid (MTX/FA) were identified in a national cohort between 2009 and 2016. Data collected included age, FIGO score, the hCG levels at MTX-R, and treatment outcomes. Results In total, 609 GTN patients commenced treatment with MTX/FA achieving a complete response in 57% (348/609). Resistance developed in 25.1% (153/609) at an hCG ≤ 1000 IU/l and switching to ActD achieved remission in 92.8% without any major toxicity with the remaining 7.2% remitting on EMA/CO. Comparative analysis of patients switching at an hCG <100 versus 100-300 versus 300-1000 IU/l revealed a significant fall in the cure rate with second-line ActD from 97% (93/96) to 87% (34/39) to 78% (14/18), respectively, P = 0.009. However, by increasing the hCG cut-off from ≤300 to ≤1000 IU/l, 14 patients were spared EMA/CO chemotherapy. Moreover, in the present series, all post-molar GTN remain in remission. Conclusion This study demonstrates that increasing the hCG cut-off from ≤300 to ≤1000 IU/l for choosing patients for ActD following MTX-R spares more women with GTN from the greater toxicity of EMA/CO without compromising 100% survival outcomes. An hCG cut-off of ≤1000 IU/l for ActD over EMA/CO treatment in MTX-R GTN spares women toxicity without affecting survival. On developing MTX-R, as the hCG cut-off for selecting ActD versus EMA/CO rises, the complete response rate for ActD falls. Half of FIGO-7 patients were cured on single-agent treatment (MTX/FA or sequential ActD), warranting further investigation.
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Affiliation(s)
- R Cortés-Charry
- Department of Obstetrics and Gynecology, Gestational Trophoblastic Disease Unit, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - L Hennah
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - F E M Froeling
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Short
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - X Aguiar
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - T Tin
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - R Harvey
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - N Unsworth
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - B Kaur
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - P Savage
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - N Sarwar
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M J Seckl
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
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Savage P, Winter M, Parker V, Harding V, Sita-Lumsden A, Fisher RA, Harvey R, Unsworth N, Sarwar N, Short D, Aguiar X, Tidy J, Hancock B, Coleman R, Seckl MJ. Demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma: a UK population study. BJOG 2020; 127:1102-1107. [PMID: 32146729 DOI: 10.1111/1471-0528.16202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. DESIGN A retrospective national population-based study. SETTING UK 1995-2015. POPULATION A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. METHODS Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. MAIN OUTCOMES Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. RESULTS Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. CONCLUSIONS Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. TWEETABLE ABSTRACT National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.
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Affiliation(s)
- P Savage
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - M Winter
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Parker
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Harding
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - A Sita-Lumsden
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R A Fisher
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R Harvey
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Unsworth
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Sarwar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - D Short
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - X Aguiar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - J Tidy
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Hancock
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Coleman
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Seckl
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
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Frijstein MM, Lok CAR, Trommel NE, ten Kate‐Booij MJ, Massuger LFAG, Werkhoven E, Short D, Aguiar X, Fisher RA, Kaur B, Sarwar N, Sebire NJ, Seckl MJ. Lung metastases in low‐risk gestational trophoblastic neoplasia: a retrospective cohort study. BJOG 2019; 127:389-395. [DOI: 10.1111/1471-0528.16036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- MM Frijstein
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
- Department of Obstetrics and Gynaecology Erasmus University Medical Centre Rotterdam the Netherlands
- Department of Obstetrics and Gynaecology Radboud University Medical Centre Nijmegen the Netherlands
| | - CAR Lok
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
| | - NE Trommel
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
| | - MJ ten Kate‐Booij
- Department of Obstetrics and Gynaecology Erasmus University Medical Centre Rotterdam the Netherlands
| | - LFAG Massuger
- Department of Obstetrics and Gynaecology Radboud University Medical Centre Nijmegen the Netherlands
| | - E Werkhoven
- Department of Biometrics Netherlands Cancer Institute – Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - D Short
- Department of Medical Oncology Charing Cross Hospital London UK
| | - X Aguiar
- Department of Medical Oncology Charing Cross Hospital London UK
| | - RA Fisher
- Department of Medical Oncology Charing Cross Hospital London UK
| | - B Kaur
- Department of Medical Oncology Charing Cross Hospital London UK
| | - N Sarwar
- Department of Medical Oncology Charing Cross Hospital London UK
| | - NJ Sebire
- Department of Medical Oncology Charing Cross Hospital London UK
| | - MJ Seckl
- Department of Medical Oncology Charing Cross Hospital London UK
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Frijstein MM, Lok CAR, Short D, Singh K, Fisher RA, Hancock BW, Tidy JA, Sarwar N, Kanfer E, Winter MC, Savage PM, Seckl MJ. The results of treatment with high-dose chemotherapy and peripheral blood stem cell support for gestational trophoblastic neoplasia. Eur J Cancer 2019; 109:162-171. [PMID: 30731277 DOI: 10.1016/j.ejca.2018.12.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 08/27/2018] [Revised: 12/13/2018] [Accepted: 12/23/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the effect of high-dose chemotherapy (HDC) with peripheral blood stem cell support (PBSCS) on survival of patients with gestational trophoblastic neoplasia (GTN) with either refractory choriocarcinomas or a poor-prognosis placental site/epithelioid trophoblastic tumours (PSTT/ETTs). METHODS Databases of two referral centres for gestational trophoblastic disease were searched, and 32 patients treated with HDC between 1994 and 2015 were identified. Tissue samples were retrieved for genetic evaluation. Cox regression analyses were performed to identify possible predictors of overall survival (OS). RESULTS HDC induced a sustained complete response in 7 patients. Overall, 41% (13/32) of the patients remained disease free after HDC with or without additional treatment. Patients who survived had much lower human chorionic gonadotropin (hCG) values (all ≤12 IU/L) before and after HDC than those who died of disease. Univariable Cox regression analysis demonstrated that hCG >12 IU/L before or after HDC, International Federation of Gynaecology and Obstetrics (FIGO) stage II-IV and presence of metastases at the time of diagnosis were significantly associated with adverse OS. However, only hCG values before HDC remained significant in a multivariable model (p < 0.001). Five of 11 (45%) patients with PSTT/ETT presenting ≥48 months after antecedent pregnancy and 6 of 14 (43%) patients with refractory choriocarcinoma were in remission. Three treatment-related deaths occurred. CONCLUSIONS Despite 3 treatment-induced deaths, HDC with PBSCS appears to be active in salvaging selected patients with poor-prognosis PSTT/ETTs and refractory choriocarcinomas. Low hCG values before HDC seems a beneficial predictor of OS and may suggest that HDC acts more like a consolidation therapy.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecology, Center of Gynaecologic Oncology Amsterdam, the Netherlands
| | - C A R Lok
- Department of Gynaecology, Center of Gynaecologic Oncology Amsterdam, the Netherlands
| | - D Short
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - K Singh
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - R A Fisher
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - B W Hancock
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - J A Tidy
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - N Sarwar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - E Kanfer
- Dept of Haematology, Hammersmith Hospital Campus of Imperial College, London, UK
| | - M C Winter
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - P M Savage
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - M J Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK.
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Frijstein MM, Lok CAR, van Trommel NE, Ten Kate-Booij MJ, Massuger LFAG, van Werkhoven E, Kaur B, Tidy JA, Sarwar N, Golfier F, Winter MC, Hancock BW, Seckl MJ. Management and prognostic factors of epithelioid trophoblastic tumors: Results from the International Society for the Study of Trophoblastic Diseases database. Gynecol Oncol 2018; 152:361-367. [PMID: 30473257 DOI: 10.1016/j.ygyno.2018.11.015] [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] [Received: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Epithelioid Trophoblastic Tumor (ETT) is an extremely rare form of Gestational Trophoblastic Neoplasia (GTN). Knowledge on prognostic factors and optimal management is limited. We identified prognostic factors, optimal treatment, and outcome from the world's largest case series of patients with ETT. METHODS Patients were selected from the international Placental Site Trophoblastic Tumor (PSTT) and ETT database. Fifty-four patients diagnosed with ETT or mixed PSTT/ETT between 2001 and 2016 were included. Cox regression analysis was used to identify prognostic factors for overall survival (OS). RESULTS Forty-five patients with ETT and 9 patients with PSTT/ETT were included. Thirty-six patients had FIGO stage I and 18 had stages II-IV disease. Patients were treated with surgery (n = 23), chemotherapy (n = 6), or a combination of surgery and chemotherapy (n = 25). In total, 39 patients survived, including 22 patients with complete sustained hCG remission for at least 1 year. Patients treated with surgery as first line treatment had early-stage disease and all survived. Most patients treated with chemotherapy with or without surgery had FIGO stages II-IV disease (55%). They underwent multiple lines of chemotherapy. Eleven of them did not survive. Interval since antecedent pregnancy and FIGO stage were prognostic factors of OS (p = 0.012; p = 0.023 respectively). CONCLUSIONS Advanced-stage disease and an interval of ≥48 months since the antecedent pregnancy are poor prognostic factors of ETT. Surgery seems adequate for early-stage disease with a shorter interval. Advanced-stage disease requires a combination of treatment modalities. Because of its rarity, ETT should be treated in a centre with experience in GTN.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands.
| | - C A R Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - N E van Trommel
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - M J Ten Kate-Booij
- Department of Gynaecologic Oncology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L F A G Massuger
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - E van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - B Kaur
- Department of Histopathology, Charing Cross Hospital, London, United Kingdom
| | - J A Tidy
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - N Sarwar
- Department of Medical Oncology, Charing Cross Hospital, London, United Kingdom
| | - F Golfier
- Department of Gynaecological Surgery and Oncology, University Hospital Lyon Sud, France
| | - M C Winter
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - B W Hancock
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - M J Seckl
- Department of Medical Oncology, Charing Cross Hospital, London, United Kingdom
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Eysbouts YK, Ottevanger PB, Massuger LFAG, IntHout J, Short D, Harvey R, Kaur B, Sebire NJ, Sarwar N, Sweep FCGJ, Seckl MJ. Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset. Ann Oncol 2018; 28:1856-1861. [PMID: 28459944 DOI: 10.1093/annonc/mdx211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Worldwide introduction of the International Fedaration of Gynaecology and Obstetrics (FIGO) 2000 scoring system has provided an effective means to stratify patients with gestational trophoblastic neoplasia to single- or multi-agent chemotherapy. However, the system is quite elaborate with an extensive set of risk factors. In this study, we re-evaluate all prognostic risk factors involved in the FIGO 2000 scoring system and examine if simplification is feasible. Patients and methods Between January 2003 and December 2012, 813 patients diagnosed with gestational trophoblastic neoplasia were identified at the Trophoblastic Disease Centre in London and scored using the FIGO 2000. Multivariable analysis and stepwise logistic regression were carried out to evaluate whether the FIGO 2000 scoring system could be simplified. Results Of the eight FIGO risk factors only pre-treatment serum human chorionic gonadotropin (hCG) levels exceeding 10 000 IU/l (OR = 5.0; 95% CI 2.5-10.4) and 100 000 IU/l (OR = 14.3; 95% CI 4.7-44.1), interval exceeding 7 months since antecedent pregnancy (OR = 4.1; 95% CI 1.0-16.2), and tumor size of over 5 cm (OR = 2.2; 95% CI 1.3-3.6) were identified as independently predictive for single-agent resistance. In addition, increased risk was apparent for antecedent term pregnancy (OR = 3.4; 95% CI 0.9-12.7) and the presence of five or more metastases (OR = 3.5; 95% CI 0.4-30.4), but patient numbers in these categories were relatively small. Stepwise logistic regression identified a simplified risk scoring model comprising age, pretreatment serum hCG, number of metastases, antecedent pregnancy, and interval but omitting tumor size, previous failed chemotherapy, and site of metastases. With this model only 1 out 725 patients was classified different from the FIGO 2000 system. Conclusion Our simplified alternative using only five of the FIGO prognostic factors appears to be an accurate system for discriminating patients requiring single as opposed to multi-agent chemotherapy. Further work is urgently needed to validate these findings.
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Affiliation(s)
| | | | | | - J IntHout
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D Short
- Department of Medical Oncology
| | | | - B Kaur
- Department of Pathology, Charing Cross and Hammersmith Campuses, Imperial College London, London, UK
| | - N J Sebire
- Department of Pathology, Charing Cross and Hammersmith Campuses, Imperial College London, London, UK
| | | | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Meyer T, Qian W, Valle J, Talbot D, Cunningham D, Reed N, Wall L, Waters J, Ross P, Anthoney A, Sumpter K, Sarwar N, Crosby T, Begum N, Young G, Hardy R, Corrie P. Capecitabine and streptozocin ± cisplatin for gastroenteropancreatic neuroendocrine tumours: predictors of long-term survival in the NET01 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.31] [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: 11/13/2022] Open
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Taylor F, Short D, Harvey R, Winter MC, Tidy J, Hancock BW, Savage PM, Sarwar N, Seckl MJ, Coleman RE. Late spontaneous resolution of persistent molar pregnancy. BJOG 2016; 123:1175-81. [DOI: 10.1111/1471-0528.13867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- F Taylor
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - D Short
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - R Harvey
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - MC Winter
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - J Tidy
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - BW Hancock
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - PM Savage
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - N Sarwar
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - MJ Seckl
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - RE Coleman
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
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Manzoor SA, Mirza SN, Zubair M, Nouman W, Hussain SB, Mehmood S, Irshad A, Sarwar N, Ammar A, Iqbal MF, Asim A, Chattha MU, Chattha MB, Zafar A, Abid R. Estimating genetic potential of biofuel forest hardwoods to withstand metal toxicity in industrial effluent under dry tropical conditions. Genet Mol Res 2015; 14:9543-54. [PMID: 26345887 DOI: 10.4238/2015.august.14.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Biofuel tree species are recognized as a promising alternative source of fuel to conventional forms. Additionally, these tree species are also effective in accumulating toxic heavy metals present in some industrial effluents. In developing countries such as Pakistan, the use of biofuel tree species is gaining popularity not only for harvesting economical and environmentally friendly biofuel, but also to sequester poisonous heavy metals from industrial wastewater. This study was aimed at evaluating the genetic potential of two biofuel species, namely, Jatropha curcas and Pongamia pinnata, to grow when irrigated with industrial effluent from the Pak-Arab Fertilizer Factory Multan, Southern Punjab, Pakistan. The growth performances of one-year-old seedlings of both species were compared in soil with adverse physiochemical properties. It was found that J. curcas was better able to withstand the toxicity of the heavy metals present in the fertilizer factory effluent. J. curcas showed maximum gain in height, diameter, and biomass production in soil irrigated with 75% concentrated industrial effluent. In contrast, P. pinnata showed a significant reduction in growth in soil irrigated with more than 50% concentrated industrial effluent, indicating that this species is less tolerant to higher toxicity levels of industrial effluent. This study identifies J. curcas as a promising biofuel tree species that can be grown using industrial wastewater.
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Affiliation(s)
- S A Manzoor
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S N Mirza
- Department of Forestry & Range Management, Pir Mehar Ali Shah-Arid Agriculture University, Rawalpindi, Punjab, Pakistan
| | - M Zubair
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - W Nouman
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S B Hussain
- Department of Plant Breeding & Genetics, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S Mehmood
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Irshad
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - N Sarwar
- Department of Agronomy, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Ammar
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - M F Iqbal
- Department of Soil Science, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Asim
- Department of Horticulture, Bahauddin Zakariya Univeristy, Multan, Punjab, Pakistan
| | - M U Chattha
- Department of Agronomy, University of Agriculture Faisalabad, Punjab, Pakistan
| | - M B Chattha
- Institute of Agricultural Sciences, Punjab University, Lahore, Pakistan
| | - A Zafar
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - R Abid
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
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McCarthy FM, Tookman L, Phillips M, Wilson P, Propper D, Steele JPC, Sarwar N, Hagemann T, Slater S. A retrospective single-study analysis of survival outcomes in metastatic colorectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14137] [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: 11/20/2022] Open
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16
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Powles T, Chowdhury S, Avril N, Bomanji J, Shamash J, Sarwar N, Rockall A, Sahdev A, Nathan PD, Kayani I. Sequential FDG-PET/CT as a surrogate marker of response to sunitinib in metastatic clear cell renal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
301 Background: The purpose of this study was to investigate sequential FDG PET-CT as a correlative marker in metastatic clear cell renal cancer (mRCC) patients treated with first line sunitinib. Three sequential scans were performed to determine the importance of the timing of scans. Methods: Forty-four untreated mRCC patients with MSKCC intermediate risk and poor risk disease were enrolled into a prospective study. FDG PET-CT scans were performed before (n=44), after 4 weeks (n=43) and 16 weeks (n=40) of sunitinib given at standard doses as the translational aspect of this trial ( NCT01024205 ). The primary endpoint was to determine whether 18F-FDG PET-CT response (defined as a 20% reduction in SUVmax) correlated with survival. Results: Forty-three (98%) patients had FDG PET-CT avid lesions at diagnosis (median SUVmax 6.8 range: <2.5–18.4). In multivariate analysis a high SUVmax and increased number of PET positive lesions correlated with worse overall survival (OS) (HR: 3.30 (95%CI: 1.36–8.45) and 3.67 (95%CI: 1.43–9.39) respectively[p<0.05]). After 4 weeks of sunitinib, metabolic responses occurred in 24 (57%) patients at 4 weeks, but this did not correlate with progression-free survival [PFS] (HR for responders= 0.87 [95%CI: 0.40–1.99]) or OS (HR for responders= 0.80 [95%CI: 0.34–1.85]) (p>0.05 for both). After 16 weeks of treatment, FDG PET-CT demonstrated disease progression in 28% (n=12) patients. At this time point, the FDG PET-CT correlated with both OS and PFS (HR 5.96 [95%CI: 2.43–19.02] and HR 12.13 [95%CI: 3.72–46.45] respectively). Conclusions: Baseline FDG PET prior to sunitinib yields prognostically significant data. FDG PET response at 16 weeks predicts outcome, which is not the case at 4 weeks. This subsets of patients with a poor prognosis at 16 weeks could be investigated within the context of a randomized clinical trial. [Table: see text]
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Affiliation(s)
- T. Powles
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - S. Chowdhury
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - N. Avril
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - J. Bomanji
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - J. Shamash
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - N. Sarwar
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - A. Rockall
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - A. Sahdev
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P. D. Nathan
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - I. Kayani
- St. Bartholomew's Hospital, London, United Kingdom; Guy's and St. Thomas' Hospital, London, United Kingdom; University College Hospital, London, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
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Powles T, Kayani I, Blank C, Chowdhury S, Horenblas S, Peters J, Shamash J, Sarwar N, Boletti K, Sadev A, O'Brien T, Berney D, Beltran L, Haanen J, Bex A. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol 2011; 22:1041-1047. [PMID: 21242586 PMCID: PMC3082157 DOI: 10.1093/annonc/mdq564] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [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: 12/21/2022] Open
Abstract
Background: The safety and efficacy of upfront sunitinib, before nephrectomy in metastatic clear cell renal cancer (mCRC), has not been prospectively evaluated. Methods: Two prospective single-arm phase II studies investigated either two cycles (study A: n = 19) or three cycles (study B: n = 33) of sunitinib before nephrectomy in mCRC. Results: Overall, 38 of 52 (73%) of patients obtained clinical benefit (by RECIST) before surgery. The partial response rate of the primary tumour was 6% [median reduction in longest diameter of 12% (range 8%−35%)]. No patients became ineligible due to local progression of disease. A nephrectomy was carried out in 37 (71%) of patients. Necrosis (>50%) was a prominent feature at nephrectomy in 49%. Surgical complications (Clavien–Dindo classification) occurred in 10 (27%) patients, including one death (3%). The median blood loss and surgical time were 725 (90–4200) ml and 189 (70–420) min, respectively. The median progression-free survival was 8 months (95% confidence interval 6–15 months). A comparison of two versus three pre-surgery cycles showed no significant difference in terms of surgical complications or efficacy. Conclusions: Nephrectomy after upfront sunitinib can be carried out safely. It obtains control of disease. Randomised studies are required to address if this approach is beneficial.
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Affiliation(s)
- T Powles
- Department of Medical Oncology, St Bartholomew's Hospital
| | - I Kayani
- Department of Experimental Cancer Medicine, University College Hospital London, London, UK
| | - C Blank
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Chowdhury
- Department of Surgery and Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Horenblas
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Peters
- Department of Surgery, Whipps Cross Hospital
| | - J Shamash
- Department of Medical Oncology, St Bartholomew's Hospital
| | - N Sarwar
- Department of Medical Oncology, St Bartholomew's Hospital
| | - K Boletti
- Department of Medical Oncology, The Royal Free Hospital, London, UK
| | - A Sadev
- Department of Medical Oncology, St Bartholomew's Hospital
| | - T O'Brien
- Department of Surgery and Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Berney
- Department of Medical Oncology, St Bartholomew's Hospital
| | - L Beltran
- Department of Surgery, Whipps Cross Hospital
| | - J Haanen
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Bex
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Powles T, Chowdhury S, Shamash J, Bazeos A, Gillessen S, Saunders N, Lim L, Sarwar N, Sadev A, Wilson P, Nathan P, Boleti K, Peters J, Agrawal S. Increased haematopoietic progenitor cells are associated with poor outcome in patients with metastatic renal cancer treated with sunitinib. Ann Oncol 2010; 22:815-820. [PMID: 20943595 DOI: 10.1093/annonc/mdq469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Haematopoietic progenitor cells (HPCs) are present in blood in metastatic renal cell cancer (mRCC). We investigate their expression in mRCC patients treated with sunitinib and correlate their expression with plasma growth factor levels [insulin-like growth factor (IGF)-1]. METHODS Circulating HPCs (CD34(+)/CD45(+)) and plasma IGF-1 levels were measured at specific sequential time points (0, 6, 18 and 28 weeks) in 43 untreated mRCC patients receiving sunitinib (50 mg for 28 days followed by 14-day off treatment). Univariate and multivariate analysis assessed the prognostic significance of HPCs and IGF-1. RESULTS HPCs levels were raised in 40 of 43 (93%) of patients. IGF-1 levels were raised in 9 of 43 patients (21%). Univariate and multivariate analysis revealed that high HPCs before treatment were associated with a significantly shorter overall survival (hazard ratio 3.3, 95% confidence interval 1.23-8.8, P=0.01), which was not the case for IGF-1 levels. Both HPC and IGF-1 levels fell with sunitinib (61% and 14% fall, respectively, P <0.05 for both). A positive correlation between the falls in HPC and IGF-1 occurred (P<0.001). CONCLUSIONS HPCs are over expressed in the peripheral blood in the majority of patients with mRCC. Higher levels are associated with poor prognosis. A concurrent fall in HPCs and growth factor expression (IGF-1) with sunitinib occurs.
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Affiliation(s)
- T Powles
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital.
| | - S Chowdhury
- Department of Medical Oncology, Guys' and St Thomas Hospital
| | - J Shamash
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - A Bazeos
- Department of Medical Oncology, Chelsea and Westminster Hospital
| | - S Gillessen
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - N Saunders
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - L Lim
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - N Sarwar
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - A Sadev
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - P Wilson
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
| | - P Nathan
- Department of Medical Oncology, Mount Vernon Hospital
| | - K Boleti
- Department of Medical Oncology, Royal Free Hospital
| | - J Peters
- Department of Urology, Whipps Cross University Hospital, London, UK
| | - S Agrawal
- Centre for Experimental Cancer Medicine, St Bartholomew's Hospital
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Sarwar N, Gao P, Seshasai SRK, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CDA, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010. [PMID: 20609967 DOI: 10.1016/s0140-6736(10)] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. METHODS We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease. FINDINGS Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. INTERPRETATION Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and non-linearly associated with risk of vascular disease. FUNDING British Heart Foundation, UK Medical Research Council, and Pfizer.
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Affiliation(s)
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- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
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Sarwar N, Gao P, Seshasai SRK, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CDA, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375:2215-22. [PMID: 20609967 PMCID: PMC2904878 DOI: 10.1016/s0140-6736(10)60484-9] [Citation(s) in RCA: 3107] [Impact Index Per Article: 221.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. METHODS We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease. FINDINGS Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. INTERPRETATION Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and non-linearly associated with risk of vascular disease. FUNDING British Heart Foundation, UK Medical Research Council, and Pfizer.
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Powles T, Kayani I, Blank CU, Chowdhury S, Horenblas S, Sarwar N, Nathan PD, Boleti E, Haanen JB, Bex A. The safety and efficacy of sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Chowdhury S, O’Brien TS, Sarwar N, Shamash J, McGrath S, Agrawal S, Lim L, Rudman SM, Harper PG, Powles T. The effect of sunitinib on immune parameters and haemopoetic stem cell markers in patients with untreated clear cell renal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4620] [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: 11/20/2022] Open
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23
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Jackson D, White I, Kostis JB, Wilson AC, Folsom AR, Wu K, Chambless L, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell JWG, Sweetnam PM, Elwood PC, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Haverkate F, de Maat MPM, Thompson SG, Fowkes FGR, Lee AJ, Smith FB, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, D'Agostino R, Kannel WB, Wilson PWF, Tofler G, Levy D, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb JD, Rodriguez B, Yano K, Salonen JT, Nyyssönen K, Tuomainen TP, Hedblad B, Engström G, Berglund G, Loewel H, Koenig W, Hense HW, Meade TW, Cooper JA, De Stavola B, Knottenbelt C, Miller GJ, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Kitamura A, Naito Y, Iso H, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans AE, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Despres JP, Dagenais GR, Tunstall-Pedoe H, Lowe GDO, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh JL, Meade TW, Rudnicka A, Brennan P, Knottenbelt C, Cooper JA, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Lowe GDO, Ford I, Robertson M, Brunner E, Shipley M, Feskens EJM, Di Angelantonio E, Kaptoge S, Lewington S, Lowe GDO, Sarwar N, Thompson SG, Walker M, Watson S, White IR, Wood AM, Danesh J. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies. Stat Med 2009; 28:1218-37. [PMID: 19222087 PMCID: PMC2922684 DOI: 10.1002/sim.3540] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154 012 participants in 31 cohorts.† Copyright © 2009 John Wiley & Sons, Ltd.
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Sarwar N, Carby A, Coombes CR, Lavery S, Trew G, Palmieri C. Referrals and outcomes for fertility preservation in a cohort of breast cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20695] [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: 11/20/2022] Open
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Naresh KN, Francis N, Sarwar N, Bower M. Expression of human herpesvirus 8 (HHV-8), latent nuclear antigen 1 (LANA1) in angiosarcoma in acquired immunodeficiency syndrome (AIDS) - a report of two cases. Histopathology 2008; 51:861-4. [PMID: 18042074 DOI: 10.1111/j.1365-2559.2007.02877.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Danesh J, Erqou S, Walker M, Thompson SG, Tipping R, Ford C, Pressel S, Walldius G, Jungner I, Folsom AR, Chambless LE, Knuiman M, Whincup PH, Wannamethee SG, Morris RW, Willeit J, Kiechl S, Santer P, Mayr A, Wald N, Ebrahim S, Lawlor DA, Yarnell JWG, Gallacher J, Casiglia E, Tikhonoff V, Nietert PJ, Sutherland SE, Bachman DL, Keil JE, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Nordestgaard BG, Frikke-Schmidt R, Giampaoli S, Palmieri L, Panico S, Vanuzzo D, Pilotto L, Simons L, McCallum J, Friedlander Y, Fowkes FGR, Lee AJ, Smith FB, Taylor J, Guralnik J, Phillips C, Wallace R, Blazer D, Khaw KT, Jansson JH, Donfrancesco C, Salomaa V, Harald K, Jousilahti P, Vartiainen E, Woodward M, D'Agostino RB, Wolf PA, Vasan RS, Pencina MJ, Bladbjerg EM, Jorgensen T, Moller L, Jespersen J, Dankner R, Chetrit A, Lubin F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Bjorkelund C, Cremer P, Nagel D, Tilvis R, Strandberg T, Rodriguez B, Bouter LM, Heine RJ, Dekker JM, Nijpels G, Stehouwer CDA, Rimm E, Pai J, Sato S, Iso H, Kitamura A, Noda H, Goldbourt U, Salomaa V, Salonen JT, Nyyssönen K, Tuomainen TP, Deeg D, Poppelaars JL, Meade T, Cooper J, Hedblad B, Berglund G, Engstrom G, Döring A, Koenig W, Meisinger C, Mraz W, Kuller L, Selmer R, Tverdal A, Nystad W, Gillum R, Mussolino M, Hankinson S, Manson J, De Stavola B, Knottenbelt C, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Naito Y, Holme I, Nakagawa H, Miura H, Ducimetiere P, Jouven X, Crespo C, Garcia-Palmieri M, Amouyel P, Arveiler D, Evans A, Ferrieres J, Schulte H, Assmann G, Shepherd J, Packard C, Sattar N, Cantin B, Lamarche B, Després JP, Dagenais GR, Barrett-Connor E, Wingard D, Bettencourt R, Gudnason V, Aspelund T, Sigurdsson G, Thorsson B, Trevisan M, Witteman J, Kardys I, Breteler M, Hofman A, Tunstall-Pedoe H, Tavendale R, Lowe GDO, Ben-Shlomo Y, Howard BV, Zhang Y, Best L, Umans J, Onat A, Meade TW, Njolstad I, Mathiesen E, Lochen ML, Wilsgaard T, Gaziano JM, Stampfer M, Ridker P, Ulmer H, Diem G, Concin H, Rodeghiero F, Tosetto A, Brunner E, Shipley M, Buring J, Cobbe SM, Ford I, Robertson M, He Y, Ibanez AM, Feskens EJM, Kromhout D, Collins R, Di Angelantonio E, Kaptoge S, Lewington S, Orfei L, Pennells L, Perry P, Ray K, Sarwar N, Scherman M, Thompson A, Watson S, Wensley F, White IR, Wood AM. The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases. Eur J Epidemiol 2007; 22:839-69. [PMID: 17876711 DOI: 10.1007/s10654-007-9165-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 07/02/2007] [Indexed: 01/22/2023]
Abstract
Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
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Webster RM, Sarwar N, Price H, Bunker CB, Brock CS. A case series of HIV-positive patients with malignant melanoma. J HIV Ther 2007; 12:75-78. [PMID: 17962799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- R M Webster
- Dept. of Oncology, Charing Cross Hospital, London, UK
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Sarwar N, Kim JS, Jiang J, Peston D, Sinnett HD, Madden P, Gee JM, Nicholson RI, Lykkesfeldt AE, Shousha S, Coombes RC, Ali S. Phosphorylation of ERalpha at serine 118 in primary breast cancer and in tamoxifen-resistant tumours is indicative of a complex role for ERalpha phosphorylation in breast cancer progression. Endocr Relat Cancer 2006; 13:851-61. [PMID: 16954434 DOI: 10.1677/erc.1.01123] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oestrogen receptor-alpha (ERalpha) is an important prognostic marker in breast cancer and endocrine therapies are designed to inhibit or prevent ERalpha activity. In vitro studies have indicated that phosphorylation of ERalpha, in particular on serine 118 (S118), can result in activation in a ligand-independent manner, thereby potentially contributing to resistance to endocrine agents, such as tamoxifen and aromatase inhibitors. Here we report the immunohistochemistry (IHC) of S118 phosphorylation in 301 primary breast tumour biopsies. Surprisingly, this analysis shows that S118 phosphorylation is higher in more differentiated tumours, suggesting that phosphorylation at this site is associated with a good prognosis in patients not previously treated with endocrine agents. However, we also report that S118 phosphorylation was elevated in tumour biopsies taken from patients who had relapsed following tamoxifen treatment, when compared to pre-treatment biopsies. Taken together, these data are consistent with the view that S118 phosphorylation is a feature of normal ERalpha function and that increases in levels of phosphorylation at this site may play a key role in the emergence of endocrine resistance in breast cancer.
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Affiliation(s)
- N Sarwar
- Department of Oncology, Imperial College London, Hammersmith Hospital Campus, UK
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Abstract
20046 Background: Estrogen receptor α (ERα) is an important predictive marker for response to endocrine therapy in breast cancer. Phosphorylation of ERα, in particular on serine 118 (S118), can result in ligand independent activation, thereby possibly contributing to resistance to endocrine therapies. The clinical significance of ERα phosphorylated at serine 118 (P-S118) in breast cancer was examined. Methods: Immunohistochemistry was performed on 301 primary breast tumor biopsies and on a small subset that had become resistant to endocrine therapy. P-S118 levels were scored using the modified McCarty’s H scoring system. Results: 282 (94%) of the 301 tumors were ERα positive. Of the 282 ERα positive patients, 282 (83%) had detectable nuclear staining for P-S118. There was no association between P-S118 staining and tumor size, nodal status, progesterone receptor and c-erbB2 status. There was however a positive correlation of P-S118 with ERα expression, (p < 0.001) and activated (phosphorylated) mitogen-activated protein kinase (MAPK) expression (p < 0.001). There was a clear inverse relationship with tumor grade and P-S118 staining (p < 0.001). Lower grade tumors being associated with higher H-scores for P-S118 staining. There was also some evidence of an association between P-S118 and age (P = 0.08). No association was found between P-S118 expression and survival. There was however a statistically significant difference in the distribution of P-S118 expression before and after becoming resistant to hormonal therapies (z = −2.357 p-value = 0.02). Comparison of H-scores showed that P-S118 levels were elevated following tumor regrowth. Conclusion: This analysis shows that S118 phosphorylation is higher in more differentiated tumors, suggesting that phosphorylation at this site is associated with a better prognosis. However, S118 phosphorylation is elevated in biopsies taken from patients who had relapsed on tamoxifen, compared to pre-treatment biopsies. Collectively these data indicate a complex role for ERα phosphorylation at least at S118, in breast cancer progression. No significant financial relationships to disclose.
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Affiliation(s)
- N. Sarwar
- Imperial College, London, United Kingdom
| | - J. Jiang
- Imperial College, London, United Kingdom
| | - S. Shousha
- Imperial College, London, United Kingdom
| | | | - S. Ali
- Imperial College, London, United Kingdom
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Danesh J, Lewington S, Thompson SG, Lowe GDO, Collins R, Kostis JB, Wilson AC, Folsom AR, Wu K, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell JWG, Sweetnam PM, Elwood PC, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Haverkate F, de Maat MPM, Fowkes FGR, Lee AJ, Smith FB, Salomaa V, Harald K, Rasi R, Vahtera E, Jousilahti P, Pekkanen J, D'Agostino R, Kannel WB, Wilson PWF, Tofler G, Arocha-Piñango CL, Rodriguez-Larralde A, Nagy E, Mijares M, Espinosa R, Rodriquez-Roa E, Ryder E, Diez-Ewald MP, Campos G, Fernandez V, Torres E, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb JD, Rodriguez B, Yano K, Salonen JT, Nyyssönen K, Tuomainen TP, Hedblad B, Lind P, Loewel H, Koenig W, Meade TW, Cooper JA, De Stavola B, Knottenbelt C, Miller GJ, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Kitamura A, Naito Y, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans AE, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Després JP, Dagenais GR, Tunstall-Pedoe H, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh JL, Rudnicka A, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Ford I, Robertson M, Brunner E, Shipley M, Feskens EJM, Kromhout D, Dickinson A, Ireland B, Juzwishin K, Kaptoge S, Lewington S, Memon A, Sarwar N, Walker M, Wheeler J, White I, Wood A. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA 2005; 294:1799-809. [PMID: 16219884 DOI: 10.1001/jama.294.14.1799] [Citation(s) in RCA: 460] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Plasma fibrinogen levels may be associated with the risk of coronary heart disease (CHD) and stroke. OBJECTIVE To assess the relationships of fibrinogen levels with risk of major vascular and with risk of nonvascular outcomes based on individual participant data. DATA SOURCES Relevant studies were identified by computer-assisted searches, hand searches of reference lists, and personal communication with relevant investigators. STUDY SELECTION All identified prospective studies were included with information available on baseline fibrinogen levels and details of subsequent major vascular morbidity and/or cause-specific mortality during at least 1 year of follow-up. Studies were excluded if they recruited participants on the basis of having had a previous history of cardiovascular disease; participants with known preexisting CHD or stroke were excluded. DATA EXTRACTION Individual records were provided on each of 154,211 participants in 31 prospective studies. During 1.38 million person-years of follow-up, there were 6944 first nonfatal myocardial infarctions or stroke events and 13,210 deaths. Cause-specific mortality was generally available. Analyses involved proportional hazards modeling with adjustment for confounding by known cardiovascular risk factors and for regression dilution bias. DATA SYNTHESIS Within each age group considered (40-59, 60-69, and > or =70 years), there was an approximately log-linear association with usual fibrinogen level for the risk of any CHD, any stroke, other vascular (eg, non-CHD, nonstroke) mortality, and nonvascular mortality. There was no evidence of a threshold within the range of usual fibrinogen level studied at any age. The age- and sex- adjusted hazard ratio per 1-g/L increase in usual fibrinogen level for CHD was 2.42 (95% confidence interval [CI], 2.24-2.60); stroke, 2.06 (95% CI, 1.83-2.33); other vascular mortality, 2.76 (95% CI, 2.28-3.35); and nonvascular mortality, 2.03 (95% CI, 1.90-2.18). The hazard ratios for CHD and stroke were reduced to about 1.8 after further adjustment for measured values of several established vascular risk factors. In a subset of 7011 participants with available C-reactive protein values, the findings for CHD were essentially unchanged following additional adjustment for C-reactive protein. The associations of fibrinogen level with CHD or stroke did not differ substantially according to sex, smoking, blood pressure, blood lipid levels, or several features of study design. CONCLUSIONS In this large individual participant meta-analysis, moderately strong associations were found between usual plasma fibrinogen level and the risks of CHD, stroke, other vascular mortality, and nonvascular mortality in a wide range of circumstances in healthy middle-aged adults. Assessment of any causal relevance of elevated fibrinogen levels to disease requires additional research.
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Affiliation(s)
- N. Sarwar
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - J.-S. Kim
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - J. Jiang
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - D. Peston
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - S. Shousha
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - R. C. Coombes
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
| | - S. Ali
- Imperial Coll, London, United Kingdom; Charing Cross Hosp, London, United Kingdom
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Buluwela L, Pike J, Mazhar D, Kamalati T, Hart SM, Al-Jehani R, Yahaya H, Patel N, Sarwar N, Sarwarl N, Heathcote DA, Schwickerath O, Phoenix F, Hill R, Aboagye E, Shousha S, Waxman J, Lemoine NR, Zelent A, Coombes RC, Ali S. Inhibiting estrogen responses in breast cancer cells using a fusion protein encoding estrogen receptor-alpha and the transcriptional repressor PLZF. Gene Ther 2005; 12:452-60. [PMID: 15647773 DOI: 10.1038/sj.gt.3302421] [Citation(s) in RCA: 12] [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] [Indexed: 11/09/2022]
Abstract
Estrogen receptor alpha (ERalpha) is a ligand-inducible transcription factor that acts to regulate gene expression by binding to palindromic DNA sequence, known as the estrogen response element, in promoters of estrogen-regulated genes. In breast cancer ERalpha plays a central role, where estrogen-regulated gene expression leads to tumor initiation, growth and survival. As an approach to silencing estrogen-regulated genes, we have studied the activities of a fusion protein between ERalpha and the promyelocytic leukemia zinc-finger (PLZF) protein, a transcriptional repressor that acts through chromatin remodeling. To do this, we have developed lines from the estrogen-responsive MCF-7 breast cancer cell line in which the expression of the fusion protein PLZF-ERalpha is conditionally regulated by tetracycline and shows that these feature long-term silencing of the expression of several well-characterized estrogen-regulated genes, namely pS2, cathepsin-D and the progesterone receptor. However, the estrogen-regulated growth of these cells is not inhibited unless PLZF-ERalpha expression is induced, an observation that we have confirmed both in vitro and in vivo. Taken together, these results show that PLZF-ERalpha is a potent repressor of estrogen-regulated gene expression and could be useful in distinguishing estrogen-regulated genes required for the growth of breast cancer cells.
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Affiliation(s)
- L Buluwela
- Department of Cancer Medicine, Imperial College London, London, UK
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Sarwar N, Said M, Jafarey SN. Single dose therapy of trichomoniasis with tinidazole. J PAK MED ASSOC 1976; 26:26-8. [PMID: 817044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tinidazole was used in a single dose of 2.1G for 52 patients found to have Trichomonas Vaginalis infection. Husbands of 28 patients were also treated. The cure rate in 35 cases followed for 4 weeks or more was 100%. The drug was well tolerated.
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