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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Author Correction: Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:19969. [PMID: 37968383 PMCID: PMC10651834 DOI: 10.1038/s41598-023-47362-8] [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: 11/17/2023] Open
Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:16087. [PMID: 37752170 PMCID: PMC10522584 DOI: 10.1038/s41598-023-42746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Ramaiya N, Manchanda R, Chowdhuri MB, Yadava N, Dey R, Kumar A, Shah K, Patel S, Jadeja KA, Patel KM, Kumar R, Aich S, Pathak SK, Tanna RL, Ghosh J. Initial results from near-infrared spectroscopy on ADITYA-U tokamak. Rev Sci Instrum 2022; 93:113552. [PMID: 36461425 DOI: 10.1063/5.0101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Paβ and Paγ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 1016 and 1.9 × 1016 particles cm-2 s-1 from neutral hydrogen lines Hα and Paβ, respectively, and the C influx value is found to be 3.5 × 1015 and 2.9 × 1015 particles cm-2 s-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.
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Affiliation(s)
- N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad 382 481, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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Purohit S, Gupta MK, Chowdhuri MB, Mansuri I, Bhandarkar M, Shukla BK, Shah K, Manchanda R, Nagora UC, Pathak SK, Jadeja KA, Tanna RL, Ghosh J. Initial results from time-resolved LaBr based hard x-ray spectrometer for ADITYA-U tokamak. Rev Sci Instrum 2022; 93:093512. [PMID: 36182481 DOI: 10.1063/5.0101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
Runaway electrons (REs) are passively studied by hard x-ray (HX) emissions generated by REs. A LaBr3(Ce) detector-based HX spectroscopic diagnostic (operational within ∼75 keV to 3.5 MeV) has been set up on the ADITYA-U. The diagnostic acquisition software utility is upgraded to obtain the temporal evolution of the HX spectrum to understand the RE energy distribution in plasma during its various phases. The peak position moves to lower energy for Ohmically heated discharges (200-80 keV), indicating a relative increase in the thermal particle content in the plasma. The peak position of RE energy shows a decreasing tendency with increasing ne with Ne gas puffing and termination of the electron cyclotron resonance pulse.
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Affiliation(s)
- S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - I Mansuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - M Bhandarkar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - B K Shukla
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - K Shah
- Department of Physics, Pandit Deendayal Energy University (PDEU), Raisan, Gandhinagar 382 007, Gujarat, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, Gujarat, IndiaDepartment of Physics, Pandit Deendayal Energy University (PDEU), Raisan, Gandhinagar 382 007, Gujarat, IndiaHomi Bhaba National Institute, Training School Complex, Anushakti Nagar, Mumbai 400 094, India
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Manchanda R, Gaba F, Talaulikar V, Pundir J, Gessler S, Davies M, Menon U. Risk-Reducing Salpingo-Oophorectomy and the Use of Hormone Replacement Therapy Below the Age of Natural Menopause: Scientific Impact Paper No. 66 October 2021: Scientific Impact Paper No. 66. BJOG 2022; 129:e16-e34. [PMID: 34672090 PMCID: PMC7614764 DOI: 10.1111/1471-0528.16896] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This paper deals with the use of hormone replacement therapy (HRT) after the removal of fallopian tubes and ovaries to prevent ovarian cancer in premenopausal high risk women. Some women have an alteration in their genetic code, which makes them more likely to develop ovarian cancer. Two well-known genes which can carry an alteration are the BRCA1 and BRCA2 genes. Examples of other genes associated with an increased risk of ovarian cancer include RAD51C, RAD51D, BRIP1, PALB2 and Lynch syndrome genes. Women with a strong family history of ovarian cancer and/or breast cancer, may also be at increased risk of developing ovarian cancer. Women at increased risk can choose to have an operation to remove the fallopian tubes and ovaries, which is the most effective way to prevent ovarian cancer. This is done after a woman has completed her family. However, removal of ovaries causes early menopause and leads to hot flushes, sweats, mood changes and bone thinning. It can also cause memory problems and increases the risk of heart disease. It may reduce libido or impair sexual function. Guidance on how to care for women following preventative surgery who are experiencing early menopause is needed. HRT is usually advisable for women up to 51 years of age (average age of menopause for women in the UK) who are undergoing early menopause and have not had breast cancer, to minimise the health risks linked to early menopause. For women with a womb, HRT should include estrogen coupled with progestogen to protect against thickening of the lining of the womb (called endometrial hyperplasia). For women without a womb, only estrogen is given. Research suggests that, unlike in older women, HRT for women in early menopause does not increase breast cancer risk, including in those who are BRCA1 and BRCA2 carriers and have preventative surgery. For women with a history of receptor-negative breast cancer, the gynaecologist will liaise with an oncology doctor on a case-by-case basis to help to decide if HRT is safe to use. Women with a history of estrogen receptor-positive breast cancer are not normally offered HRT. A range of other therapies can be used if a woman is unable to take HRT. These include behavioural therapy and non-hormonal medicines. However, these are less effective than HRT. Regular exercise, healthy lifestyle and avoiding symptom triggers are also advised. Whether to undergo surgery to reduce risk or not and its timing can be a complex decision-making process. Women need to be carefully counselled on the pros and cons of both preventative surgery and HRT use so they can make informed decisions and choices.
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Taylor JA, Burnell M, Ryana A, Karpinskyj C, Kalsi JK, Taylor H, Apostolidou S, Sharma A, Manchanda R, Woolas R, Campbell S, Parmar M, Singh N, Jacobs IJ, Menon U, Gentry-Maharaj A. Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS. BJOG 2022; 129:110-118. [PMID: 34555263 PMCID: PMC7615389 DOI: 10.1111/1471-0528.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. DESIGN Prospective cohort study. SETTING Thirteen NHS Trusts in England, Wales and Northern Ireland. POPULATION A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. METHODS Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. MAIN OUTCOME MEASURES Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. RESULTS Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85-1.13, P = 0.765). CONCLUSIONS This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models. TWEETABLE ABSTRACT Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.
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Affiliation(s)
- JA Taylor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - M Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Ryana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - JK Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- Department Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK
| | - H Taylor
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - S Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - R Manchanda
- Barts Health NHS Trust and Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - R Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - N Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - IJ Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- University of New South Wales, Sydney, NSW, Australia
| | - U Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
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Sundar S, Cummins C, Kumar S, Long J, Arora V, Balega J, Broadhead T, Duncan T, Edmondson R, Fotopoulou C, Glasspool R, Kolomainen D, Leeson S, Manchanda R, McNally O, Morrison J, Mukhopadhyay A, Paul J, Tidy J, Wood N. Quality of life from cytoreductive surgery in advanced Ovarian cancer: investigating association with disease burden and surgical complexity in the international, prospective, SOCQER2 cohort study. BJOG 2021; 129:1122-1132. [PMID: 34865316 PMCID: PMC9306902 DOI: 10.1111/1471-0528.17041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/22/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach DESIGN: Prospective multicentre observational study SETTING: United Kingdom, Kolkata, India, and Melbourne, Australia gynaecological cancer surgery centres. PARTICIPANTS Patients undergoing surgical resection for late stage ovarian cancer. Exposure Low, intermediate or high Surgical Complexity Score (SCS) surgery MAIN OUTCOMES AND MEASURES: Primary: EORTC-QLQ-C30 Global score change. Secondary: EORTC OV28, progression free survival. RESULTS Patients' pre-operative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n=88) in the low, 4.0 (SD 2.1, n=55) in the intermediate and 4.3 (SD 2.1, n=52) in the high SCS group after 6 weeks (p=0.048) and 4.3 (SD 2.1, n=51), 5.1 (SD 2.2, n=41) and 5.1 (SD 2.2, n=35) respectively after 12 months (p=0.133). In a repeated measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups, p= 0.840 but there was a small statistically significant improvement in all groups over time (p<0.001). The high SCS group experienced small to moderate decreases in physical (p=0.004), role (p=0.016) and emotional (p=0.001) function at 6 weeks post-surgery which resolved by 6-12 months. CONCLUSIONS AND RELEVANCE Global QoL of patients undergoing low, intermediate, and high SCS surgery improved at 12 months post operation and was no worse in patients undergoing extensive surgery.
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Affiliation(s)
- S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham.,Sandwell and West Birmingham NHS Trust
| | - C Cummins
- Institute of Applied health Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - S Kumar
- Institute of Applied health Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - J Long
- Institute of Applied health Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - V Arora
- Bondi Women's Health, Sydney, NSW, Australia
| | - J Balega
- Sandwell and West Birmingham NHS Trust
| | - T Broadhead
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Duncan
- Norfolk & Norwich University Hospital, Norwich, UK
| | | | | | | | | | - S Leeson
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - R Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London
| | - O McNally
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Morrison
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - J Paul
- University of Glasgow, Glasgow, UK
| | - J Tidy
- University of Sheffield, Sheffield, UK
| | - N Wood
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Reisel D, Burnell M, Side L, Loggenberg K, Gessler S, Desai R, Sanderson S, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Jewish cultural and religious factors and uptake of population-based BRCA testing across denominations: a cohort study. BJOG 2021; 129:959-968. [PMID: 34758513 DOI: 10.1111/1471-0528.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing. DESIGN Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115). SETTING London Ashkenazi-Jewish (AJ) population. POPULATION OR SAMPLE AJ men and women, >18 years. METHODS Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial 'interest' and 'intention to test' pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing. MAIN OUTCOME MEASURES Interest, intention, uptake of BRCA testing. RESULTS In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation. CONCLUSIONS Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations. TWEETABLE ABSTRACT Jewish cultural/religious factors do not affect BRCA testing, with robust uptake seen across all denominational affiliations.
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Affiliation(s)
- D Reisel
- Institute for Women's Health, University College, London, UK
| | - M Burnell
- Institute for Women's Health, University College, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Loggenberg
- Institute for Women's Health, University College, London, UK
| | - S Gessler
- Institute for Women's Health, University College, London, UK
| | - R Desai
- Institute for Women's Health, University College, London, UK
| | - S Sanderson
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Dept Clinical Genetics, Guy's Hospital, London, UK.,University of Technology Sydney, Ultimo, NSW, Australia
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - U Beller
- Department of Gynaecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Wardle
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- Institute for Women's Health, University College, London, UK.,University of New South Wales, Sydney, NSW, Australia
| | - R Manchanda
- MRC Clinical Trials Unit, University College London, London, UK.,Wolfson Institute of Population Health, CRUK Barts Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
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9
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Shukla G, Chowdhuri MB, Shah K, Manchanda R, Ramaiya N, Tanna RL, Mayya KBK, Ghosh J. Impurity toroidal rotation profile measurement using upgraded high-resolution visible spectroscopic diagnostic on ADITYA-U tokamak. Rev Sci Instrum 2021; 92:063517. [PMID: 34243548 DOI: 10.1063/5.0043789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
A high-resolution spectroscopic diagnostic for the measurement of spatial profiles of impurity ion toroidal rotation velocities on the ADITYA-U tokamak has been upgraded to cover the complete plasma minor radius. Earlier, the coverage of diagnostics toward the plasma edge was restricted due to the placement of collection optics on the tangential port outside the vacuum vessel. The coverage of the full plasma minor radius, from 0 to 24 cm, has been achieved using the newly designed and developed collection optics that have seven lines of sight to view the tokamak plasma mounted inside a customized re-entrant view port which is installed in the shadow of the limiter inside the vacuum vessel. The upgraded diagnostic also includes a faster charged coupled device detector with a smaller pixel size for the detection of a small wavelength shift. The complete spatial profile has been measured using the Doppler shifted passive change exchange spectral line at 529.0 nm from the C5+ ion. In this article, we present the collection optics' design, installation, calibration, and results obtained using the upgraded diagnostic.
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Affiliation(s)
- G Shukla
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K B K Mayya
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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10
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Manchanda R, Dhar N, Kumar M, Kumar N, Tiwari A. Thickened sural nerve in Hansen's disease. QJM 2021; 114:202-203. [PMID: 32614397 DOI: 10.1093/qjmed/hcaa216] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Manchanda
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Dhar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - M Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - A Tiwari
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
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11
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Shah K, Ghosh J, Shukla G, Chowdhuri MB, Manchanda R, Yadava N, Ramaiya N, Jadeja KA, Patel KM, Tanna RL, Mayya KBK. Observations of visible argon line emissions and its spatial profile from Aditya-U tokamak plasma. Rev Sci Instrum 2021; 92:053548. [PMID: 34243287 DOI: 10.1063/5.0043877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
The spectroscopic studies of medium and high Z impurities have been the subject of interest in fusion research due to their role in mitigating plasma disruption and reducing heat load on the plasma facing components. Line emissions from these impurities provide the rotation velocity and ion temperature measurements along with the understanding of the overall impurity behavior in plasma. In the Aditya-U tokamak, the spatially resolved Ar II line emissions have been observed using a high resolution multi-track spectroscopic diagnostic consisting of a 1 m Czerny-Turner spectrometer coupled with a charge coupled device (CCD) detector using seven lines of sight viewing plasma tangentially along the toroidal direction. The spatially resolved Ar II lines at 458.96 nm have been observed. The singly ionized Ar emission peaks at the radial location of ρ = 0.8 of the plasma having a minor radius of 25 cm. Moreover, a 0.5 m UV-visible spectrometer coupled with a CCD detector and having a line of sight passing through the plasma midplane from the radial port was used to record visible Ar survey spectra within the 670-810 nm wavelength range, and all these lines have been identified for further analysis.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N Yadava
- The National Institute of Engineering, Mysuru 570 008, Karnataka, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
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12
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Grube M, Krämer P, Chiu D, Bosse T, Scheunhage D, Koebel M, Singh N, Manchanda R, Hammond R, Heitz F, Harter P, du Bois A, Ataseven B, Neudeck N, Beschorner C, Fischer A, Greif K, Krämer B, Brucker S, Talhouk A, Anglesio M, Staebler A, Kommoss S. Immunhistochemische Expression von L1CAM in endometrioiden Ovarialkarzinomen – Ein neuer prognostischer Marker? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718139] [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: 10/23/2022] Open
Affiliation(s)
- M Grube
- Universitätsfrauenklinik Tübingen
| | - P Krämer
- Universitätsfrauenklinik Tübingen
| | - D Chiu
- Department of Obstetrics and Gynecology, University of British Columbia
| | - T Bosse
- Leiden University Medical Center
| | | | - M Koebel
- Department of Pathology and Laboratory Medicine, University of Calgary
| | - N Singh
- Dept of Cellular Pathology, BartsHealth NHS Trust
| | - R Manchanda
- Dept of Cellular Pathology, BartsHealth NHS Trust
| | - R Hammond
- Dept of Cellular Pathology, BartsHealth NHS Trust
| | | | | | | | | | - N Neudeck
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - C Beschorner
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - A Fischer
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - K Greif
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - B Krämer
- Universitätsfrauenklinik Tübingen
| | | | - A Talhouk
- Department of Obstetrics and Gynecology, University of British Columbia
| | - M Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia
| | - A Staebler
- Institut für Pathologie, Universitätsklinikum Tübingen
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13
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Gaba F, Blyuss O, Chandrasekaran D, Osman M, Goyal S, Gan C, Izatt L, Tripathi V, Esteban I, McNicol L, Ragupathy K, Crawford R, Evans DG, Legood R, Menon U, Manchanda R. Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study. BJOG 2020; 128:714-726. [PMID: 32803845 DOI: 10.1111/1471-0528.16424] [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] [Accepted: 07/13/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. DESIGN Multicentre, cohort, questionnaire study (IRSCTN:12310993). SETTING United Kingdom (UK). POPULATION UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. METHODS Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. MAIN OUTCOMES RRESDO acceptability, menopausal sequelae, satisfaction/regret. RESULTS In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2-0.9, P = 0.025). CONCLUSION Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness. TWEETABLE ABSTRACT RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.
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Affiliation(s)
- F Gaba
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - O Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK.,Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - D Chandrasekaran
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M Osman
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - S Goyal
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - C Gan
- Department of Gynaecological Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - V Tripathi
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - I Esteban
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | - L McNicol
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - R Crawford
- Department of Gynaecological Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D G Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - R Manchanda
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
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14
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Abstract
Hysteroscopy is the gold standard for evaluating the uterine cavity, diagnosing intrauterine pathology, and operative intervention for some causes of abnormal uterine bleeding. The American College of Obstetricians and Gynecologists concluded that, when the endometrium measures ≤4 mm with transvaginal ultrasonography, the likelihood that bleeding is secondary to endometrial carcinoma is less than 1% (negative predictive value 99%), and endometrial biopsy is not recommended. Endometrial sampling in this clinical scenario will likely result in insufficient tissue for evaluation and it is reasonable to consider initial management for atrophy. A thickened endometrium on transvaginal ultrasonography (>4 mm in a postmenopausal woman with postmenopausal bleeding) warrants additional evaluation with endometrial sampling. A negative tissue biopsy following 'blind' endometrial sampling in women with postmenopausal bleeding is not considered to be an endpoint, and further evaluation of the endometrial cavity with hysteroscopy to exclude focal disease is imperative.
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Affiliation(s)
- R Manchanda
- Gynaecological Endoscopy Unit, Manchanda's Endoscopic Centre and PSRI Hospital, Delhi, India
| | - S Thapa
- Gynaecological Endoscopy, Rosewalk Hospital, New Delhi, India
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15
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Manchanda R, Burnell M, Gaba F, Desai R, Wardle J, Gessler S, Side L, Sanderson S, Loggenberg K, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Legood R, Beller U, Tomlinson I, Menon U, Jacobs I. Randomised trial of population‐based
BRCA
testing in Ashkenazi Jews: long‐term outcomes. BJOG 2019; 127:364-375. [PMID: 31507061 DOI: 10.1111/1471-0528.15905] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- R Manchanda
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
| | - M Burnell
- MRC Clinical Trials Unit University College London London UK
| | - F Gaba
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
| | - R Desai
- MRC Clinical Trials Unit University College London London UK
| | - J Wardle
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - S Gessler
- MRC Clinical Trials Unit University College London London UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust Southampton UK
| | - S Sanderson
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - K Loggenberg
- North East Thames Regional Genetics Unit Department of Clinical Genetics Great Ormond Street Hospital London UK
| | - AF Brady
- North West Thames Regional Genetics Service Northwick Park Hospital Harrow UK
| | - H Dorkins
- St Peter's College University of Oxford Oxford UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Chapman
- West Midlands Regional Genetics Service Department of Clinical Genetics Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Jacobs
- Department of Clinical Genetics Guy's Hospital London UK
- University of Technology Sydney Sydney NSW Australia
| | - R Legood
- Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK
| | - U Beller
- Department of Gynaecology Shaare Zedek Medical Centre Jerusalem Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - I Jacobs
- University of New South Wales UNSW Sydney Sydney NSW Australia
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16
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Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
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Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
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17
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Manchanda R, Gaba F. A commentary on population genetic testing for primary prevention: changing landscape and the need to change paradigm. BJOG 2019; 126:686-689. [DOI: 10.1111/1471-0528.15657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 12/25/2022]
Affiliation(s)
- R Manchanda
- Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit at UCL Faculty of Population Health Sciences Institute of Clinical Trials and Methodology University College London London UK
| | - F Gaba
- Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
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18
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Gaba F, Piek J, Menon U, Manchanda R. Risk‐reducing early salpingectomy and delayed oophorectomy as a two‐staged alternative for primary prevention of ovarian cancer in women at increased risk: a commentary. BJOG 2019; 126:831-839. [DOI: 10.1111/1471-0528.15651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Affiliation(s)
- F Gaba
- Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
| | - J Piek
- Department of Gynaecological Oncology Catharina Hospital Eindhoven the Netherlands
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - R Manchanda
- Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
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19
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Shah K, Chowdhuri MB, Shukla G, Manchanda R, Mayya KBK, Jadeja KA, Pablant NA, Ghosh J. Design of tangential x-ray crystal spectrometer for Aditya-U tokamak. Rev Sci Instrum 2018; 89:10F115. [PMID: 30399683 DOI: 10.1063/1.5039359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
A tangential soft x-ray crystal spectrometer has been designed to measure the x-ray spectrum of He-like argon for the Aditya-U tokamak plasma. The system enables to measure electron temperature using the intensity ratio of the resonance line to the satellite line. For this purpose, an x-ray spectral line at 3.9494 Å from He-like argon, Ar16+, is considered. The spectrometer consists of a cylindrically bent silicon (111) crystal and a CCD detector to measure the resonance spectral line and its satellite lines in the wavelength region of 3.94-4.0 Å, viewing the plasma tangentially at an angle of 26° with respect to the toroidal direction in the magnetic axis. Considering Aditya-U tokamak plasma parameters and its geometrical constraints, plasma to crystal and crystal to detector distances have been kept at 1.47 m and 0.5 m, respectively, to detect a sufficient signal. The engineering design has been optimized after adequately addressing the issues related to port geometry and machine accessibility. Details on the design of the crystal spectrometer are presented in this paper.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N A Pablant
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
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20
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Shukla G, Chowdhuri MB, Shah K, Manchanda R, Mayya KBK, Ghosh J. Plasma rotation measurement using UV and visible spectroscopy on Aditya-U tokamak. Rev Sci Instrum 2018; 89:10D132. [PMID: 30399770 DOI: 10.1063/1.5039333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
A high resolution spectroscopic diagnostic for the measurement of the spatial profile of toroidal rotation velocity (vt) and temperature (Ti) of carbon ions has been developed and implemented on the Aditya-U tokamak. The diagnostic consists of a high resolution 1 m (f/8.7) spectrometer having an 1800 grooves/mm grating coupled with a charged couple device. The setup allows measurements from 5 toroidal lines-of-sights passing through different minor radii in the horizontal mid-plane of the Aditya-U tokamak. The carbon line emissions at 529 nm in visible and 229.6 and 227.09 nm in the ultra violet spectral range are recorded using the setup. Initial results show that typical Aditya-U plasmas have a maximum carbon ion temperature (Ti) of ∼120 eV and a rotation velocity (vt) of ∼-14 km/s in the counter plasma-current direction.
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Affiliation(s)
- G Shukla
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K B K Mayya
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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21
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Chuang L, Berek J, Randall T, McCormack M, Schmeler K, Manchanda R, Rebbeck T, Jeng C, Pyle D, Quinn M, Trimble E, Naik R, Lai C, Ochiai K, Denny L, Bhatla N. Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities. Gynecol Oncol Rep 2018; 25:65-69. [PMID: 29928684 PMCID: PMC6008286 DOI: 10.1016/j.gore.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022] Open
Abstract
Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.
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Affiliation(s)
- L. Chuang
- Western Connecticut Health Network, Larner College of Medicine at the University of Vermont, Danbury, CT, USA
| | - J. Berek
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. Randall
- The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - K. Schmeler
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R. Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T. Rebbeck
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - C.J. Jeng
- Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - D. Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - M. Quinn
- University of Melbourne, Melbourne, VIC, Australia
| | - E. Trimble
- Center for Global Health, National Cancer Institute, Bethesda, MS, USA
| | - R. Naik
- Northern Gynecological Oncology Centre, Gateshead, UK
| | - C.H. Lai
- Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - K. Ochiai
- Jikei University School of Medicine, Tokyo, Japan
| | - L. Denny
- University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - N. Bhatla
- All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- D Chandrasekaran
- Barts Cancer Institute, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK.,Gynaecological Cancer Research Centre, Women's Cancer, University College London, London, UK
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23
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Manchanda R, Legood R, Antoniou AC, Pearce L, Menon U. Commentary on changing the risk threshold for surgical prevention of ovarian cancer. BJOG 2018; 125:541-544. [PMID: 28548227 DOI: 10.1111/1471-0528.14763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
- Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A C Antoniou
- Strangeways Research Laboratory, Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - L Pearce
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - U Menon
- Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK
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24
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Affiliation(s)
- R Manchanda
- Barts Cancer Institute; QMUL, Charterhouse Square London UK
- Department of Gynaecological Oncology; Royal London Hospital; London UK
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Burnell M, Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Manchanda R, Das N, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Shanbhag S, Thackeray A, Wood N, Reynolds K, Ryan A, Menon U. Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study. BJOG 2016; 123:2171-2180. [DOI: 10.1111/1471-0528.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M Burnell
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Iyer
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Gentry-Maharaj
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Nordin
- East Kent Gynaecological Oncology Centre; Queen Elizabeth the Queen Mother Hospital; Margate UK
| | - R Liston
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Manchanda
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - N Das
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - R Gornall
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - A Beardmore-Gray
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - K Hillaby
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - S Leeson
- Department of Obstetrics and Gynaecology; BetsiCadwaladr University Health Board; Bangor UK
| | - A Linder
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - A Lopes
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | | | - T Mould
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre; Birmingham City Hospital; Birmingham UK
| | - A Olaitan
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - B Rufford
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - S Shanbhag
- Department of Gynaecological Oncology; Glasgow Royal Infirmary; Glasgow UK
| | | | - N Wood
- Department of Gynaecological Oncology; Lancashire Teaching Hospitals NHS Foundation trust; Royal Preston Hospital; Preston UK
| | - K Reynolds
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - A Ryan
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - U Menon
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
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26
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Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, Das N, Desai R, Gornall R, Beardmore-Gray A, Nevin J, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Varkey S, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer 2015; 112:475-84. [PMID: 25535730 PMCID: PMC4453652 DOI: 10.1038/bjc.2014.630] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/30/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. METHODS Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. RESULTS Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). CONCLUSIONS This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.
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Affiliation(s)
- R Iyer
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Nordin
- National Cancer Intelligence Network Gynaecology Clinical Reference Group, 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Liston
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - N Das
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - R Desai
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Gornall
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - A Beardmore-Gray
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
| | - K Hillaby
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - S Leeson
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Penrhosgarnedd, Bangor, Gwynedd, North Wales LL57 2PW, UK
| | - A Linder
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Lopes
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - D Meechan
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - T Mould
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - S Varkey
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Olaitan
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - B Rufford
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S Shanbhag
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK
| | - A Thackeray
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - N Wood
- Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, North Fulwood, Preston Lancashire PR2 9HT, UK
| | - K Reynolds
- Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, St Bartholomew's Hospital (Barts), West Smithfield, London EC1A 7BE, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
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Shukla BK, Pradhan S, Patel P, Babu R, Patel J, Patel H, Dhorajia P, Tanna V, Atrey PK, Manchanda R, Gupta M, Joisa S, Gupta CN, Danial R, Singh P, Jha R, Bora D. 42GHz ECRH assisted Plasma Breakdown in tokamak SST-1. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20158702008] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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28
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Chowdhuri MB, Ghosh J, Manchanda R, Kumar A, Banerjee S, Ramaiya N, Virani N, Mali A, Amardas A, Kumar P, Tanna RL, Gupta CN, Bhatt SB, Chattopadhyay PK. Measurement of spatial and temporal behavior of H(α) emission from Aditya tokamak using a diagnostic based on a photomultiplier tube array. Rev Sci Instrum 2014; 85:11E411. [PMID: 25430318 DOI: 10.1063/1.4889912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A photo multiplier tube (PMT) array based spectroscopic diagnostic with fast time response of 10 μs and spatial resolution ∼3 cm has been developed and installed on Aditya tokamak to study the spatial and temporal behavior of Hα emissions from typical discharges. Collimated light has been collected from the plasma along 16 lines of sight passing through entire plasma poloidal cross section of Aditya and detected by two 8 channels PMT arrays after selecting Hα emission using interference filter. The studies are carried out during plasma formation phase of Aditya by changing vertical field and its delay with respect to loop voltage. It is observed that plasma initiated in the high field side in typical discharges of Aditya. The plasma formation position is matched with null field location estimated through simulation.
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Affiliation(s)
- M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - Ajay Kumar
- Metallurgical Engineering and Material Science Department, Indian Institute of Technology Bombay, Powai, Mumbai 400 076, India
| | - S Banerjee
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - Niral Virani
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - Aniruddh Mali
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - A Amardas
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - Pintu Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - C N Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - S B Bhatt
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
| | - P K Chattopadhyay
- Institute for Plasma Research, Bhat, Gandhinagar, Gujarat 382 428, India
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Manchanda R, Godfrey M, Wong-Taylor L, Halaska M, Burnell M, Grabowski J, Gultekin M, Haidopoulos D, Zapardiel I, Vranes B, Kesic V, Zola P, Colombo N, Verheijen R, Bossart M, Piek J. The need for accredited training in gynaecological oncology: a report from the European Network of Young Gynaecological Oncologists (ENYGO). Ann Oncol 2013; 24:944-52. [DOI: 10.1093/annonc/mds588] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Manchanda R. Editorial. Indian Journal of Research in Homoeopathy 2012. [DOI: 10.53945/2320-7094.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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31
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Gupta H, Raj J, Rathi A, Sundaram E, Kumar S, Manchanda R. Morpho-anatomy of leaf, stem and root of Alternanthera sessilis (L.) R. Br. ex DC and Alternanthera pungens Kunth (Amaranthaceae) and its significance in drug identification. Indian Journal of Research in Homoeopathy 2012. [DOI: 10.53945/2320-7094.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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32
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Manchanda R. Editorial. Indian Journal of Research in Homoeopathy 2012. [DOI: 10.53945/2320-7094.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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33
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Fourkala EO, Gentry-Maharaj A, Burnell M, Ryan A, Manchanda R, Dawnay A, Jacobs I, Widschwendter M, Menon U. Histological confirmation of breast cancer registration and self-reporting in England and Wales: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening. Br J Cancer 2012; 106:1910-6. [PMID: 22596242 PMCID: PMC3388556 DOI: 10.1038/bjc.2012.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In research studies, accurate information of cancer diagnosis is crucial. In women with breast cancer (BC), we compare cancer registration (CR) in England/Wales and self-reporting with independent confirmation. METHODS In the UK Collaborative Trial of Ovarian Cancer Screening, notification of BC diagnosed between randomisation and 31 December 2009 was obtained through (1) CR (17 October 2011) and (2) self-reporting using postal-questionnaire. Breast cancer was confirmed using a detailed questionnaire (BC questionnaire BCQ) completed by the treating clinician (gold standard). Apparent sensitivity and positive-predictive value of CR/self-reporting vs BCQ were calculated. RESULTS Of 1065 women with possible BC notification, diagnosis was confirmed in 932 (87.5%). A total of 3.1% (28 out of 918) of BC CR and 12.4% (128 out of 1032) of women with self-reported BC only had in-situ carcinoma on BCQ. Another 4.6% (43 out of 932) of BCQ-confirmed cancer did not have a BC registration, and 3.6% (34 out of 932) did not self-report BC. Apparent sensitivity of CR and self-reporting vs BCQ were 95.4 and 96.4%, respectively. Positive-predictive value of self-reporting (87.1%) was significantly lower than that of CR (96.8%). Women aged<65 were more likely to over report in-situ carcinoma as BC. Overall, 73 (6.8%) women would have been misclassified/missed if CR, and 167 (15.6%) if self-reporting data alone was used. CONCLUSION This study confirms the reliability of BC registration in England/Wales and highlights the fact that 1 in 10 women self-reporting BC might only have in-situ breast carcinoma.
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Affiliation(s)
- E O Fourkala
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Dawnay
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - I Jacobs
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - M Widschwendter
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - U Menon
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
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Abstract
BACKGROUND Past research on the relationship between treatment delay and outcomes for first-episode psychosis has primarily focused on the role of duration of untreated psychosis (DUP) in predicting symptomatic outcomes up to 2 years. In the current study we examine the influence of both DUP and duration of untreated illness (DUI) on symptoms and functioning at 5 years follow-up while controlling for other early characteristics. METHOD A total of 132 patients with first-episode psychosis and treated in an early intervention program were prospectively followed up for 5 years. Outcomes assessed included positive and negative symptoms, overall functioning, weeks on disability pension and weeks of full-time competitive employment. RESULTS While DUP showed a significant correlation with level of positive symptoms at follow-up, this was not independent of pre-morbid social adjustment. DUI emerged as a more robust independent predictor of negative symptoms, social and occupational functioning and use of a disability pension. CONCLUSIONS Delay between onset of non-specific symptoms and treatment may be a more important influence on long-term functioning for first-episode patients than DUP. This suggests the possible value of treating such signs and symptoms as early as possible regardless of the effectiveness of such interventions in reducing likelihood or severity of psychotic symptoms.
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Affiliation(s)
- R M G Norman
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - R Manchanda
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - D Windell
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - R Harricharan
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - S Northcott
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - L Hassall
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
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Manchanda R, Burnell M, Abdelraheim A, Johnson M, Sharma A, Benjamin E, Brunell C, Saridogan E, Gessler S, Oram D, Side L, Rosenthal AN, Jacobs I, Menon U. Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG 2012; 119:527-36. [PMID: 22260402 DOI: 10.1111/j.1471-0528.2011.03257.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy (RRSO) over time in women at high-risk of familial ovarian cancer. DESIGN Prospective observational cohort. SETTING Tertiary high-risk familial gynaecological cancer clinic. POPULATION/SAMPLE New clinic attendees between March 2004 and November 2009, fulfilling the high-risk criteria for the UK Familial Ovarian Cancer Screening Study. METHODS Risk management options discussed included RRSO and ovarian surveillance. Outcome data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function (CIF) of RRSO over time, and the sub-hazard ratio (SHR) was used to assess the strength of the association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis was used to model the cumulative probabilities of covariates on the CIF. RESULTS Of 1133 eligible women, 265 (21.4%) opted for RRSO and 868 (69.9%) chose screening. Women undergoing RRSO were older (49 years, interquartile range 12.2 years) than those preferring screening (43.4 years, interquartile range 11.9 years) (P < 0.0005). The CIF for RRSO at 5 years was 0.55 (95% CI 0.45-0.64) for BRCA1/2 carriers and 0.22 (95% CI 0.19-0.26) for women of unknown mutation status (P < 0.0001); 0.42 (95% CI 0.36-0.47) for postmenopausal women (P < 0.0001); 0.29 (95% CI 0.25-0.33) for parity ≥1 (P = 0.009) and 0.47 (95% CI 0.39-0.55) for a personal history of breast cancer (P < 0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation (SHR 2.31, 95% CI 1.7-3.14), postmenopausal status (SHR 2.16, 95% CI 1.62-2.87)) and a personal history of breast cancer (SHR 1.5, 95% CI 1.09-2.06). CONCLUSIONS Decision-making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.
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Affiliation(s)
- R Manchanda
- Department of Gynaecological Oncology, EGA Institute for Women's Health, UCL, London, UK.
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Norman R, Manchanda R, Northcott S, Harricharan R, Windell D. P-1279 - Social support and five year functional outcomes in an early intervention program for psychosis. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75446-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vaes E, Manchanda R, Autier P, Nir R, Nir D, Bleiberg H, Robert A, Menon U. Differential diagnosis of adnexal masses: sequential use of the risk of malignancy index and HistoScanning, a novel computer-aided diagnostic tool. Ultrasound Obstet Gynecol 2012; 39:91-98. [PMID: 21695741 DOI: 10.1002/uog.9079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the value of ovarian Histo-Scanning(™) , a novel computerized technique for interpreting ultrasound data, in combination with the risk of malignancy index (RMI) in improving triage for women with adnexal masses. METHODS RMI indices were assessed in 199 women enrolled in a prospective study to investigate the use of HistoScanning. Ultrasound scores were obtained by blinded analysis of archived images. The following sequential test was developed: HistoScanning was modeled as a second-line test for RMI between a lower cut-off and an upper cut-off. The optimal combination of these cut-offs that together maximized the Youden index (Sensitivity + Specificity - 1) was determined. RESULTS Using RMI at the standard cut-off value of 250 resulted in a sensitivity of 74% and a specificity of 86%. When RMI was combined with HistoScanning, the highest accuracy was achieved by using HistoScanning as a sequential second-line test for patients with RMI values between 105 and 2100. At these cut-off values, sequential use of RMI and HistoScanning resulted in mean sensitivity and specificity estimates of 88% and 95%, respectively. CONCLUSIONS Our data suggest that HistoScanning may have the potential to improve the diagnostic accuracy of RMI, which could result in better triage for women with adnexal masses. Further prospective validation is warranted.
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Affiliation(s)
- E Vaes
- Université Catholique de Louvain, Brussels, Belgium.
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Manchanda R, Abdelraheim A, Johnson M, Rosenthal AN, Benjamin E, Brunell C, Burnell M, Side L, Gessler S, Saridogan E, Oram D, Jacobs I, Menon U. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG 2011; 118:814-24. [DOI: 10.1111/j.1471-0528.2011.02920.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pichert G, Jacobs C, Jacobs I, Menon U, Manchanda R, Johnson M, Hamed H, Firth C, Evison M, Tutt A, de Silva L, Langman C, Izatt L. Novel one-stop multidisciplinary follow-up clinic significantly improves cancer risk management in BRCA1/2 carriers. Fam Cancer 2010; 9:313-9. [PMID: 20300867 DOI: 10.1007/s10689-010-9333-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to measure the impact of a multidisciplinary one-stop follow-up clinic (MDOSC) on breast and ovarian surveillance, risk reducing surgery and enrolment in clinical trials in BRCA1/2 carriers. All BRCA1/2 carriers in our region were invited and chose which specialists to see in our MDOSC offering best practice using clinical protocols based on national guidelines and published data. Uptake was evaluated over 24 months recording numbers of individuals undergoing breast and ovarian surveillance, risk reducing surgery, newly diagnosed cancers, their method of detection and participation in clinical trials. 172 (60%) of invited BRCA1/2 carriers chose to attend the MDOSC. Breast surveillance was initiated in 88% and screening frequency altered in 14% of women to comply with national guidelines. Risk reducing salpingo-oophorectomy was chosen by 47% of women and an additional 39% were considering it. The rate of failure to remove fallopian tubes fell from 15 to 3% of procedures (P < 0.01) and peritoneal washings and serial sectioning of tubes and ovaries rose from 25% and 14% before, to 67% (P < 0.001) and 63% (P < 0.001) procedures, respectively, after initiation of our MDOSC. 24% of women considered and 18% decided to undergo risk reducing mastectomy during the follow-up period. Participation in clinical trials increased significantly from 51 to 229 enrolments (P < 0.001). Our novel MDOSC designed to devise an individually tailored cancer risk management strategy had a high uptake amongst our BRCA1/2 carriers. Attendance resulted in improved breast and ovarian cancer risk management.
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Affiliation(s)
- G Pichert
- Clinical Genetics Department, Guy's and St Thomas NHS Foundation Trust, Guys Hospital, 7th Floor Borough Wing, Great Maze Pond Road, SE1 9RT, London, UK.
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Vaes E, Manchanda R, Nir R, Nir D, Bleiberg H, Robert A, Menon U. 1329 A sequential use of the Risk of Malignancy Index and Ovarian HistoScanning for the differential diagnosis of adnexal masses. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Manchanda R, Venkateswarlu K. Identification of the Components of Excitatory Junction Potentials in the Guinea Pig Vas Deferens. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368379709015654] [Citation(s) in RCA: 4] [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: 11/13/2022]
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Manchanda R, Rosenthal A, Burnell M, Fraser L, Mackay J, Skates S. Change in stage distribution observed with annual screening for ovarian cancer in BRCA carriers. J Med Genet 2009; 46:423-4. [DOI: 10.1136/jmg.2009.067462] [Citation(s) in RCA: 5] [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: 11/04/2022]
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Manchanda R, Baldwin P, Crawford R, Vowler SL, Moseley R, Latimer J, Welton K, Shafi M. Is close follow up feasible for high-risk cervical premalignant lesion in developing countries? BJOG 2009. [DOI: 10.1111/j.1471-0528.2008.02019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malla A, Norman R, Bechard-Evans L, Schmitz N, Manchanda R, Cassidy C. Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service. Psychol Med 2008; 38:1585-1593. [PMID: 18205969 DOI: 10.1017/s0033291707002656] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [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: 11/07/2022]
Abstract
BACKGROUND Differential association of risk factors associated with relapse following treatment of first-episode psychosis (FEP) have not been studied adequately, especially for patients treated in specialized early intervention (SEI) services, where some of the usual risk factors may be ameliorated. METHOD Consecutive FEP patients treated in an SEI service over a 4-year period were evaluated for relapse during a 2-year follow-up. Relapse was based on ratings on the Scale for Assessment of Positive Symptoms (SAPS) and weekly ratings based on the Life Chart Schedule (LCS). Predictor variables included gender, duration of untreated psychosis (DUP), total duration of untreated illness (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse during follow-up and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with the Cox proportional-hazards regression model for time to relapse as the dependent variables. RESULTS Of the 189 eligible patients, 145 achieved remission of positive symptoms. A high rate of medication adherence (85%) and relatively low relapse rates (29.7%) were observed over the 2-year follow-up. A higher relapse rate was associated with a co-morbid diagnosis of substance abuse assessed during the follow-up period [odds ratio (OR) 2.84, 95% confidence interval (CI) 1.24-6.51]. The length of time to relapse was not associated with any single predictor. CONCLUSIONS Specialized treatment of substance abuse may be necessary to further reduce risk of relapse even after improving adherence to medication.
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Affiliation(s)
- A Malla
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, 6875 Boulevard Lasalle, Montreal, Quebec, Canada.
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Manchanda R, Baldwin P, Crawford R, Vowler SL, Moseley R, Latimer J, Welton K, Shafi M. Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years. BJOG 2008; 115:1238-42. [DOI: 10.1111/j.1471-0528.2008.01853.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To assess whether an Early Case Identification Program (ECIP) for first-episode psychosis (FEP), which showed no significant short-term effects, has a delayed impact on duration of untreated psychosis (DUP). METHOD Using a historical control design, FEP patients were assessed on clinical variables over three consecutive phases, 2 years prior, 2 years during and 3 years after implementation of the ECIP. Additional analyses were conducted on non-affective and schizophrenia spectrum psychoses cases only. RESULTS There was no overall significant difference in DUP across the three phases. For cases treated within the first year of illness a nonsignificant reduction in DUP to less than 2 months observed during the active phase was sustained post-ECIP. CONCLUSION In some jurisdictions community-wide early case detection may fail to have an immediate or delayed effect on DUP, especially for cases who normally present for treatment with DUP >1 year.
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Affiliation(s)
- C M Cassidy
- Department of Psychiatry, Douglas Hospital Research Centre, McGill University, Montréal, Quebec, Canada
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Abstract
OBJECTIVE This study assesses the relationship of EEG to several aspects of 3 year symptomatic and functional outcome in first episode psychosis. METHOD A total of 117 patients with first episode psychosis had their baseline EEG classified by modified Mayo Clinic criteria as normal, essentially normal or dysrhythmia. Socio-demographic variables, duration of illness and of untreated psychosis and premorbid adjustment were also recorded. Positive and negative symptoms of psychoses, depression, anxiety and global functioning were rated on entry and after 3 years of treatment. RESULTS Patients with a dysrhythmic EEG at entry into treatment showed significantly greater persistence in both positive and negative symptoms of psychoses as well as anxiety and depression over 3 years. These findings were independent of duration of untreated illness or premorbid adjustment. CONCLUSION An abnormal baseline EEG in patients with first episode psychosis is associated with a poorer symptomatic outcome at 3-year follow-up.
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Affiliation(s)
- R Manchanda
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.
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Manchanda R, Palep-singh M, Prentice A. Can uterine artery embolisation affect endometrial perfusion and function. J OBSTET GYNAECOL 2008; 28:246-8. [DOI: 10.1080/01443610801967000] [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: 10/22/2022]
Affiliation(s)
- R. Manchanda
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | - M. Palep-singh
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | - A. Prentice
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
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Abstract
Cryptococcosis is caused by cryptococcus neoformans. Immunosuppression is a predisposing factor for the development of cryptococcosis. However, reports exist that cryptococcus neoformans can cause infection in immunocompetent hosts. We report a case of disseminated cryptococcosis in a 7.5-year-old immunocompetent child.
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Affiliation(s)
- R. Godbole
- Department of Pathology, King Edward Memorial Hospital, Pune, 411 011 India
| | - P. Nayar
- Department of Pathology, King Edward Memorial Hospital, Pune, 411 011 India
| | - A. Pradhan
- Department of Pathology, King Edward Memorial Hospital, Pune, 411 011 India
| | - R. Manchanda
- Department of Pathology, King Edward Memorial Hospital, Pune, 411 011 India
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Manchanda R. Modalités pratiques de la ventilation non invasive en pression positive, au long cours, à domicile, dans les maladies neuromusculaires. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)71806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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