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Naughton F, Hope A, Siegele-Brown C, Grant K, Notley C, Colles A, West C, Mascolo C, Coleman T, Barton G, Shepstone L, Prevost T, Sutton S, Crane D, Greaves F, High J. A smoking cessation smartphone app that delivers real-time 'context aware' behavioural support: the Quit Sense feasibility RCT. Public Health Res (Southampt) 2024; 12:1-99. [PMID: 38676391 DOI: 10.3310/kqyt5412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background During a quit attempt, cues from a smoker's environment are a major cause of brief smoking lapses, which increase the risk of relapse. Quit Sense is a theory-guided Just-In-Time Adaptive Intervention smartphone app, providing smokers with the means to learn about their environmental smoking cues and provides 'in the moment' support to help them manage these during a quit attempt. Objective To undertake a feasibility randomised controlled trial to estimate key parameters to inform a definitive randomised controlled trial of Quit Sense. Design A parallel, two-arm randomised controlled trial with a qualitative process evaluation and a 'Study Within A Trial' evaluating incentives on attrition. The research team were blind to allocation except for the study statistician, database developers and lead researcher. Participants were not blind to allocation. Setting Online with recruitment, enrolment, randomisation and data collection (excluding manual telephone follow-up) automated through the study website. Participants Smokers (323 screened, 297 eligible, 209 enrolled) recruited via online adverts on Google search, Facebook and Instagram. Interventions Participants were allocated to 'usual care' arm (n = 105; text message referral to the National Health Service SmokeFree website) or 'usual care' plus Quit Sense (n = 104), via a text message invitation to install the Quit Sense app. Main outcome measures Follow-up at 6 weeks and 6 months post enrolment was undertaken by automated text messages with an online questionnaire link and, for non-responders, by telephone. Definitive trial progression criteria were met if a priori thresholds were included in or lower than the 95% confidence interval of the estimate. Measures included health economic and outcome data completion rates (progression criterion #1 threshold: ≥ 70%), including biochemical validation rates (progression criterion #2 threshold: ≥ 70%), recruitment costs, app installation (progression criterion #3 threshold: ≥ 70%) and engagement rates (progression criterion #4 threshold: ≥ 60%), biochemically verified 6-month abstinence and hypothesised mechanisms of action and participant views of the app (qualitative). Results Self-reported smoking outcome completion rates were 77% (95% confidence interval 71% to 82%) and health economic data (resource use and quality of life) 70% (95% CI 64% to 77%) at 6 months. Return rate of viable saliva samples for abstinence verification was 39% (95% CI 24% to 54%). The per-participant recruitment cost was £19.20, which included advert (£5.82) and running costs (£13.38). In the Quit Sense arm, 75% (95% CI 67% to 83%; 78/104) installed the app and, of these, 100% set a quit date within the app and 51% engaged with it for more than 1 week. The rate of 6-month biochemically verified sustained abstinence, which we anticipated would be used as a primary outcome in a future study, was 11.5% (12/104) in the Quit Sense arm and 2.9% (3/105) in the usual care arm (estimated effect size: adjusted odds ratio = 4.57, 95% CIs 1.23 to 16.94). There was no evidence of between-arm differences in hypothesised mechanisms of action. Three out of four progression criteria were met. The Study Within A Trial analysis found a £20 versus £10 incentive did not significantly increase follow-up rates though reduced the need for manual follow-up and increased response speed. The process evaluation identified several potential pathways to abstinence for Quit Sense, factors which led to disengagement with the app, and app improvement suggestions. Limitations Biochemical validation rates were lower than anticipated and imbalanced between arms. COVID-19-related restrictions likely limited opportunities for Quit Sense to provide location tailored support. Conclusions The trial design and procedures demonstrated feasibility and evidence was generated supporting the efficacy potential of Quit Sense. Future work Progression to a definitive trial is warranted providing improved biochemical validation rates. Trial registration This trial is registered as ISRCTN12326962. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/31) and is published in full in Public Health Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Aimie Hope
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Chloë Siegele-Brown
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Claire West
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Garry Barton
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, Kings College London, London, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - David Crane
- Department of Behavioural Science and Health, University College London, London, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
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Hagag AM, Kaye R, Hoang V, Riedl S, Anders P, Stuart B, Traber G, Appenzeller-Herzog C, Schmidt-Erfurth U, Bogunovic H, Scholl HP, Prevost T, Fritsche L, Rueckert D, Sivaprasad S, Lotery AJ. Systematic review of prognostic factors associated with progression to late age-related macular degeneration: Pinnacle study report 2. Surv Ophthalmol 2023:S0039-6257(23)00140-6. [PMID: 37890677 DOI: 10.1016/j.survophthal.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Abstract
There is a need to identify accurately prognostic factors that determine the progression of intermediate to late-stage age-related macular degeneration (AMD). Currently, clinicians cannot provide individualised prognoses of disease progression. Moreover, enriching clinical trials with rapid progressors may facilitate delivery of shorter intervention trials aimed at delaying or preventing progression to late AMD. Thus, we performed a systematic review to outline and assess the accuracy of reporting prognostic factors for the progression of intermediate to late AMD. A meta-analysis was originally planned. Synonyms of AMD and disease progression were used to search Medline and EMBASE for articles investigating AMD progression published between 1991 and 2021. Initial search results included 3229 articles. Predetermined eligibility criteria were employed to systematically screen papers by two reviewers working independently and in duplicate. Quality appraisal and data extraction were performed by a team of reviewers. Only 6 studies met the eligibility criteria. Based on these articles, exploratory prognostic factors for progression of intermediate to late AMD included phenotypic features (e.g. location and size of drusen), age, smoking status, ocular and systemic co-morbidities, race, and genotype. Overall, study heterogeneity precluded reporting by forest plots and meta-analysis. The most commonly reported prognostic factors were baseline drusen volume/size, which was associated with progression to neovascular AMD, and outer retinal thinning linked to progression to geographic atrophy. In conclusion, poor methodological quality of included studies warrants cautious interpretation of our findings. Rigorous studies are warranted to provide robust evidence in the future.
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Affiliation(s)
- Ahmed M Hagag
- University College London Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Boehringer Ingelheim Limited, Bracknell, United Kingdom
| | - Rebecca Kaye
- University of Southampton, Faculty of Medicine, Southampton, United Kingdom
| | - Vy Hoang
- University of Southampton, Faculty of Medicine, Southampton, United Kingdom
| | - Sophie Riedl
- Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Philipp Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland; Ophthalmology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; AIBILI, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Beth Stuart
- University of Southampton, Faculty of Medicine, Southampton, United Kingdom
| | - Ghislaine Traber
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | | | | | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Hendrik P Scholl
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | | | | | - Daniel Rueckert
- Imperial College London, London, United Kingdom; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sobha Sivaprasad
- University College London Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
| | - Andrew J Lotery
- University of Southampton, Faculty of Medicine, Southampton, United Kingdom.
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Sutton J, Menten MJ, Riedl S, Bogunović H, Leingang O, Anders P, Hagag AM, Waldstein S, Wilson A, Cree AJ, Traber G, Fritsche LG, Scholl H, Rueckert D, Schmidt-Erfurth U, Sivaprasad S, Prevost T, Lotery A. Correction: Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration-the PINNACLE trial protocol. Eye (Lond) 2022; 37:1750. [PMID: 35953562 DOI: 10.1038/s41433-022-02131-1] [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: 11/09/2022] Open
Affiliation(s)
- Janice Sutton
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin J Menten
- BioMedIA, Imperial College London, London, UK.,Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sophie Riedl
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunović
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Oliver Leingang
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Philipp Anders
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ahmed M Hagag
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sebastian Waldstein
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria.,Department of Ophthalmology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Amber Wilson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Angela J Cree
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ghislaine Traber
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Lars G Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hendrik Scholl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Daniel Rueckert
- BioMedIA, Imperial College London, London, UK.,Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ursula Schmidt-Erfurth
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
| | - Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Eldred-Evans D, Burak P, Connor MJ, Day E, Evans M, Fiorentino F, Gammon M, Hosking-Jervis F, Klimowska- Nassar N, McGuire W, Padhani AR, Price D, Prevost T, Sokhi H, Tam H, Winkler M, Ahmed HU. Population-based prostate cancer screening using a prospective, blinded, paired screen-positive comparison of PSA and fast MRI: The IP1-PROSTAGRAM study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5513 Background: The prostate-specific antigen (PSA) test can lead to under- and over-diagnosis of prostate cancer and has not been recommended for population screening. A fast MRI scan might overcome the limitations of PSA. IP1-PROSTAGRAM is the first study to evaluate the performance of a 15-minute non-contrast MRI for prostate cancer screening in comparison to PSA. Methods: IP1-PROSTAGRAM was a prospective, population-based, screen-positive paired-cohort study. Men aged 50-69 years in the UK were invited for prostate cancer screening through seven primary care practices or community-based recruitment. Participants underwent a PSA and MRI scan (T2-weighted and diffusion). MRI was scored using PIRADS version 2.0 without knowledge of PSA; screen-positive MRI (defined as either PIRADS score 3-5 or 4-5) were compared against a screen-positive PSA defined as ≥3ng/ml. If any test was screen-positive, a systematic 12-core biopsy was performed with MRI-ultrasound image-fusion targeted biopsy to MRI suspicious areas, as appropriate. Clinically-significant cancer was defined as any Gleason score ≥3+4. The primary outcome was the proportion of screen-positive MRI at different scores; important secondary outcomes were the number of clinically-significant and insignificant cancers detected. Results: 2034 men were invited to participate of whom 408 consented and 406 were screened by both PSA and MRI (10/Oct/2018-15/May/2019). The proportion with a screen-positive MRI (score 3-5) was higher than the proportion with a screen-positive PSA (17.7% [95%CI 14.3-21.8] vs. 9.9% [95%CI 7.3-13.2]; p < 0.001). A screen-positive MRI (score 4-5) was similar to a screen-positive PSA (10.6% [95%CI 7.9-14.0] vs. 9.9% [95%CI 7.3-13.2], p = 0.71). An MRI score 3-5 or 4-5 used to denote a screen-positive MRI, compared to PSA alone, detected 14, 11 and 7 clinically-significant cancers, respectively. There were 7, 5 and 6 clinically-insignificant cancers detected, respectively. No serious adverse events occurred. Conclusions: When screening the general population for prostate cancer, MRI using a score of 4-5 to define a screen-positive test, compared to PSA alone at ≥3ng/ml, could lead to more men diagnosed with clinically-significant cancer without increasing the number of men biopsied or diagnosed with clinically-insignificant cancer. Clinical trial information: NCT03702439 .
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Affiliation(s)
| | - Paula Burak
- Imperial Clinical Trials Unit, London, United Kingdom
| | | | - Emily Day
- Imperial Clinical Trials Unit, Imperial College London, London, United Kingdom
| | | | | | - Martin Gammon
- Imperial Prostate, Imperial College London, London, United Kingdom
| | | | | | - William McGuire
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Derek Price
- Imperial Prostate, Imperial College London, London, United Kingdom
| | - Toby Prevost
- Imperial Clinical Trials Unit, Imperial College London, London, United Kingdom
| | - Heminder Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, United Kingdom
| | - Henry Tam
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mathias Winkler
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Sivaprasad S, Raman R, Conroy D, Mohan, Wittenberg R, Rajalakshmi R, Majeed A, Krishnakumar S, Prevost T, Parameswaran S, Turowski P, Maheswari U, Khobragade R, Netuveli G, Sadanandan R, Greenwood J, Ramasamy K, Rao M, Bergeles C, Das T. The ORNATE India Project: United Kingdom-India Research Collaboration to tackle visual impairment due to diabetic retinopathy. Eye (Lond) 2020; 34:1279-1286. [PMID: 32398841 DOI: 10.1038/s41433-020-0854-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The ORNATE India project is funded by the UK Research and Innovation (UKRI) through the Global Challenges Research Fund. The aim is to build research capacity and capability in India and the UK to tackle global burden of diabetes-related visual impairment. As there are over 77 million people with diabetes in India, it is challenging to screen every person with diabetes annually for sight-threatening diabetic retinopathy (DR). Therefore, alternate safe approaches need to be developed so that those at-risk of visual impairment due to DR is identified promptly and treated. METHODS The project team utilised diverse global health strategies and research methods to co-design work packages to build research capacity and capability to ensure effective, affordable and efficient DR services are made available for the population. The strategies and methods employed included health system strengthening; implementation science; establishing care pathways; co-designing collaborative studies on affordable technologies, developing quality standards and guidelines to decrease variations in care; economic analysis; risk modelling and stratification. Five integrated work packages have been developed to deal with all aspects of DR care. These included implementation of a DR screening programme in the public health system in a district in Kerala, evaluating regional prevalence of diabetes and DR and assessing ideal tests for holistic screening for diabetes and its complications in 20 areas in India, utilising artificial intelligence on retinal images to facilitate DR screening, exploring biomarker and biosensor research to detect people at risk of diabetes complications, estimating cost of blindness in India and risk modelling to develop risk-based screening models for diabetes and its complications. A large collaborative network will be formed to propagate research, promote shared learning and bilateral exchanges between high- and middle-income countries to tackle diabetes-related blindness.
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Affiliation(s)
- S Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - R Raman
- Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - D Conroy
- UCL Institute of Ophthalmology, London, UK
| | - Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | | | - A Majeed
- Imperial College London, London, UK
| | - S Krishnakumar
- Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - S Parameswaran
- Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - P Turowski
- UCL Institute of Ophthalmology, London, UK
| | | | | | | | | | | | - K Ramasamy
- Aravind Medical Research Foundation, Madurai, India
| | - M Rao
- Imperial College London, London, UK
| | | | - T Das
- Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
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Goldberg R, Scotta C, Cooper D, Nissim-Eliraz E, Nir E, Tasker S, Irving PM, Sanderson J, Lavender P, Ibrahim F, Corcoran J, Prevost T, Shpigel NY, Marelli-Berg F, Lombardi G, Lord GM. Correction of Defective T-Regulatory Cells From Patients With Crohn's Disease by Ex Vivo Ligation of Retinoic Acid Receptor-α. Gastroenterology 2019; 156:1775-1787. [PMID: 30710527 DOI: 10.1053/j.gastro.2019.01.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) is characterized by an imbalance of effector and regulatory T cells in the intestinal mucosa. The efficacy of anti-adhesion therapies led us to investigate whether impaired trafficking of T-regulatory (Treg) cells contributes to the pathogenesis of CD. We also investigated whether proper function could be restored to Treg cells by ex vivo expansion in the presence of factors that activate their regulatory activities. METHODS We measured levels of the integrin α4β7 on Treg cells isolated from peripheral blood or lamina propria of patients with CD and healthy individuals (controls). Treg cells were expanded ex vivo and incubated with rapamycin with or without agonists of the retinoic acid receptor-α (RARA), and their gene expression profiles were analyzed. We also studied the cells in cytokine challenge, suppression, and flow chamber assays and in SCID mice with human intestinal xenografts. RESULTS We found that Treg cells from patients with CD express lower levels of the integrin α4β7 than Treg cells from control patients. The pathway that regulates the expression of integrin subunit α is induced by retinoic acid (RA). Treg cells from patients with CD incubated with rapamycin and an agonist of RARA (RAR568) expressed high levels of integrin α4β7, as well as CD62L and FOXP3, compared with cells incubated with rapamycin or rapamycin and all-trans retinoic acid. These Treg cells had increased suppressive activities in assays and migrated under conditions of shear flow; they did not produce inflammatory cytokines, and RAR568 had no effect on cell stability or lineage commitment. Fluorescently labeled Treg cells incubated with RAR568 were significantly more likely to traffic to intestinal xenografts than Treg cells expanded in control medium. CONCLUSIONS Treg cells from patients with CD express lower levels of the integrin α4β7 than Treg cells from control patients. Incubation of patients' ex vivo expanded Treg cells with rapamycin and an RARA agonist induced expression of α4β7 and had suppressive and migratory activities in culture and in intestinal xenografts in mice. These cells might be developed for treatment of CD. ClinicalTrials.gov, Number: NCT03185000.
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Affiliation(s)
- Rimma Goldberg
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Trust and King's College London, London, UK
| | - Cristiano Scotta
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Dianne Cooper
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Einat Nissim-Eliraz
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Eilam Nir
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Scott Tasker
- School of Immunology and Microbial Sciences, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Trust and King's College London, London, UK
| | - Peter M Irving
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeremy Sanderson
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Lavender
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Fowzia Ibrahim
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, London, UK
| | - Jonathan Corcoran
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Toby Prevost
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Nahum Y Shpigel
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Giovanna Lombardi
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Graham M Lord
- School of Immunology and Microbial Sciences, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Trust and King's College London, London, UK.
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Gulliford MC, Charlton J, Prevost T, Booth H, Fildes A, Ashworth M, Littlejohns P, Reddy M, Khan O, Rudisill C. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records. Value Health 2017; 20:85-92. [PMID: 28212974 PMCID: PMC5338873 DOI: 10.1016/j.jval.2016.08.734] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/06/2016] [Accepted: 08/27/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. METHODS A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. RESULTS In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. CONCLUSIONS Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Helen Booth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison Fildes
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Marcus Reddy
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Omar Khan
- Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, London, UK
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8
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Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost T, Gulliford MC. Fildes et al. Respond. Am J Public Health 2015; 105:e3-4. [DOI: 10.2105/ajph.2015.302853] [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: 11/04/2022]
Affiliation(s)
- Alison Fildes
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Judith Charlton
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Caroline Rudisill
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Peter Littlejohns
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Toby Prevost
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
| | - Martin C. Gulliford
- Alison Fildes, Judith Charlton, Peter Littlejohns, Toby Prevost, and Martin C. Gulliford are with the Department of Primary Care and Public Health Sciences, King’s College London, London, UK. Caroline Rudisill is with the Department of Social Policy, London School of Economics and Political Science, London
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9
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Kirkham B, Chaabo K, Hall C, Vincent A, Vasconcelos J, Prevost T, Panayi G, Corrigall V. FRI0159 Results of a Single Dose Ascending First-in-Man Trial of a Novel Biologic, Human Stress Protein Rasolvir (BIP) in Rheumatoid Arthritis (RA): The Ragulo Trial. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3346] [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: 11/03/2022]
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10
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Simmons D, Yu D, Bunn C, Cohn S, Wenzel H, Prevost T. Hospitalisation among patients with diabetes associated with a Diabetes Integrated Care Initiative: a mixed methods case study. Future Hosp J 2015; 2:92-98. [PMID: 31098093 DOI: 10.7861/futurehosp.2-2-92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Integrated care has been postulated to result in improvements to diabetes outcomes, including reduced hospitalisation. The Diabetes Integrated Care Initiative (DICI) aimed to integrate primary, secondary and community diabetes care in East Cambridgeshire and Fenland (ECF). The aims of this study were to describe changes in care and hospitalisation rates over the first 3 years of the initiative, 2009-2012. The evaluation involved a mixed-methods approach, including a before-after design with controls from adjacent geographical areas and from patients without diabetes, alongside a 30-month ethnographic study including interviews with patients and health professionals. Over the three years, admission rates among patients with diabetes in the intervention area continued to grow. In fact, the increases in admissions in ECF were 7.4% (95% CI 5.2-9.2) and 45.5% (95% CI 42.5-48.5) greater than in the neighbouring areas of Huntingdonshire and Greater Cambridge, respectively. The rates of increase in diabetic foot, non-elective or other hospital admissions were not reduced. In summary, the DICI was not associated with improved diabetes care or reduced diabetes hospitalisation over the 3 years studied, despite substantial investment. While the principle of integration remains an ideal, linking different providers in ECF, especially those that are positioned between primary and secondary care, created barriers rather than bridges to better diabetes outcomes.
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Affiliation(s)
- David Simmons
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK, and Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Dahai Yu
- Primary Care and Health Sciences, Keele University, Stafford, UK
| | - Christopher Bunn
- King's Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Cohn
- Department of Health Services Research and Policy, LSHTM, London, UK
| | | | - Toby Prevost
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
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Booth H, Khan O, Prevost T, Reddy M, Dregan A, Charlton J, Ashworth M, Rudisill C, Littlejohns P, Gulliford MC. Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study. Lancet Diabetes Endocrinol 2014; 2:963-8. [PMID: 25466723 DOI: 10.1016/s2213-8587(14)70214-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 12/17/2022]
Abstract
BACKGROUND The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. METHODS We did a matched cohort study of adults (age 20–100 years) identified from a UK-wide database of family practices, who were obese (BMI ≥30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched them--according to BMI, age, sex, index year, and HbA1c--with 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. FINDINGS During a maximum of 7 years of follow-up (median 2·8 years [IQR 1·3–4·5]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 4·3% (95% CI 2·9–6·5) of bariatric surgery patients and 16·2% (13·3–19·6) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 28·2 (95% CI 24·4–32·7) per 1000 person-years in controls and 5·7 (4·2–7·8) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 0·20 (95% CI 0·13–0·30, p<0·0001). This estimate was robust after varying the comparison group in sensitivity analyses, excluding gestational diabetes, or allowing for competing mortality risk. INTERPRETATION Bariatric surgery is associated with reduced incidence of clinical diabetes in obese participants without diabetes at baseline for up to 7 years after the procedure. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Helen Booth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
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12
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Marcovecchio ML, Woodside J, Jones T, Daneman D, Neil A, Prevost T, Dalton RN, Deanfield J, Dunger DB. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): urinary screening and baseline biochemical and cardiovascular assessments. Diabetes Care 2014; 37:805-13. [PMID: 24198300 DOI: 10.2337/dc13-1634] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the association between early increases in albumin excretion and cardiovascular (CV) and renal markers in a large cohort of young people with type 1 diabetes. RESEARCH DESIGN AND METHODS As part of preliminary screening for a multicenter, randomized controlled trial of statins/ACE inhibitors, we measured albumin-creatinine ratio (ACR) in six early morning urine samples from 3,353 adolescents (10-16 years of age) and calculated tertiles based on an established algorithm. From those subjects deemed to be at higher risk (upper ACR tertile), we recruited 400 into the intervention study (trial cohort). From those subjects deemed to be at lower risk (middle-lower ACR tertiles), we recruited 329 to the observation cohort. At baseline, vascular measurements (carotid intima-media thickness, pulse wave velocity [PWV], flow-mediated dilatation, digital pulse amplitude tonometry), renal markers (symmetric dimethylarginine, cystatin C, creatinine), and CV disease markers (lipids and apolipoproteins [Apo] A-1 and B, C-reactive protein, asymmetric dimethylarginine) were assessed. RESULTS Age- and sex-adjusted PWV was higher in the trial than in the observational cohort (5.00 ± 0.84 vs. 4.86 ± 0.70 m/s; P = 0.021). Similarly, non-HDL cholesterol (2.95 ± 0.83 vs. 2.81 ± 0.78 mmol/L; P = 0.02) and ApoB-ApoA-1 ratio (0.50 ± 0.14 vs. 0.47 ± 0.11; P = 0.04) were higher in the trial cohort. Cystatin C and creatinine were decreased (0.88 ± 0.13 vs. 0.90 ± 0.13 mg/L, P = 0.04; 51.81 ± 10.45 vs. 55.35 ± 11.05 μmol/L, P < 0.001; respectively) and estimated glomerular filtration rate (137.05 ± 23.89 vs. 129.31 ± 22.41 mL/min/1.73 m(2); P < 0.001) increased in the trial compared with the observational cohort. CONCLUSIONS Our data demonstrate that in adolescents with type 1 diabetes, the group with the highest tertile of albumin excretion showed more evidence of early renal and CV disease than those in the lower tertiles.
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13
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Lloyd SKW, Kasbekar AV, Kenway B, Prevost T, Hockman M, Beale T, Graham J. Cochlear Rotation and its Relevance to Cochlear Implantation. Cochlear Implants Int 2013. [DOI: 10.1179/146701010x12726366067815] [Citation(s) in RCA: 3] [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: 10/31/2022]
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14
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Corrie PG, Moody M, Wood V, Bavister L, Prevost T, Parker RA, Sabes-Figuera R, McCrone P, Balsdon H, McKinnon K, O'Sullivan B, Tan RS, Barclay SIG. Protocol for the OUTREACH trial: a randomised trial comparing delivery of cancer systemic therapy in three different settings: patient's home, GP surgery and hospital day unit. BMC Cancer 2011; 11:467. [PMID: 22035502 PMCID: PMC3214181 DOI: 10.1186/1471-2407-11-467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/29/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The national Cancer Reform Strategy recommends delivering care closer to home whenever possible. Cancer drug treatment has traditionally been administered to patients in specialist hospital-based facilities. Technological developments mean that nowadays, most treatment can be delivered in the out-patient setting. Increasing demand, care quality improvements and patient choice have stimulated interest in delivering some treatment to patients in the community, however, formal evaluation of delivering cancer treatment in different community settings is lacking. This randomised trial compares delivery of cancer treatment in the hospital with delivery in two different community settings: the patient's home and general practice (GP) surgeries. METHODS/DESIGN Patients due to receive a minimum 12 week course of standard intravenous cancer treatment at two hospitals in the Anglia Cancer Network are randomised on a 1:1:1 basis to receive treatment in the hospital day unit (control arm), or their own home, or their choice of one of three neighbouring GP surgeries. Overall patient care, treatment prescribing and clinical review is undertaken according to standard local practice. All treatment is dispensed by the local hospital pharmacy and treatment is delivered by the hospital chemotherapy nurses. At four time points during the 12 week study period, information is collected from patients, nursing staff, primary and secondary care teams to address the primary end point, patient-perceived benefits (using the emotional function domain of the EORTC QLQC30 patient questionnaire), as well as secondary end points: patient satisfaction, safety and health economics. DISCUSSION The Outreach trial is the first randomised controlled trial conducted which compares delivery of out-patient based intravenous cancer treatment in two different community settings with standard hospital based treatment. Results of this study may better inform all key stakeholders regarding potential costs and benefits of transferring clinical services from hospital to the community. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN66219681.
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Affiliation(s)
| | | | - Victoria Wood
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Toby Prevost
- General Practice and Primary Care Research Unit, University of Cambridge, UK
| | - Richard A Parker
- General Practice and Primary Care Research Unit, University of Cambridge, UK
| | - Ramon Sabes-Figuera
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Kings College London, UK
| | - Paul McCrone
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Kings College London, UK
| | - Helen Balsdon
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Ray S Tan
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen IG Barclay
- General Practice and Primary Care Research Unit, University of Cambridge, UK
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15
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Burton K, Prevost T, Gahir D, Mukesh M, Harris F, Jena R, Burnet N, Jefferies S. Outcome of Vestibular Schwannoma Treated with Fractionated Radiotherapy from a Single UK Centre. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Griffin N, Addley H, Sala E, Shaw AS, Grant LA, Eldaly H, Davies SE, Prevost T, Alexander GJ, Lomas DJ. Vascular invasion in hepatocellular carcinoma: is there a correlation with MRI? Br J Radiol 2011; 85:736-44. [PMID: 21385912 DOI: 10.1259/bjr/94924398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide. Prognosis is predicted by size at diagnosis, vascular invasion and tumour proliferation markers. This study investigates if MRI features of histologically proven HCCs correlate with vascular invasion. METHODS Between 2006 and 2008, 18 consecutive patients, with a total of 27 HCCs, had comprehensive MRI studies performed at our institution within a median of 36 days of histology sampling. Each lesion was evaluated independently on MRI by 3 radiologists (blinded to both the radiology and histopathology reports) using a 5-point confidence scale for 23 specific imaging features. The mean of the rating scores across readers was calculated to determine interobserver consistency. The most consistent features were then used to examine the value of features in predicting vascular invasion, using a χ(2 )test for trend, having eliminated those features without sufficient variability. RESULTS 22 of the 23 imaging features showed sufficient variability across lesions. None of these significantly correlated with the presence of vascular invasion, although a trend was identified with the presence of washout in the portal venous phase on MRI and the median size of lesions, which was greater with vascular invasion. CONCLUSION This study suggests that no single MRI feature accurately predicts the presence of vascular invasion in HCCs, although a trend was seen with the presence of washout in the portal venous phase post gadolinium. Larger prospective studies are required to investigate this further.
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Affiliation(s)
- N Griffin
- Department of Radiology, Guys and St Thomas' Hospital, London, UK
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17
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Dudderidge TJ, Kelly JD, Wollenschlaeger A, Okoturo O, Prevost T, Robson W, Leung HY, Williams GH, Stoeber K. Diagnosis of prostate cancer by detection of minichromosome maintenance 5 protein in urine sediments. Br J Cancer 2010; 103:701-7. [PMID: 20648010 PMCID: PMC2938246 DOI: 10.1038/sj.bjc.6605785] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The accuracy of prostate-specific antigen (PSA) testing in prostate cancer detection is constrained by low sensitivity and specificity. Dysregulated expression of minichromosome maintenance (Mcm) 2–7 proteins is an early event in epithelial multistep carcinogenesis and thus MCM proteins represent powerful cancer diagnostic markers. In this study we investigate Mcm5 as a urinary biomarker for prostate cancer detection. Methods: Urine was obtained from 88 men with prostate cancer and from two control groups negative for malignancy. A strictly normal cohort included 28 men with complete, normal investigations, no urinary calculi and serum PSA <2 ng ml–1. An expanded control cohort comprised 331 men with a benign final diagnosis, regardless of PSA level. Urine was collected before and after prostate massage in the cancer patient cohort. An immunofluorometric assay was used to measure Mcm5 levels in urine sediments. Results: The Mcm5 test detected prostate cancer with 82% sensitivity (confidence interval (CI)= 72–89%) and with a specificity ranging from 73 (CI=68–78%) to 93% (CI=76–99%). Prostate massage led to increased Mcm5 signals compared with pre-massage samples (median 3440 (interquartile range (IQR) 2280 to 5220) vs 2360 (IQR <1800 to 4360); P=0.009), and was associated with significantly increased diagnostic sensitivity (82 vs 60% P=0.012). Conclusions: Urinary Mcm5 detection seems to be a simple, accurate and noninvasive method for identifying patients with prostate cancer. Large-scale prospective trials are now required to evaluate this test in diagnosis and screening.
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Affiliation(s)
- T J Dudderidge
- Department of Pathology and Cancer Institute, University College London, Rockefeller Building, 21 University Street, London, WC1E 6JJ, UK
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18
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Loddo M, Kingsbury SR, Rashid M, Proctor I, Holt C, Young J, El Sheikh S, Falzon M, Eward KL, Prevost T, Sainsbury R, Stoeber K, Williams GH. Cell cycle phase progression analysis identifies unique replication phenotypes of major prognostic and predictive significance in cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-5066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #5066
BACKGROUND: The cell cycle machinery acts as an integration point for information transduced through complex and redundant upstream oncogenic signalling pathways. Multiparameter analysis of core regulatory proteins involved in G1-S and G2-M cell cycle phase transitions provides a powerful biomarker readout for assessment of the cell cycle state. We have applied this novel algorithm to breast cancer, investigating its cell cycle kinetics, and determining how this impacts on pathobiology and disease progression in-vivo.
 METHODS AND FINDINGS: Protein expression profiles of key constituents of the DNA replication licensing pathway (Mcm2, geminin) and mitotic machinery (Plk1, Aurora A, Aurora substrate Histone H3S10ph), mediators of G1-S and G2-M transition respectively, were generated for a cohort of 182 patients. Arrested differentiation and development of genomic instability was associated with increased engagement of cells into the cell division cycle (p<0.0001). Three unique cell cycle phenotypes were identified; (I) well differentiated tumours composed predominantly of Mcm2 negative cells indicative of an out-of-cycle state (18% of cases), (II) high Mcm2 expressing tumours but with low geminin, Aurora A, Plk1 and H3S10ph levels (S-G2-M progression markers) indicative of a G1 delayed/arrested state (24% cases), (III) high expressing Mcm2 tumours, but also expressing high levels of the S-G2-M progression markers, indicative of accelerated cell cycle progression (58% of cases). The accelerated cell cycle phenotype had a significantly higher risk of relapse when compared with out-of-cycle and G1 delayed/arrested tumour phenotypes (HR=3.90 [1.81-8.40], p<0.001). Notably high grade tumours with the G1 delayed/arrested phenotype showed an identical low risk of relapse to well differentiated out-of-cycle tumours (HR=1.00 [0.22-4.46], p=0.99), suggesting that many patients are receiving inappropriate S-G2-M phase directed adjuvant chemotherapy.
 CONCLUSIONS: This biomarker algorithm provides novel insights into the cell cycle state of dynamic tumour cell populations in-vivo, information that impacts on individualised therapeutic decisions. The cell cycle phenotype has a major influence on disease progression, identifying those patients at most risk of relapse. Importantly, it is only patients displaying an accelerated phenotype, tumours that show S-G2-M phase transit, that are likely to derive benefit from S and G2-M phase specific adjuvant chemotherapeutic agents and mechanistic drugs.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5066.
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Affiliation(s)
- M Loddo
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
| | - SR Kingsbury
- 2 Wolfson Institute for Biomedical Research, University College London, London, United Kingdom
| | - M Rashid
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
| | - I Proctor
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
| | - C Holt
- 3 Anglia Ruskin University, Cambridge, United Kingdom
| | - J Young
- 3 Anglia Ruskin University, Cambridge, United Kingdom
| | - S El Sheikh
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
| | - M Falzon
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
| | - KL Eward
- 3 Anglia Ruskin University, Cambridge, United Kingdom
| | - T Prevost
- 4 Centre for Applied Medical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - R Sainsbury
- 5 Princess Anne Hospital, Southampton, United Kingdom
| | - K Stoeber
- 2 Wolfson Institute for Biomedical Research, University College London, London, United Kingdom
| | - GH Williams
- 1 Department of Pathology and Cancer Institute, University College London, London, United Kingdom
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Abstract
OBJECTIVE To compare day hospital to day centre rehabilitation using scales to measure mobility, activities of daily living and quality of life. DESIGN Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. SETTING Mainly rural health district. Day hospital and social services day centres in market towns. INTERVENTIONS Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. MAIN OUTCOME MEASURES World Health Organization mobility scale scored with and without aid, Nottingham Extended Activities of Daily Living Scale and Nottingham Health Profile. SUBJECTS One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). RESULTS At three months there were no statistically significant differences between rehabilitation at day hospital and day centre for any of the outcome measurements. However, there were significant improvements between baseline and three months for the following subscales [mean change per six-week period (95% confidence interval) ]: WHO mobility subscale (with aid) -0.67 (-0.99,-0.35); Nottingham Health Profile mobility subscale -10 (-15.5,-4.5) Nottingham extended ADL mobility subscale +3.08 (1.78,4.37); Nottingham extended ADL leisure subscale +1.66 (0.96,2.36). CONCLUSION There were no differences between day hospital and day centre in the outcomes measured. Day rehabilitation appeared to improve functional ability and mobility and scales reflecting these domains deserve further evaluation as outcome measures in this patient group. However, no improvement in quality of life was observed.
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Affiliation(s)
- S Burch
- Hinchingbrooke Hospital, Huntingdon, UK
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20
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Andrieu N, Prevost T, Rohan TE, Luporsi E, Lê MG, Gerber M, Zaridze DG, Lifanova Y, Renaud R, Lee HP, Duffy SW. Variation in the interaction between familial and reproductive factors on the risk of breast cancer according to age, menopausal status, and degree of familiality. Int J Epidemiol 2000; 29:214-23. [PMID: 10817116 DOI: 10.1093/ije/29.2.214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have found that reproductive factors might have a variable effect on the occurrence of breast cancer (BC) according to the existence or not of a family history of BC. The effect of a family history of BC on the risk of BC may also vary according to the age at diagnosis and the degree of kinship. This may confound the relation between familial risk and reproductive factors. A combined analysis was performed to study the interaction between familial risk and reproductive factors according to degree of familiality, age at interview and menopausal status. METHODS The present analysis included 2948 cases and 4170 controls in seven case-control studies from four countries. The combined relative risks were estimated using a Bayesian random-effects logistic regression model. RESULTS The main effects of reproductive life factors on the risk of BC are in agreement with previous studies. Two-way interactions between subject's age or menopausal status and a family history of BC were not significant. Although the three-way interaction between age, familial risk and parity was not significant, familial risk seemed to be increased slightly for women with high parity compared with women with low parity in the older age group, and seemed to be slightly decreased for women with high parity compared with women with low parity in younger women. The subject's age also appeared to have an effect on the interaction between familial risk and the age at first childbirth (P = 0.1). CONCLUSIONS A possible influence of reproductive and menstrual factors on familial risk of BC has been suggested previously and was also evident in the present study. Three-way interactions between age, family history and parity or age at first childbirth might exist and they merit further investigation.
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Affiliation(s)
- N Andrieu
- Unité INSERM 521, Institut Gustave Roussy, Villejuif, France.
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Abstract
OBJECTIVE To compare the outcome of day hospital to day centre rehabilitation. DESIGN Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. SETTING Mainly rural health district. Day hospital and social services day centres in market towns. SUBJECTS One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). INTERVENTIONS Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. MAIN OUTCOME MEASURES Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index. RESULTS More day centre (23/55) than day hospital patients (6/50) (p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) (n = 34) and day centres = +1.5 (0.48) (n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (-1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) (n = 35) and day centres was +0.9 (0.63) (n = 38). The mean difference was -0.88 (-2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was -1.45 (0.5) (n = 23) and day centre was -1.59 (0.47) (n = 27). The difference was -0.14 (1.52, +1.24). (These analyses are all on an intention-to-treat basis.) CONCLUSION Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.
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Affiliation(s)
- S Burch
- Hinchingbrooke Hospital, Huntingdon, Cambs, UK
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22
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Borland C, Burch S, McKay M, Longbottom J, Prevost T. A Randomised Controlled Trial of Day Hospital and Day Centre Rehabilitation. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_3.p22-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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