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King J, Patel K, Woolf D, Hatton MQ. The Use of Palliative Radiotherapy in the Treatment of Lung Cancer. Clin Oncol (R Coll Radiol) 2022; 34:761-770. [PMID: 36115746 DOI: 10.1016/j.clon.2022.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
There have been significant advances in the systemic treatment of stage IV lung cancer, which is now recommended first line in patients with adequate fitness. This includes some patients with brain metastases due to the increased understanding of the central nervous system penetration of targeted therapies. The trials evidence base for palliative radiotherapy pre-dated this routine use of systemic therapy in our practice, which means that the sequence and role of palliative radiotherapy are not currently well defined in the first-line treatment setting. However, due to its efficacy in symptom control, radiotherapy remains a core component in the palliative management of lung cancer, particularly in the second-line setting and those unsuited to primary systemic treatment. This overview focuses on the evidence behind palliative radiotherapy to the thorax and brain for non-small cell and small cell lung cancer and the potential for future studies, including the TOURIST Trial Platform, to guide the future direction of these treatments.
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Affiliation(s)
- J King
- The Christie Hospital NHS Foundation Trust, Manchester, UK.
| | - K Patel
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - D Woolf
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M Q Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
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Dellon E, Rothenberg M, Hirano I, Bredenoord A, Lucendo A, Sun X, Patel K, Beazley B. DUPILUMAB IMPROVES CLINICAL, SYMPTOMATIC, HISTOLOGIC, ENDOSCOPIC ASPECTS OF EOE: POOLED RESULTS FROM PHASE 3 LIBERTY-EOE-TREET. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.603] [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: 11/11/2022]
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Patel K, Cuervo-Pardo L, Cresoe S, Cavero-Chavez V. AN UNUSUAL TRANSITION FROM CUTANEOUS TO SYSTEMIC MASTOCYTOSIS IN A PEDIATRIC PATIENT. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.960] [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: 11/11/2022]
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Manzar G, Wu S, Khan M, Corrigan K, Yoder A, Gunther J, Thomas S, Manasanch E, Lee H, Lim T, Amini B, Lin P, Orlowski R, Patel K, Becnel M, Kaufman G, Weber D, Dabaja B, Pinnix C, Fang P. Outcome of Patients with Central Nervous System Multiple Myeloma (CNS-MM) Treated with CNS-Directed Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1473] [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: 10/31/2022]
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Patel K, Thigpen B, Chohan L, Nijjar J. Laparoscopic Hysterectomy Following Robotic Radical Trachelectomy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang S, Reynolds M, Dusenbery K, Chen C, Alaei P, Alshreef A, Sterling D, Sloan L, Patel K, Ferreira C. Considerations in Treatment Planning and Dosimetric Specifications of Permanent 131Cs Brachytherapy Implantation in Treatment of Brain Tumor – An Institutional Experience. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2217] [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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Patel K, Robertson E, Kwong ASF, Griffith GJ, Willan K, Green MJ, Patalay P, Porteous D, Katikreddi SV. Inequalities in psychological distress before and during the COVID-19 pandemic among UK adults. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence about how population mental health has evolved from before and over the COVID-19 pandemic remains mixed, with impacts on mental health inequalities being unclear. We investigated changes in mental health and sociodemographic inequalities from before and across the first year of the pandemic.
Methods
Data from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were analysed, estimates pooled, and stratified by age, sex, ethnicity, country and lone household status. Trends in the prevalence of poor mental health were assessed before the pandemic (TP0) and across the pandemic at three time periods (initial lockdown (TP1), easing of restrictions (TP2), and a subsequent lockdown (TP3)).
Results
In total, 49,993 adult participants were analysed across the 11 cohort studies. There was an overall worsening in mental health from pre-pandemic scores across all three pandemic timepoints, (TP1 Standardised Mean Difference: 0.15 (95% CI: 0.06 - 0.25); TP2 SMD: 0.18 (0.09 - 0.27); TP3 SMD: 0.21 (0.10 - 0.32)) with no evidence of improvement during the period of eased lockdown restrictions in summer 2020. Changes from pre-pandemic psychological distress were higher in females during the pandemic (TP3 SMD: 0.23 (0.11 - 0.35)), amongst those with degree-level education (TP3 SMD: 0.26 (0.14 - 0.38)), and adults aged 25-44 years. We did not find evidence of changes in distress differing by ethnicity, lone household status or UK nation.
Conclusions
The substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted and a sustained worsening was observed across the pandemic. Mental health declines have been unequal across the population and these results have implications for policy, including the need for specific investment for support for those most affected to mitigate the effects of the pandemic and measures to reduce inequalities within these specific groups.
Key messages
• A sustained deterioration in mental health was observed from before the start of the COVID-19 pandemic, and did not recover when social restrictions were eased.
• Deterioration in mental health varied by sociodemographic factors, namely age, sex, and education, and highlights a need for improved mental health care provision to minimise widening inequalities.
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Affiliation(s)
- K Patel
- MRC Unit For Lifelong Health and Ageing, UCL , London, UK
| | - E Robertson
- Social and Public Health Sciences Unit, University of Glasgow , Glasgow, UK
| | - ASF Kwong
- Division of Psychiatry, University of Edinburgh , Edinburgh, UK
- MRC Integrative Epidemiology Unit, University of Bristol , Bristol, UK
| | - GJ Griffith
- MRC Integrative Epidemiology Unit, University of Bristol , Bristol, UK
- Population Health Sciences, University of Bristol , Bristol, UK
| | - K Willan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - MJ Green
- Social and Public Health Sciences Unit, University of Glasgow , Glasgow, UK
| | - P Patalay
- MRC Unit For Lifelong Health and Ageing, UCL , London, UK
- Centre for Longitudinal Studies, UCL , London, UK
| | - D Porteous
- Institute of Genetics and Cancer, University of Edinburgh , Edinburgh, UK
- Centre for Medical Information, University of Edinburgh , Edinburgh, UK
| | - SV Katikreddi
- Social and Public Health Sciences Unit, University of Glasgow , Glasgow, UK
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Patel K, Bajaj N, Statton B, Li X, Herath NS, Nyamakope K, Davidson R, Stoks J, Purkayastha S, Ware JS, O'Regan DP, Lambiase PD, Cluitmans M, Peters NS, Ng FS. Bariatric surgery reverses ventricular repolarisation heterogeneity in obesity: mechanistic insights into fat-related arrhythmic risk. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity is a growing global health problem that confers higher risks of atrial arrhythmias and sudden cardiac death. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.
Purpose
To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).
Methods
ECGi was performed in 16 obese patients pre-bariatric surgery (PreSurg; mean age 43±12 years, 13 female) and 16 age- and sex-matched non-obese (lean) individuals (42±11 years). 12 of the 16 obese patients also underwent ECGi after bariatric surgery (PostSurg). Over 2000 atrial and ventricular epicardial electrograms were computed using high density body surface mapping (256-lead ECG) and heart-torso geometries from cardiac magnetic resonance imaging, by solving the inverse problem of electrocardiography. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10 mm radius divided by the corresponding distance.
Results
Body mass index was greater in PreSurg vs lean (46.7±5.5 vs 22.8±2.6 kg/m2, p<0.0001) and decreased with surgery (PostSurg 36.8±6.5 kg/m2, p<0.0001). Epicardial adipose tissue (EAT) was greater in PreSurg vs lean (83±56 vs 28±13 ml, p<0.0001) and decreased post-surgery (PostSurg 69±45 ml, p=0.0010). Total atrial AT was prolonged in PreSurg vs lean (62±15 vs 46±12 ms, p=0.0028), which persisted post-surgery (PostSurg 67±15 ms, p=0.86). Atrial ATG were also greater in PreSurg vs lean (26±11 vs 14±8 ms, p=0.0007) and did not change with weight loss (PostSurg 25±12, p=0.44). Ventricular RTG were greater in PreSurg vs lean (26±11 vs 15±7 ms/mm, p=0.0024) and decreased with weight loss (PostSurg 19±8, p=0.0009). Ventricular RTG were similar between PostSurg and lean (p=0.20). EAT from lean and PreSurg individuals correlated with atrial ATG (r=0.36, p=0.044) and ventricular RTG (r=0.54, p=0.0014). Ventricular AT were similar between lean (31±6 ms), PreSurg (34±5 ms) and PostSurg (35±9 ms); all p>0.05.
Conclusion
Steep ventricular repolarisation gradients and prolonged atrial activation contribute to the proarrhythmic substrate in obesity. Ventricular repolarisation gradients correlate with epicardial adiposity and both regress post-bariatric surgery. By contrast, atrial activation remains prolonged after weight loss. These results provide mechanistic insights into obesity-related arrhythmic risks and their reversibility with weight loss following bariatric surgery.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).
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Affiliation(s)
- K Patel
- National Heart and Lung Institute , London , United Kingdom
| | - N Bajaj
- National Heart and Lung Institute , London , United Kingdom
| | - B Statton
- Imperial College London , London , United Kingdom
| | - X Li
- National Heart and Lung Institute , London , United Kingdom
| | - N S Herath
- Imperial College London , London , United Kingdom
| | - K Nyamakope
- Imperial College London , London , United Kingdom
| | - R Davidson
- Imperial College London , London , United Kingdom
| | - J Stoks
- Maastricht University , Maastricht , The Netherlands
| | | | - J S Ware
- National Heart and Lung Institute , London , United Kingdom
| | - D P O'Regan
- Imperial College London , London , United Kingdom
| | - P D Lambiase
- University College London , London , United Kingdom
| | - M Cluitmans
- Maastricht University , Maastricht , The Netherlands
| | - N S Peters
- National Heart and Lung Institute , London , United Kingdom
| | - F S Ng
- National Heart and Lung Institute , London , United Kingdom
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Presenter RRBN, Shah N, Alencar A, Gerson J, Patel M, Jurczak W, Patel K, Mato A, Cheah C, Wang M. PIRTOBRUTINIB, A HIGHLY SELECTIVE, NON-COVALENT (REVERSIBLE) BTK INHIBITOR IN PREVIOUSLY TREATED MANTLE CELL LYMPHOMA: UPDATED RESULTS FROM THE PHASE 1/2 BRUIN STUDY. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.214] [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: 11/11/2022] Open
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Abstract
Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes diagnosed in young individuals that lack the typical features of type 1 and type 2 diabetes. The genetic subtype of MODY determines the most effective treatment and this is the driver for MODY genetic testing in diabetes populations. Despite the obvious clinical and health economic benefits, MODY is significantly underdiagnosed with the majority of patients being inappropriately managed as having type 1 or type 2 diabetes. Low detection rates result from the difficulty in identifying patients with a likely diagnosis of MODY from the high background population of young onset type 1 and type 2 diabetes, compounded by the lack of MODY awareness and education in diabetes care physicians. MODY diagnosis can be improved through (1) access to education and training, (2) the use of sensitive and specific selection criteria based on accurate prediction models and biomarkers to identify patients for testing, (3) the development and mainstream implementation of simple criteria-based selection pathways applicable across a range of healthcare settings and ethnicities to select the most appropriate patients for genetic testing and (4) the correct use of next generation sequencing technology to provide accurate and comprehensive testing of all known MODY and monogenic diabetes genes. The creation and public sharing of educational materials, clinical and scientific best practice guidelines and genetic variants will help identify the missing patients so they can benefit from the more effective clinical care that a genetic diagnosis brings.
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Affiliation(s)
- Kevin Colclough
- Exeter Genomics LaboratoryRoyal Devon & Exeter NHS Foundation TrustExeterUK
| | - Kashyap Patel
- Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
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Branstetter BF, Reddy N, Patel K, Sekula R. Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus: A Novel Measurement to Distinguish Different Causes of Classic Trigeminal Neuralgia. AJNR Am J Neuroradiol 2022; 43:1460-1463. [PMID: 36109121 PMCID: PMC9575533 DOI: 10.3174/ajnr.a7634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Classic trigeminal neuralgia is a clinical syndrome of facial pain, most often attributable to vascular compression of the proximal cisternal segment of the trigeminal nerve and treatable with microvascular decompression of the nerve. Some patients, however, meet all clinical criteria for classic trigeminal neuralgia yet do not respond to microvascular decompression. Because the reasons for surgical failure are not well understood, the aim of this study was to determine if a subset of patients with classic trigeminal neuralgia could be distinguished by measuring the angle of the trigeminal nerve in the sagittal plane as the nerve traverses the porus trigeminus. MATERIALS AND METHODS We retrospectively identified patients with either classic trigeminal neuralgia (n = 300) or hemifacial spasm (n = 300) who had undergone MR imaging, including 3-plane steady-state free precession imaging. Patients with hemifacial spasm served as controls. On sagittal steady-state free precession images, we measured the angle of each trigeminal nerve as it crosses through the porus trigeminus into the Meckel cave (SATNaPT). In patients with classic trigeminal neuralgia, we separated the nerves into symptomatic and asymptomatic sides. We compared these 3 groups using the Student t test. RESULTS Control patients had a mean SATNaPT of 170° (SD, 11°) with a normal distribution. The contralateral asymptomatic nerve in patients with classic trigeminal neuralgia had the same distribution of angles. The symptomatic nerves in patients with classic trigeminal neuralgia had a bimodal distribution; 83% of patients fell into the same distribution as the asymptomatic nerves, but the other 15% had an average angle of 143° (SD, 7°). This difference was statistically significant (P < .0001). CONCLUSIONS Patients with the clinical syndrome of classic trigeminal neuralgia fell into 2 categories based on the radiologic measurement of the SATNaPT. Most patients had an anatomically normal nerve that was affected by vascular compression, but 17% of these patients had aberrant anatomy that may cause or contribute to their clinical presentation. Further study is needed to determine whether this subset of patients should receive a different surgery to better address their underlying anatomic abnormality. The SATNaPT measurement should be included in every MR imaging interpretation performed on patients with classic trigeminal neuralgia.
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Affiliation(s)
- B F Branstetter
- From the Departments of Radiology (B.F.B.)
- Otolaryngology (B.F.B.)
| | - N Reddy
- University of Pittsburgh (N.R., K.P.), Pittsburgh, Pennsylvania
| | - K Patel
- University of Pittsburgh (N.R., K.P.), Pittsburgh, Pennsylvania
| | - R Sekula
- Neurosurgery (R.S.), University of Pittsburgh School Medicine, Pittsburgh, Pennsylvania
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Barreto RR, Patel K, Coombs C, Shah N, Eyre T, Wierda W, Ghia P, Davids M, Jurczak W, Mato A. PIRTOBRUTINIB, A HIGHLY SELECTIVE, NON-COVALENT (REVERSIBLE) BTK INHIBITOR IN PREVIOUSLY TREATED CLL/SLL: UPDATED RESULTS FROM THE PHASE 1/2 BRUIN STUDY. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.235] [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: 11/05/2022] Open
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Kamal MA, Kuznik A, Qi L, Więcek W, Hussein M, Hassan H, Patel K, Obadia T, Toroghi MK, Conrado DJ, Al‐Huniti N, Casciano R, O'Brien MP, Barnabas RV, Cohen MS, Smith PF. Assessing the Combined Public Health Impact of Pharmaceutical Interventions on Pandemic Transmission and Mortality: An Example in SARS CoV-2. Clin Pharmacol Ther 2022; 112:1224-1235. [PMID: 35984050 PMCID: PMC9538838 DOI: 10.1002/cpt.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
To assess the combined role of anti-viral monoclonal antibodies (mAbs) and vaccines in reducing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) transmission and mortality in the United States, an agent-based model was developed that accounted for social contacts, movement/travel, disease progression, and viral shedding. The model was calibrated to coronavirus disease 2019 (COVID-19) mortality between October 2020 and April 2021 (aggressive pandemic phase), and projected an extended outlook to estimate mortality during a less aggressive phase (April-August 2021). Simulated scenarios evaluated mAbs for averting infections and deaths in addition to vaccines and aggregated non-pharmaceutical interventions. Scenarios included mAbs as a treatment of COVID-19 and for passive immunity for postexposure prophylaxis (PEP) during a period when variants were susceptible to the mAbs. Rapid diagnostic testing paired with mAbs was evaluated as an early treatment-as-prevention strategy. Sensitivity analyses included increasing mAb supply and vaccine rollout. Allocation of mAbs for use only as PEP averted up to 14% more infections than vaccine alone, and targeting individuals ≥ 65 years averted up to 37% more deaths. Rapid testing for earlier diagnosis and mAb use amplified these benefits. Doubling the mAb supply further reduced infections and mortality. mAbs provided benefits even as proportion of the immunized population increased. Model projections estimated that ~ 42% of expected deaths between April and August 2021 could be averted. Assuming sensitivity to mAbs, their use as early treatment and PEP in addition to vaccines would substantially reduce SARS-CoV-2 transmission and mortality even as vaccination increases and mortality decreases. These results provide a template for informing public health policy for future pandemic preparedness.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ruanne V. Barnabas
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North CarolinaChapel HillNorth CarolinaUSA
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Momah T, Patel K. Acute Cholecystitis and Diverticular Abscess Patient with COVID-19 Infection. West Afr J Med 2022; 39:982-984. [PMID: 36128899] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This is a case of a 53-year-old African American woman with newly diagnosed concomitant acute cholecystitis, diverticulitis, and SARS-COV-2 infection. She underwent treatment for COVID-19 with antibiotics and supportive treatment, and on day 32 after initial symptoms presented, she had an elective laparoscopic cholecystectomy. Our patient was one of the first cases to present with acute cholecystitis and diverticulitis complicated by COVID-19, and serves as a template for surgical management of non-emergent abdominal pathologies in the midst of the COVID-19 pandemic.
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Affiliation(s)
- T Momah
- University of Mississippi Medical Center, USA
| | - K Patel
- University of Mississippi Medical Center, USA
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Cannon S, Clissold R, Sukcharoen K, Tuke M, Hawkes G, Beaumont RN, Wood AR, Gilchrist M, Hattersley AT, Oram RA, Patel K, Wright C, Weedon MN. Recurrent 17q12 microduplications contribute to renal disease but not diabetes. J Med Genet 2022; 60:491-497. [PMID: 36109160 PMCID: PMC10176419 DOI: 10.1136/jmg-2022-108615] [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: 04/05/2022] [Accepted: 09/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND 17q12 microdeletion and microduplication syndromes present as overlapping, multisystem disorders. We assessed the disease phenotypes of individuals with 17q12 CNV in a population-based cohort. METHODS We investigated 17q12 CNV using microarray data from 450 993 individuals in the UK Biobank and calculated disease status associations for diabetes, liver and renal function, neurological and psychiatric traits. RESULTS We identified 11 17q12 microdeletions and 106 microduplications. Microdeletions were strongly associated with diabetes (p=2×10-7) but microduplications were not. Estimated glomerular filtration rate (eGFR mL/min/1.73 m2) was consistently lower in individuals with microdeletions (p=3×10-12) and microduplications (p=6×10-25). Similarly, eGFR <60, including end-stage renal disease, was associated with microdeletions (p=2×10-9, p<0.003) and microduplications (p=1×10-9, p=0.009), respectively, highlighting sometimes substantially reduced renal function in each. Microduplications were associated with decreased fluid intelligence (p=3×10-4). SNP association analysis in the 17q12 region implicated changes to HNF1B as causing decreased eGFR (NC_000017.11:g.37741642T>G, rs12601991, p=4×10-21) and diabetes (NC_000017.11:g.37741165C>T, rs7501939, p=6×10-17). A second locus within the region was also associated with fluid intelligence (NC_000017.11:g.36593168T>C, rs1005552, p=6×10-9) and decreased eGFR (NC_000017.11:g.36558947T>C, rs12150665, p=4×10-15). CONCLUSION We demonstrate 17q12 microdeletions but not microduplications are associated with diabetes in a population-based cohort, likely caused by HNF1B haploinsufficiency. We show that both 17q12 microdeletions and microduplications are associated with renal disease, and multiple genes within the region likely contribute to renal and neurocognitive phenotypes.
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Affiliation(s)
- Stuart Cannon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Rhian Clissold
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Kittiya Sukcharoen
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Marcus Tuke
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Gareth Hawkes
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Robin N Beaumont
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew R Wood
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Mark Gilchrist
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Kashyap Patel
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Caroline Wright
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Michael N Weedon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Colclough K, Patel K. Response to Comment on Colclough et al. and Saint-Martin et al. Syndromic Monogenic Diabetes Genes Should Be Tested in Patients With a Clinical Suspicion of Maturity-Onset Diabetes of the Young. Diabetes 2022;71:530-537, and Gene Panel Sequencing of Patients With Monogenic Diabetes Brings to Light Genes Typically Associated With Syndromic Presentations. Diabetes 2022;71:578-584. Diabetes 2022; 71:e11-e12. [PMID: 35984960 DOI: 10.2337/db22-0400] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Kevin Colclough
- Exeter Genomics Laboratory, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, U.K
| | - Kashyap Patel
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
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Patel K, Beaver D, Gruber N, Printezis G, Giannopulu I. Mental imagery of whole-body motion along the sagittal-anteroposterior axis. Sci Rep 2022; 12:14345. [PMID: 35999355 PMCID: PMC9399091 DOI: 10.1038/s41598-022-18323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
Whole-body motor imagery is conceptualised as a mental symbolisation directly and indirectly associated with neural oscillations similar to whole-body motor execution. Motor and somatosensory activity, including vestibular activity, is a typical corticocortical substrate of body motion. Yet, it is not clear how this neural substrate is organised when participants are instructed to imagine moving their body forward or backward along the sagittal-anteroposterior axis. It is the aim of the current study to identify the fingerprint of the neural substrate by recording the cortical activity of 39 participants via a 32 electroencephalography (EEG) device. The participants were instructed to imagine moving their body forward or backward from a first-person perspective. Principal Component Analysis (i.e. PCA) applied to the neural activity of whole-body motor imagery revealed neural interconnections mirroring between forward and backward conditions: beta pre-motor and motor oscillations in the left and right hemisphere overshadowed beta parietal oscillations in forward condition, and beta parietal oscillations in the left and right hemisphere overshadowed beta pre-motor and motor oscillations in backward condition. Although functional significance needs to be discerned, beta pre-motor, motor and somatosensory oscillations might represent specific settings within the corticocortical network and provide meaningful information regarding the neural dynamics of continuous whole-body motion. It was concluded that the evoked multimodal fronto-parietal neural activity would correspond to the neural activity that could be expected if the participants were physically enacting movement of the whole-body in sagittal-anteroposterior plane as they would in their everyday environment.
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Affiliation(s)
- K Patel
- School of Human Sciences and Humanities, University of Houston, Houston, 77001, USA
| | - D Beaver
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - N Gruber
- Department of Mathematics, University of Innsbruck, 6020, Innsbruck, Austria.,VASCage, 6020, Innsbruck, Austria
| | - G Printezis
- Department of Electrical Engineering, Technological University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - I Giannopulu
- Creative Robotics Lab, UNSW, Sydney, 2021, Australia. .,Clinical Research and Technological Innovation, 75016, Paris, France.
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Fujikawa P, Brand K, Shah S, Munshi V, Patel K. Multiple Myeloma Uncovered Under Excessive Antacid and Chronic NSAID Use in a Young Female. Cureus 2022; 14:e27629. [PMID: 36072215 PMCID: PMC9437417 DOI: 10.7759/cureus.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/11/2022] Open
Abstract
Multiple myeloma (MM) is a plasma cell dyscrasia in which nearly all cases are diagnosed in patients over 40 years old. This report illustrates a case of a young female who presented with severe generalized weakness, acute kidney injury, hypercalcemia, and anemia. Her symptoms were initially attributed to chronic NSAID and antacid intake, especially given her young age. However, further workup was pursued to rule out other potential diagnoses despite her age. She was ultimately diagnosed with multiple myeloma and started on bortezomib, cyclophosphamide, and dexamethasone. This report emphasizes the importance of maintaining a broad differential diagnosis. Untrained physicians can easily overlook rare cases. Timely diagnosis and treatment are key, and therefore, a high degree of suspicion is crucial for this patient population.
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Patel K, Mukhi H, Patel A, Nathwani N, Mehta D, Sherak J, Clinton N, Pisarik H, Brown B, Rogers S, Kruczynski M, Ferreyros N, Okon T. Addressing cancer health disparities in a multilateral collaboration in an independent community cancer clinic: translating words into action. Am J Manag Care 2022; 28:SP398-SP401. [PMID: 36049231 DOI: 10.37765/ajmc.2022.88856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ramarao-Milne P, Kondrashova O, Patch AM, Nones K, Koufariotis LT, Newell F, Addala V, Lakis V, Holmes O, Leonard C, Wood S, Xu Q, Mukhopadhyay P, Naeini MM, Steinfort D, Williamson JP, Bint M, Pahoff C, Nguyen PT, Twaddell S, Arnold D, Grainge C, Basirzadeh F, Fielding D, Dalley AJ, Chittoory H, Simpson PT, Aoude LG, Bonazzi VF, Patel K, Barbour AP, Fennell DA, Robinson BW, Creaney J, Hollway G, Pearson JV, Waddell N. Comparison of actionable events detected in cancer genomes by whole-genome sequencing, in silico whole-exome and mutation panels. ESMO Open 2022; 7:100540. [PMID: 35849877 PMCID: PMC9463385 DOI: 10.1016/j.esmoop.2022.100540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background Next-generation sequencing is used in cancer research to identify somatic and germline mutations, which can predict sensitivity or resistance to therapies, and may be a useful tool to reveal drug repurposing opportunities between tumour types. Multigene panels are used in clinical practice for detecting targetable mutations. However, the value of clinical whole-exome sequencing (WES) and whole-genome sequencing (WGS) for cancer care is less defined, specifically as the majority of variants found using these technologies are of uncertain significance. Patients and methods We used the Cancer Genome Interpreter and WGS in 726 tumours spanning 10 cancer types to identify drug repurposing opportunities. We compare the ability of WGS to detect actionable variants, tumour mutation burden (TMB) and microsatellite instability (MSI) by using in silico down-sampled data to mimic WES, a comprehensive sequencing panel and a hotspot mutation panel. Results We reveal drug repurposing opportunities as numerous biomarkers are shared across many solid tumour types. Comprehensive panels identify the majority of approved actionable mutations, with WGS detecting more candidate actionable mutations for biomarkers currently in clinical trials. Moreover, estimated values for TMB and MSI vary when calculated from WGS, WES and panel data, and are dependent on whether all mutations or only non-synonymous mutations were used. Our results suggest that TMB and MSI thresholds should not only be tumour-dependent, but also be sequencing platform-dependent. Conclusions There is a large opportunity to repurpose cancer drugs, and these data suggest that comprehensive sequencing is an invaluable source of information to guide clinical decisions by facilitating precision medicine and may provide a wealth of information for future studies. Furthermore, the sequencing and analysis approach used to estimate TMB may have clinical implications if a hard threshold is used to indicate which patients may respond to immunotherapy. Genome analysis revealed that treatment biomarkers are shared across solid tumours, highlighting repurposing opportunities. Comprehensive panels detect most known biomarkers; however, WGS detects more biomarkers for treatments in clinical trials. TMB is well correlated between sequencing methods, but absolute values vary and are dependent on mutation types considered.
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Affiliation(s)
- P Ramarao-Milne
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - O Kondrashova
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - A-M Patch
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Nones
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L T Koufariotis
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - F Newell
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - V Addala
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - V Lakis
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - O Holmes
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - C Leonard
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - S Wood
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Q Xu
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - P Mukhopadhyay
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - M M Naeini
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - D Steinfort
- Department of Thoracic Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - J P Williamson
- Department of Thoracic Medicine, Liverpool Hospital Sydney, Sydney, Australia
| | - M Bint
- Department of Thoracic Medicine, Sunshine Coast University Hospital, Birtinya, Australia
| | - C Pahoff
- Department of Respiratory Medicine, Gold Coast University Hospital, Southport, Australia
| | - P T Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - S Twaddell
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - D Arnold
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - C Grainge
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - F Basirzadeh
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - D Fielding
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - A J Dalley
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - H Chittoory
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - P T Simpson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - L G Aoude
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - V F Bonazzi
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - K Patel
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - A P Barbour
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia; Upper Gastro-intestinal Surgical Unit, Department of Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - D A Fennell
- Cancer Research UK Centre Leicester, University of Leicester & University Hospitals of Leicester NHS Trust, Leicester, UK
| | - B W Robinson
- National Centre for Asbestos Related Disease, Institute of Respiratory Health, University of Western Australia, Nedlands, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - J Creaney
- National Centre for Asbestos Related Disease, Institute of Respiratory Health, University of Western Australia, Nedlands, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - G Hollway
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J V Pearson
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - N Waddell
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
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Colclough K, van Heugten R, Patel K. An update on the diagnosis and management of monogenic diabetes. Practical Diabetes 2022. [DOI: 10.1002/pdi.2410] [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: 11/08/2022]
Affiliation(s)
- Kevin Colclough
- Exeter Genomics Laboratory, Royal Devon & Exeter NHS Foundation Trust Exeter UK
| | - Rachel van Heugten
- Exeter Genomics Laboratory, Royal Devon & Exeter NHS Foundation Trust Exeter UK
| | - Kashyap Patel
- Institute of Biomedical and Clinical Science University of Exeter Medical School Exeter UK
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, 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Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Elumalai T, Barker C, Elliott T, Malik J, Tran A, Hudson A, Song YP, Patel K, Lyons J, Hoskin P, Choudhury A, Mistry H. Translation of Prognostic and Pharmacodynamic Biomarkers from Trial to Non-trial Patients with Metastatic Castration-resistant Prostate Cancer Treated with Docetaxel. Clin Oncol (R Coll Radiol) 2022; 34:e291-e297. [PMID: 35314092 DOI: 10.1016/j.clon.2022.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
AIMS We conducted a pooled analysis of four randomised controlled trials and a non-trial retrospective dataset to study the changes in serum prostate-specific antigen (PSA) concentrations during treatment and its impact on survival in men treated with docetaxel for metastatic castration-resistant prostate cancer. We also compared the outcomes and pre-treatment prognostic factors between trial and non-trial patients. MATERIALS AND METHODS Data were obtained from four randomised controlled trials and a non-trial cohort from a tertiary cancer centre. The PSA kinetics covariates chosen were absolute value (PSAT), best percentage change (BPCH) and tumour growth rate (K). The association between the covariates collected and overall survival was assessed within a Cox proportional hazards model. How well a covariate captured the difference between trial and non-trial patients was assessed by reporting on models with or without trial status as a covariate. RESULTS We reviewed individual datasets of 2282 patients. The median overall survival for trial patients was 20.4 (95% confidence interval 19.6-22.2) months and for the non-trial cohort was 12.4 (10.7-14.7) months (P < 0.001). Of the pre-treatment factors, we found that only lactate dehydrogenase fully captured the difference in prognosis between the trial and non-trial cohorts. All PSA kinetic metrics appeared to be prognostic in both the trial and non-trial patients. However, the effect size was reduced in non-trial versus trial patients (interaction P < 0.001). Of the time-dependent covariates, we found that BPCH best captured the difference between trial and non-trial patient prognosis. CONCLUSIONS The analysis presented here highlights how data from open-source trial databases can be combined with emerging clinical practice databases to assess differences between trial versus non-trial patients for particular treatments. These results highlight the importance of developing prognostic models using both pre-treatment and time-dependent biomarkers of new treatments.
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Affiliation(s)
- T Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Barker
- The Christie NHS Foundation Trust, Manchester, UK
| | - T Elliott
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - J Malik
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, UK
| | - Y P Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Lyons
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK.
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Pandya M, Patel K. P-596 Comparative efficacy of Letrozole (5 mg) versus Clomiphene citrate (100 mg) for ovulation induction among infertile women. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does Letrozole have better offerings while being compared to Clomiphene citrate as an Ovulation inducing agent in infertile women?
Summary answer
Compared to clomiphene, Letrozole - an aromatase inhibitor, is associated with higher live-birth and ovulation rates among infertile women.
What is known already
Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause.
Clomiphene citrate has been traditionally used as the drug of choice for treatment of women with anovulatory infertility. In the last decade, an aromatase inhibitor, letrozole, has emerged as an alternative ovulation induction agent among anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to clomiphene citrate therapy, as confirmed by literature.
Study design, size, duration
Randomized double-blind study. Total 100 women were randomly assigned and divided into 2 groups of 50 patients each. The 2 groups were well matched at baseline. Study participants are of age 20 to 39 years. Study began in October 2019 and was completed in October 2021.
Participants/materials, setting, methods
Group 1: Clomiphene citrate (100 mg daily) and group 2: letrozole (5 mg daily), started from any day between 3-5 of the menstrual cycle and continued up to 5 consecutive days. Both groups have received Estradiol Valerate 4 mg on the 12th day of menstruation until 16th day of menstruation.
All patients had USG monitoring of follicular and endometrium size with perifollicular flow and uterine scoring system for reproduction (USSR) score with timed intercourse.
Main results and the role of chance
Women who received letrozole as compared to those who received clomiphene citrate had more cumulative live births (36 of 50 [72%] vs. 28 of 50 [56%]). Number of women ovulated in Letrozole group was – 42 (84%) while in Clomiphene citrate (CC) Group it was 39 (78%). The ovulation rate was significantly higher with letrozole than with clomiphene citrate. Among the study participants who ovulated, there was a significantly greater chance of singleton pregnancy with letrozole compared to clomiphene citrate.
The mean number of dominant follicles (18 mm) was 1.40 ± 0.58 for letrozole and 1.10 ± 0.86 for clomiphene citrate (P-value = <0.05). The size of follicular development by day 14 was 17.6 ± 2.92 mm in Letrozole group while in Clomiphene citrate group it was 15.8 ± 3.84 mm (P-value = <0.05). The mean endometrial thickness by day 14 was 7.2 ± 0.77 mm for Letrozole and 6.8 ± 0.92 mm for clomiphene citrate (P-value = <0.05).
Limitations, reasons for caution
In our study, we have not considered lifestyle intervention before enrolment; although such interventions are recommended by experts, but there is currently no evidence from high quality clinical trials that they improve pregnancy outcomes in obese women.
Wider implications of the findings
Although Letrozole has still not gained universal acceptance as an ovulating agent for a variety of reasons, emerging evidences suggests that Letrozole could be an effective option and is non inferior to clomiphene citrate as an ovulating agent especially, in patients with non- responders to Clomiphene citrate and PCOS women.
Trial registration number
Not applicable
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Affiliation(s)
- M.R Pandya
- Scientific Research institute- Surendranagar-, Dept. of Obstetrics and Gynecology- Scientific Research institute- Surendranagar-Gujarat- India , surendranagar, India
| | - K Patel
- Nootan Medical College and Research Centre- Visnagar- Gujarat- India, Dept. of Obstetrics and Gynaecology- , Visnagar, India
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Brahmbhatt N, Mishra V, Aggrawal R, Chaudhary S, Shah K, Priya P, Solanki S, Sheth H, Patel K, Suthar A, Patel K, Repswal P, Dongare A. P-059 Effect of outcome of microfluidic sperm sorter and conventional swim-up technique on DNA integrity of the sperm. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does the approach of sperm preparation technique plays any role in sperm DNA Integrity
Summary answer
Outcome of the semen sample is directly proportional to the choice of preparation technique. Microfluidics improves sperm selection and results in better sperm DNA integrity
What is known already
Microfluidic systems are promising tools for fluid manipulation that can noninvasively separate motile sperm with higher hydrodynamics profile from the lower ones. It also enables to manipulate micro swimmers as compared to the traditional methods that to without centrifugation .As it is already known that Semen analysis and preparation is one of the most important aspects in andrology and microfluidics can improve sperm analysis and selection, therefore increasing the ART success rates
Study design, size, duration
Comparative study from July 2019 to Dec 2021 in IVF unit of IKDRC Hospital .A total number of 900 patients were enrolled in the study and were randomized by using computer generated list then divided into two groups, Group A contains 460 samples and Group B having 440 samples.
Participants/materials, setting, methods
Group A (n = 460) sample was prepared by using Microfluidic sperm Sorting technique and Group B (n = 440) sample was prepared by conventional Swim up technique. Samples were analyzed according to WHO 2010 laboratory manual for examination and processing of human sperm, including all normozoospermic samples. Primary outcomes of the study was DNA Fragmentation index (DFI) and it was evaluated by using sperm chromatin dispersion (SCD) test and secondary outcomes was Progressive motility .
Main results and the role of chance
DNA fragmentation index is significantly lower in group A where Microfluidic Sperm Sorting technique (MFSS )is used than in group B where conventional swim up technique is use (10.06% vs 34.2%, p<0.0001) significant values implies that DNA integrity is better in group A than in group B and progressive motility was also found to be significantly higher in group A as compared to group B (57.6%vs16.9%, p <0.001).
Limitations, reasons for caution
As sample size was smaller, larger randomized control studies are needed to strengthen these results and all normal samples were used for the analysis and preparation , abnormal parameters were not involved .
Wider implications of the findings
According to our study the samples prepared by Microfluidic technique have higher DNA integrity than samples prepared by Swim up technique. Lower DNA Fragmentation index in microfluidics outcome indicates lower DNA damage. Choice of technique for the preparation of semen sample also plays a key role in better sperm selection.
Trial registration number
N/A
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Affiliation(s)
- N Brahmbhatt
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - V Mishra
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - R Aggrawal
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - S Chaudhary
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - K Shah
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - P Priya
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - S Solanki
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
| | - H Sheth
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - K Patel
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - A Suthar
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - K Patel
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - P Repswal
- IVF Unit -Department of obs and gynae , Embryology, ahemdabad, India
| | - A Dongare
- IVF Unit -Department of obs and gynae, obstetrics and gynaecology , ahemdabad, India
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Patel SA, Forrester A, Kang H, Collin E, Patel K. A Case of Foix-Chavany-Marie Syndrome With Asynchronous Bilateral Opercular Infarcts and Chronic Bilateral Cerebellar Infarcts. Cureus 2022; 14:e26013. [PMID: 35855258 PMCID: PMC9286304 DOI: 10.7759/cureus.26013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Foix-Chavany-Marie syndrome (FCMS) is characterized by bilateral facio-glosso-pharyngo-masticatory paralysis of voluntary muscles due to bilateral infarction in the anterior opercular region of the brain. Here, we report a case of a 52-year-old female who presented with FCMS due to an acute left anterior opercular stroke in the setting of a chronic asymptomatic right opercular infarct and asymptomatic bilateral cerebellar infarcts. She also had a concurrent acute-on-chronic episode of congestive heart failure exacerbation. She made a significant recovery by the time of hospital discharge.
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Wills NK, Nair N, Patel K, Sikder O, Adriaanse M, Eikelboom J, Wasserman S. Efficacy and safety of intensified versus standard prophylactic anticoagulation therapy in patients with Covid-19: a systematic review and meta-analysis. Open Forum Infect Dis 2022; 9:ofac285. [PMID: 35859991 PMCID: PMC9214161 DOI: 10.1093/ofid/ofac285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background Randomized controlled trials (RCTs) have reported inconsistent effects from intensified anticoagulation on clinical outcomes in coronavirus disease 2019 (COVID-19). We performed an aggregate data meta-analysis from available trials to quantify effect on nonfatal and fatal outcomes and identify subgroups who may benefit. Methods We searched multiple databases for RCTs comparing intensified (intermediate or therapeutic dose) vs prophylactic anticoagulation in adults with laboratory-confirmed COVID-19 through 19 January 2022. We used random-effects meta-analysis to estimate pooled risk ratios for mortality, thrombotic, and bleeding events (at end of follow-up or discharge) and performed subgroup analysis for clinical setting and dose of intensified anticoagulation. Results Eleven RCTs were included (N = 5873). Intensified vs prophylactic anticoagulation was not associated with a mortality reduction up to 45 days (risk ratio [RR], 0.93 [95% confidence interval {CI}, .79–1.10]). There was a possible signal of mortality reduction for non–intensive care unit (ICU) patients, although with low precision and high heterogeneity (5 studies; RR, 0.84 [95% CI, .49–1.44]; I2 = 75%). Risk of venous thromboembolism was reduced (RR, 0.53 [95% CI, .41–.69]; I2 = 0%), with effect driven by therapeutic rather than intermediate dosing (interaction P = .04). Major bleeding was increased with intensified anticoagulation (RR, 1.73 [95% CI, 1.17–2.56]) with no interaction for dosing and clinical setting. Conclusions Intensified anticoagulation has no effect on mortality among hospitalized adults with COVID-19 and is associated with increased bleeding risk. The observed reduction in venous thromboembolism risk and trend toward reduced mortality in non-ICU settings requires exploration in additional RCTs. Clinical Trials Registration. CRD42021273449 (PROSPERO).
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Affiliation(s)
- Nicola K Wills
- University of Cape Town Department of Medicine, , Cape Town, South Africa
| | - Nikhil Nair
- McMaster University Michael G. DeGroote School of Medicine, , Hamilton, Ontario, Canada
| | - Kashyap Patel
- University of Ottawa School of Medicine, , Ottawa, Ontario, Canada
| | - Omaike Sikder
- McMaster University Michael G. DeGroote School of Medicine, , Hamilton, Ontario, Canada
| | | | - John Eikelboom
- McMaster University Michael G. DeGroote School of Medicine, , Hamilton, Ontario, Canada
| | - Sean Wasserman
- University of Cape Town Division of Infectious Diseases and HIV Medicine, Department of Medicine, , Cape Town, South Africa
- University of Cape Town Welcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, , Cape Town, South Africa
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [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] Open
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Jain N, Thompson P, Burger J, Ferrajoli A, Takahashi K, Estrov Z, Borthakur G, Bose P, Kadia T, Pemmaraju N, Sasaki K, Konopleva M, Jabbour E, Garg N, Wang X, Kanagal-Shamanna R, Patel K, Wang W, Wang S, Jorgensen J, Lopez W, Ayala A, Plunkett W, Gandhi V, Kantarjian H, O’Brien S, Keating M, Wierda W. S149: LONG TERM OUTCOMES OF IFCG REGIMEN FOR FIRSTLINE TREATMENT OF PATIENTS WITH CLL WITH MUTATED IGHV AND WITHOUT DEL(17P)/TP53 MUTATION. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843488.43813.af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Datta SN, Chalokia RS, Wing KW, Patel K, Solanki R, Desai J. Ultramini-percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of 10-30 mm calculi: a randomized controlled trial. Urolithiasis 2022; 50:361-367. [PMID: 35107612 DOI: 10.1007/s00240-022-01304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
The surgical management of renal stones 10-30 mm is usually performed with percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Standard form of percutaneous nephrolithotomy has paved the way for miniaturized PCNL in many centres. We wanted to evaluate the efficacy, safety and the cost-effectiveness of ultramini-percutaneous nephrolithotomy (UMP) versus RIRS in the treatment of renal stones with stone burden 10-30 mm. Patients with renal stone burden 10-30 mm were prospectively randomized into either UMP or RIRS. The demographic data, stone characteristic, operative time and cost of the equipment were recorded. The stone free status, analgesic requirement, deterioration of the renal function and hemoglobin and the postoperative complications as per Clavein-Dindo grade were recorded. One hundred and fifty patients met inclusion criteria. Out of these 98 underwent UMP and 46 RIRS. Six withdrew the consent before the procedure. Mean stone size was comparable in either of the groups. Mean laser time and stone extraction time was significantly less for UMP compared to RIRS (41.17 min versus 73.58 min p < 0.0001). Mean consumable costs in the UMP group were considerably less at US$45.73 compared to the RIRS group at $423.11 (p < 0.0001). The stone free rates at 1 month of follow-up were 100% for UMP group and 73% for RIRS group. There were insignificant changes to mean hemoglobin and glomerular filtration rate (GFR) in all patients and the average length of the stay was similar in both the groups. The postoperative complications revealed Grade I and II rate of 10% in the UMP group and 35% in the RIRS group, respectively. We concluded that UMP to be safe, effective and more economical to the RIRS for renal stones up to 3 cm in size.Trial registered with ISRCTN registry ID ISRCTN20935105, Retrospective.
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Affiliation(s)
| | | | - K W Wing
- Department of Urology, Colchester General Hospital, Colchester, UK
| | - K Patel
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - R Solanki
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India.
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Arunakumari P, Patel K, Tahir A, Wong C. 061 An audit of the practice of care in patients with premature ovarian insufficiency (POI) in a UK tertiary referral center. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.090] [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: 11/04/2022]
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84
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Lewis TL, Patel K, Shepherd KL, MacInnes P, Ray R, Kokkinakis M. Hallux valgus surgery in children with cerebral palsy: A systematic review. Foot Ankle Surg 2022; 28:476-482. [PMID: 35012870 DOI: 10.1016/j.fas.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity. OBJECTIVE To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy. METHODS A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included. RESULTS 58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented. CONCLUSION Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.
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Affiliation(s)
- T L Lewis
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK; King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK.
| | - K Patel
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - K L Shepherd
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - P MacInnes
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - M Kokkinakis
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
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Lillis A, Beverly S, Collins S, O’Driscoll M, Marsh E, Matthews J, Donovan J, Banya W, Madge S, Ukor EF, Felton I, Jones A, Belkarty B, Kapila D, Ge Y, Bowd G, Joshi N, Wahed M, Patel K, Simmonds N. P201 Bowel screening for cancer in pre-transplant people with cystic fibrosis and the accuracy of faecal immunochemical testing. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00530-6] [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: 11/26/2022]
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86
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Patel K, Bajaj N, Li X, Statton B, Stoks J, Nyamakope K, Davidson R, Savvidou S, Purkayastha S, Ware JS, O’regan D, Lambiase P, Cluitmans M, Peters NS, Ng FS. Bariatric surgery reduces ventricular repolarisation gradients in obese patients - results from an electrocardiographic imaging study. Europace 2022. [DOI: 10.1093/europace/euac053.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) British Heart Foundation
Background
Obesity confers higher risks of atrial arrhythmias and is associated with abnormal ventricular repolarisation. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.
Purpose
To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).
Methods
ECGi was performed in 8 obese patients before (PreOb) and after (PostOb) bariatric surgery (mean age 39+/-11years, 7 female), and in 8 age- and sex-matched non-obese controls (NOb) (40+/-11 years). ECGi recordings were made at rest, on exercise, and during recovery from exercise. For ECGi analysis, >2000 atrial and ventricular epicardial electrograms were calculated from body surface potential recordings from 256 sites and information from cardiac magnetic resonance imaging, by solving the inverse problem. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10mm radius divided by the corresponding Euclidean distance.
Results
BMI was greater in PreOb vs NOb (46.6+/-4.8 vs 23.8+/-2.6kg/m2, p<0.0001) and decreased with surgery (PostOb 35.3+/-4.2kg/m2, p<0.0001). Total atrial AT was prolonged in PreOb vs NOb (68+/-12 vs 45+/-10ms, p=0.016) and did not change post-surgery (PreOb vs PostOb: 68+/-12 vs 67+/-16ms, p=0.81). Atrial ATG were also greater in PreOb vs NOb: max 254+/-111 vs 106+/-58ms, p=0.035; mean 24+/-6 vs 12+/-6ms, p=0.0087) and did not change with weight loss (PreOb vs PostOb: max 254+/-111 vs 222+/-69ms/mm, p=0.61; mean 24+/-6 vs 21+/-7ms/mm, p=0.52). Ventricular RTG were greater in PreOb vs NOb (max: 287+/-73 vs 131+/-89ms/mm, p=0.012; mean: 33+/-10 vs 17+/-9ms/mm, p=0.0052). Ventricular RTG decreased with weight loss (PreOb vs PostOb: max 287+/-73 vs 151+/-54ms/mm, p=0.0070; mean: 33+/-10 vs 21+/-8ms/mm, p=0.018), and were similar between PostOb and NOb (max, p=0.81; mean p=0.58). Ventricular AT and RT were non-different in NOb, PreOb and PostOb.
Conclusion
Obesity is associated with pro-arrhythmic electrophysiological remodelling, including steeper ventricular repolarisation gradients and slower atrial activation. At 6 months post-bariatric surgery, there was a reduction in ventricular repolarisation gradients though atrial conduction abnormalities persisted. These findings provide a mechanistic insight into obesity-related arrhythmic risks and its potential reversibility with weight loss surgery.
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Affiliation(s)
- K Patel
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - N Bajaj
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - X Li
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - B Statton
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Stoks
- Maastricht University, Maastricht, Netherlands (The)
| | - K Nyamakope
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davidson
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Savvidou
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Purkayastha
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JS Ware
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - D O’regan
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Lambiase
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Cluitmans
- Maastricht University, Maastricht, Netherlands (The)
| | - NS Peters
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - FS Ng
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
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Patel D, Patel K. T008 Therapeutic importance of astilbin for the treatment of renal injury and hyperuricemia: Biological importance of xanthine oxidase in the kidney disorders. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.245] [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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88
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Patel D, Patel K. M245 Medicinal importance of gymnema sylvestre in traditional and complementary medicine for musculoskeletal disorders with their chemical and biological standardization. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.464] [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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89
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Patel D, Patel K. W213 Therapeutic interventions of aegeline for insulin resistance and type 2 diabetes: biological application through scientific research data analysis and molecular mechanism. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.972] [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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90
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Patel D, Patel K. T009 Therapeutic potential of cirsimaritin in the medicine for their effectiveness as anti-breast cancer drug: Biological importance and pharmacological activities. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.246] [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: 11/24/2022]
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91
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Patel D, Patel K. T301 Therapeutic potential of visnagin against liver inflammation mediated through oxidative stress: application of inflammatory mediators for the physiological functions. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.127] [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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92
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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93
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Patt D, Gordan L, Patel K, Okon T, Ferreyros N, Markward N, Sullivan M, Burnett B, Getachew B, Harris C. Considerations to increase rates of breast cancer screening across populations. Am J Manag Care 2022; 28:SP136-SP138. [PMID: 35285592 DOI: 10.37765/ajmc.2022.88855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES COVID-19 has caused considerable drops in utilization of breast cancer screening services during the pandemic, especially among certain racial and ethnic groups. Members of the Community Oncology Alliance (COA)-including the COA president, South Carolina oncologist Kashyap Patel, MD-have reported increases in patients, particularly those of color, presenting with stage III and IV cancer at diagnosis. According to data released by the Biden administration, more than 9.5 million recommended cancer screenings had been missed in the United States as a result of the COVID-19 pandemic, as of February 2022. President Joe Biden and First Lady Jill Biden, EdD, aim to address this in the 2022 revitalized Cancer Moonshot Initiative. The findings made by COA as well as by Avalere also suggest that the pandemic has exacerbated existing health care disparities. METHODS Using a multipayer database, we analyzed breast cancer screening rates for 2 periods-March 1 to September 30, 2019, and March 1 to September 30, 2020-among Medicare fee-for-service (FFS), managed Medicaid, and commercial insurance beneficiaries to understand the potential impact of the COVID-19 pandemic on adherence to the US Preventive Services Task Force breast cancer screening recommendations, which are currently undergoing review. Screening rates were evaluated across 5 racial/ethnic groups and by payer type. RESULTS Mean monthly mammogram screening rates among eligible White Medicare FFS beneficiaries dropped to 0.6% in April 2020, but these screening rates recovered to 6.5% by June 2020. Screening rates for eligible Black Medicare FFS beneficiaries recovered on a pace slightly slower than that of White beneficiaries, but more rapidly than that of other groups. By comparison, American Indian/Alaska Native beneficiaries had a mean monthly screening rate of 0.5% in April 2020, which recovered to 3.1% in June 2020; these were below 2019 screening rates of 4.2% for April and 3.9% for June. Differences in screening rates by payer type were also observed. Patients with commercial insurance had higher screening rates compared with those covered by Medicare FFS and managed Medicaid. CONCLUSIONS Our principal finding shows that mean breast cancer screening rates decreased in April 2020 across all payers, but recovery to prepandemic screening levels has occurred more slowly among certain racial and ethnic minority groups. Differences in recovery rates by payer type highlight a strong relationship between income level and screening utilization.
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Logan A, Buchholz E, Patel K. Evaluation of Mycophenolate Dose Reductions within the First Year After Lung Transplantation and Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Logan A, Davis N, Delk I, Hassett L, Olson S, Patel K. Characterization of Lung Transplant COVID19+ Patients and Mortality Outcomes. J Heart Lung Transplant 2022. [PMCID: PMC8988559 DOI: 10.1016/j.healun.2022.01.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study is to report the characteristic and mortality outcomes of lung transplant patients that contracted COVID19. Methods A retrospective chart review was conducted of lung transplant recipients who tested positive for COVID19 from 6/1/2020 to 9/1/2021. Results Forty-five patients were included for mortality incidence review with 2 patients who were admitted to outside facilities during their COVID diagnosis with limited treatment data. Mortality incidence was 15.5% with cohort mean age of 62 (±11.7). Median time from transplant to infection was 1281 days (223-5800). Five patients required O2 and n=5 were intubated with 80% mortality (n=4) among those intubated. Baseline demographics of age, gender, indication for transplant or race were not statistically different among patients that died vs those that survived. Vaccinations (2 doses) prior to infection were evident in n=35 (77.8%) of the patients. Maintenance immunosuppressants and covid therapies (table 1) did not have an associated difference in survival from infection. A significant association with mortality was found from the time of reported symptoms to triage or hospitalization in those that survived vs died, 3.3 vs 9.4 days (p=0.003). Conclusion This is one of the largest cohorts reporting lung transplant recipients who contracted COVID19, and despite lungs being the organ directly affected by COVID19, mortality rates are comparable to rates reported in other solid organ transplants. Time to triage from symptom onset to clinic management or hospital admission for COVID appears to be associated with improved mortality rates.
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Shankar S, Logan A, Davis N, Baker L, Patel K. Outcomes in Single versus Standard Dose Basiliximab After Lung Transplant. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Patel K, Bhatia-Patel S, Nayak A, Attia T, Rosenblum J, Vega J, Sahu A, Jokhadar M. Systemic Right Ventricle Mechanical Support with Impella 5.5 as a Bridge to Cardiac Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Uppoor RB, Patel K. Syncope: Diagnostic Yield of Various Clinical Investigations. Cureus 2022; 14:e23596. [PMID: 35505734 PMCID: PMC9053362 DOI: 10.7759/cureus.23596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: The present study was designed to evaluate the clinical profile of patients with syncope and the usefulness of various tests to reach a diagnosis of syncope and its etiology. Methods: This was a cross-sectional, observational study that enrolled 90 consecutive patients (aged ≥ 12 years) who presented with syncope. Detailed information was obtained from each enrolled patient on history and physical examination. All patients underwent electrocardiography (ECG) and echocardiographic examination. Other specific tests were also performed based on the findings from medical history, physical examination, ECG, and echocardiography findings. Results: Among 90 patients with syncope, 45% were males, and age distribution showed a bimodal distribution with two peaks. A total of 67% and 5% of patients had past history of syncope and injury due to syncope, respectively. Of the patients, 38% underwent Holter monitoring, 79 (87%) underwent head-up tilt table test (HUTT) test, 8% underwent treadmill test, 36% underwent CT/MRI of the brain, 25% underwent electroencephalography, 40% underwent carotid sinus massage, 7% underwent coronary angiography, 3% underwent electrophysiological study, and 3% of patients underwent carotid Doppler ultrasound. The commonly noted syncope was vasovagal/neutrally mediated syncope (68%). However, the etiology of syncope could not be determined in six (7%) patients. Conclusion: This study concluded that the initial evaluation of patients with syncope should focus on history, physical examination, and ECG examination. Information obtained from such basic evaluations should be used to guide the selection of further high yield tests to reduce the cost of evaluation and for appropriate workup for the diagnosis of syncope.
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Sahu LK, Tripathi N, Gupta M, Singh V, Yadav R, Patel K. Impact of COVID-19 Pandemic Lockdown in Ambient Concentrations of Aromatic Volatile Organic Compounds in a Metropolitan City of Western India. J Geophys Res Atmos 2022; 127:e2022JD036628. [PMID: 35602912 PMCID: PMC9111284 DOI: 10.1029/2022jd036628] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 06/15/2023]
Abstract
The real-time Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX) concentrations were measured in a metropolitan city of India during January to May of 2020 and 2014-2015-2018 to assess the impact of emission reduction during the COVID-19 lockdown. The total BTEX (∑BTEX) concentrations were 11.5 ± 9.0, 15.7 ± 16, 5.3 ± 5.0, 2.9 ± 2.0, and 0.93 ± 1.2 ppbv in January-May 2020, respectively. The evening rush hour peaks of BTEX during lockdown decreased by 4-5 times from the same period of years 2014-2015-2018. A significant decline in background concentrations suggests a regional-scale reduction in anthropogenic emissions. The contributions of ∑TEX compounds to ∑BTEX increased from 42% to 59% in winter to 64%-75% during the lockdown under hot summer conditions. While emission reductions dominated during the lockdown period, the meteorological and photochemical factors may also have contributed. Meteorological influence on actual observed BTEX data was removed by normalizing with ventilation coefficient (VC). The actual ambient air reductions of 85%-90% and VC-normalized reductions of 54%-88% of the BTEX concentrations during lockdown were estimated compared to those during the same period of 2014-2015-2018. The estimated changes using nighttime data, which take into account BTEX photooxidation removal, are ∼8% lower than the VC-normalized estimates using all data. These significant reductions in BTEX concentrations are consistent with the change in people's movement as inferred from mobility data during the lockdown. Although enforced, the significant decline in ambient BTEX levels during lockdown was a good change for the air quality. The study suggests a need for more effective science-based policies that consider local and regional factors.
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Affiliation(s)
- L. K. Sahu
- Physical Research Laboratory (PRL)AhmedabadIndia
| | | | - Mansi Gupta
- Physical Research Laboratory (PRL)AhmedabadIndia
- Indian Institute of Technology GandhinagarGandhinagarIndia
| | - Vikas Singh
- National Atmospheric Research Laboratory (NARL)GadankiIndia
| | - Ravi Yadav
- Indian Institute of Tropical Meteorology (IITM)PuneIndia
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