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Tresson P, Quiquandon S, Long A. Comment and Questions on "European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections". Eur J Vasc Endovasc Surg 2020; 61:162-163. [PMID: 33004281 DOI: 10.1016/j.ejvs.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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Mura M, Della Schiava N, Long A, Chirico EN, Pialoux V, Millon A. Carotid intraplaque haemorrhage: pathogenesis, histological classification, imaging methods and clinical value. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1273. [PMID: 33178805 PMCID: PMC7607119 DOI: 10.21037/atm-20-1974] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vulnerable carotid atherosclerotic plaques are characterised by several risk factors, such as inflammation, neovascularization and intraplaque haemorrhage (IPH). Vulnerable plaques can lead to ischemic events such as stroke. Many studies reported a relationship between IPH, plaque rupture, and ischemic stroke. Histology is the gold standard to evaluate IPH, but it required carotid endarterectomy (CEA) surgery to collect the tissue sample. In this context, several imaging methods can be used as a non-invasive way to evaluate plaque vulnerability and detect IPH. Most imaging studies showed that IPH is associated with plaque vulnerability and stroke, with magnetic resonance imaging (MRI) being the most sensitive and specific to detect IPH as a predictor of ischemic events. These conclusions are however still debated because of the limited number of patients included in these studies; further studies are required to better assess risks associated with different IPH stages. Moreover, IPH is implicated in plaque vulnerability with other risk factors which need to be considered to predict ischemic risk. In addition, MRI sequences standardization is required to compare results from different studies and agree on biomarkers that need to be considered to predict plaque rupture. In these circumstances, IPH detection by MRI could be an efficient clinical method to predict stroke. The goal of this review article is to first describe the pathophysiological process responsible for IPH, its histological detection in carotid plaques and its correlation with plaque rupture. The second part will discuss the benefits and limitations of imaging the carotid plaque, and finally the clinical interest of imaging IPH to predict plaque rupture, focusing on MRI-IPH.
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Quiquandon S, Bordet M, Rivoire E, Della Schiava N, Lermusiaux P, Millon A, Rabilloud M, Tresson P, Long A. ASA score is a risk factor of infection of the operative site after infra inguinal bypass. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sullivan K, Rudinsky S, Casey K, Long A, Osit A, Reilly E, Morrison T, Auten J, Caskey M, Halliday M, Biggs K. 88 Risk of Serious Bacterial Infections among Recently Immunized Young Febrile Infants in the General Emergency Setting. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khan Y, Carey-Smith R, Taylor M, Woodhouse J, Jacques A, Wood D, Long A. Treatment and outcomes for synovial sarcoma patients in Western Australia: the role of neoadjuvant chemoradiotherapy. Cancer Rep (Hoboken) 2020; 3:e1268. [PMID: 32881345 PMCID: PMC7941415 DOI: 10.1002/cnr2.1268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background This is a retrospective review of synovial sarcoma (SS) patients treated over the last 12 years in Western Australia (WA). SS is both chemo and radiotherapy sensitive. Results of trials in adjuvant chemotherapy are conflicting and there is limited support for neoadjuvant chemotherapy. The use of combined chemoradiotherapy is based on institutional preferences. Aim We reviewed the outcomes for SS patients treated in WA over a 12 year period focusing on patients who received neoadjuvant chemoradiotherapy (NACRT). Methods Patient details including demographics, histopathology, treatment details, were obtained from the WA sarcoma database (2006‐2018). Progression free survival (PFS) and overall survival (OS) were derived for whole cohort. Results Twenty seven patients were identified with SS with equal gender incidence. Median age of the cohort was 36 (14‐76) years. The most common primary site of disease was extremity (81.5%). 22/27 patients presented with only localized disease and 59.2% of these received neo‐adjuvant treatment. Of those who received neoadjuvant treatment, 56.2% had NACRT, while 25.0% and 18.7% of patients had chemotherapy and radiotherapy respectively. Mesna, doxorubicin, ifosfamide, dacarbazine (MAID) was the most commonly used chemotherapy regimen as neoadjuvant or adjuvant treatment while ifosfamide (93.7%) was the most commonly used chemotherapy drug in any setting. There was no reported case of disease progression in group of patients who received NACRT apart from one patient who had oligometastatic disease at diagnosis. Median OS of the whole cohort was 38 months while median PFS was 24 months. Bone marrow toxicity was the most commonly reported high grade toxicity in NACRT group (55.5%) but there were no treatment related deaths. Conclusion NACRT is not widely adopted and treatment is based on institutional preferences, however our data shows that NACRT is a feasible therapy option. NACRT should be evaluated prospectively in a randomized trial.
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Khider L, Soudet S, Laneelle D, Boge G, Bura-Rivière A, Constans J, Dadon M, Desmurs-Clavel H, Diard A, Elias A, Emmerich J, Galanaud JP, Giordana P, Gracia S, Hamade A, Jurus C, Le Hello C, Long A, Michon-Pasturel U, Mirault T, Miserey G, Perez-Martin A, Pernod G, Quere I, Sprynger M, Stephan D, Wahl D, Zuily S, Mahe G, Sevestre MA. Proposal of the French Society of Vascular Medicine for the prevention, diagnosis and treatment of venous thromboembolic disease in outpatients with COVID-19. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:210-213. [PMID: 32571561 PMCID: PMC7183940 DOI: 10.1016/j.jdmv.2020.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
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Moloney C, Long A, Pastores GM, Plant BJ, Murphy DM. A bolt from the blue; A case report of an unusual asthma exacerbation. Respir Med Case Rep 2019; 29:100983. [PMID: 31908916 PMCID: PMC6938945 DOI: 10.1016/j.rmcr.2019.100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background We describe this case of a young gentleman presenting with acute dyspnoea on a background history of known, long-standing asthma. His dramatic presentation, notable for profound hypoxia and cyanosis, led to an unexpected additional diagnosis of type one congenital methaemoglobinaemia. Case presentation A 26-year-old Irish gentleman was transferred urgently to the emergency department resuscitation room with marked cyanosis and tachypnoea. His oxygen saturation was 70% on 100% high flow oxygen. His arterial blood gas (On Fi02 90%) demonstrated a PaO2 = 76.8 kPa, SpO2 = 99%, pCO2 = 3 kPa and pH = 7.51. A saturation gap was evident and on further analysing the arterial blood gas, the methaemoglobin level was noted to be 28%. No contributing drugs were identified. Our patient was diagnosed with type one congenital methaemoglobinaemia. He recovered well from this admission, however, has had recurrent presentations to hospital since with high methaemoglobin levels noted on each occasion. Discussion Congenital methemoglobinemia is a rare, often overlooked differential diagnosis in patients presenting with cyanosis and dyspnoea. This is the only case, to our knowledge, of a patient with both asthma and congenital methaemoglobinaemia. Congenital methaemoglobinaemia was first described in 1943 by Dr Deeny who described two siblings as suffering from 'Familial Idiopathic Methaemoglobinaemia'. The case we present is the first reported Irish case of congenital methaemoglobinaemia, we are aware of, since 1943.Current treatment strategies include high-flow oxygen, methylene blue infusion (contraindicated in glucose-6-phosphate-dehydrogenase deficiency) and red cell exchange transfusions in the emergency setting whilst oral ascorbic acid and riboflavin are preventative.
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Sindher S, Kumar D, Purington N, Tupa D, Long A, Cao S, Woch M, Tan T, Skura S, Garcia-Lloret M, Chinthrajah S. P312 EFFICACY OF A FIXED DOSE OF OMALIZUMAB DURING MULTI-ALLERGEN ORAL-IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saleh M, Cassier P, Eberst L, Naik G, II VM, Pant S, Terret C, Gao L, Long A, Mao H, McNeely S, Carlesi R, Fu S. Ramucirumab plus merestinib in previously treated metastatic colorectal cancer: safety, pharmacokinetic, and preliminary efficacy findings from a Phase 1 study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz157.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bordet M, Roquet G, Bureau du Colombier P, Long A, Feugier P. A Thrombosed Popliteal Aneurysm Ruptured in the Setting of Chronic Limb Ischemia: A Rare Complication that Can Occur at Long Term. Ann Vasc Surg 2019; 60:478.e15-478.e18. [PMID: 31200046 DOI: 10.1016/j.avsg.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Abstract
Rupture of a chronic thrombosed or excluded popliteal arterial aneurysm is rare, but has been previously reported in the literature. The management of a ruptured thrombosed popliteal aneurysm, in a context of chronic limb ischemia, raises the problem of latent ischemia and its outcome. In this case report, we present the first case of a ruptured thrombosed popliteal aneurysm in a patient presenting chronic ischemia.
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Long A, Sindher S, Purington N, Andorf S, Tupa D, Nadeau K, Chinthrajah R. DOSE-DEPENDENT BIOMARKER CUT-OFFS PREDICTIVE OF ORAL FOOD CHALLENGE OUTCOMES. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sindher S, Long A, Purington N, Tupa D, Andorf S, Nadeau K, Chinthrajah R. INCREASED SEVERITY UPON REPEAT ORAL FOOD CHALLENGES IN MULTI-FOOD ALLERGIC INDIVIDUALS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thiney M, Della Schiava N, Ecochard R, Feugier P, Lermusiaux P, Millon A, Long A. Effects on Mortality and Cardiovascular Events of Adherence to Guideline-Recommended Therapy 4 Years after Lower Extremity Arterial Revascularization. Ann Vasc Surg 2018; 52:138-146. [DOI: 10.1016/j.avsg.2018.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
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Halkett GKB, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK. Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:967-975. [PMID: 28190236 DOI: 10.1007/s13187-017-1175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.
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Usman A, Lewis S, Hinsliff-Smith K, Long A, Housley G, Jordan J, Gage H, Dening T, Gladman JRF, Gordon AL. 46MEASURING HEALTH RELATED QUALITY OF LIFE OF CARE HOME RESIDENTS, COMPARISON OF SELF-REPORT BY OLDER PEOPLE WITH CAPACITY TO CONSENT AND STAFF PROXIES USING EQ-5D-5L AND HOWRU. Age Ageing 2018. [DOI: 10.1093/ageing/afy121.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fatzinger McShane P, Felter K, Ferguson D, Glass E, Handley R, Kohler E, Long A, Sachs A, Taley M, Turner D, Werth J, Wrobleski M. Dietetic Interns' Exposure to Urban Food Desert Corner Stores: Are Healthy Foods Available to Low-income Clients? J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Henni S, Mahe G, Lamotte C, Laurent R, Riviere AB, Aubourg M, Sarlon G, Laneelle D, Long A, Signolet I, Picquet J, Feuilloy M, Abraham P. Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain. Eur J Intern Med 2018; 52:28-34. [PMID: 29306678 DOI: 10.1016/j.ejim.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/05/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In lower extremity peripheral artery disease (PAD), transcutaneous oximetry at exercise (Ex-TcpO2) has been largely validated in research practice, but evidence of routine practice in various vascular laboratories is missing. We hypothesized that Ex-TcPO2 would change the diagnosis hypotheses, investigations and treatments for patients referred for exertional limb pain. MATERIAL & METHODS A multicenter prospective trial was conducted in nine different referral centers. Investigators performed Ex-TcpO2 and recorded investigations and treatments already scheduled for the patient. We encoded referral physician's diagnostic hypothesis. Before Ex-TcpO2, vascular physicians were asked to give their diagnosis hypotheses. A minimal decrease from rest of oxygen pressure (DROP)<minus 15mmHg defined the presence of exercise-induced ischemia on the area of interest. After Ex-TcPO2, we recorded post-test diagnostic hypothesis and investigations and treatments to be cancelled or performed. We compared the diagnosis hypotheses, scheduled investigations and treatments, before and after the Ex-TcpO2. RESULTS We included 603 patients (485 males: 80.4%), aged 64.7±9.8years. The post-test diagnosis hypothesis differed in 266 patients (44.1%; p<0.0001) and in 96 patients (15.9%) from the pre-test hypothesis of referring and vascular physician, respectively. This led to the recommendation to cancel 27 scheduled investigations or treatments of a total cost of ~130,000 euros. DISCUSSION Ex-TcPO2 in patients with exertional limb pain is applicable in various vascular institutions, and significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain.
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Dejerome C, Grange C, De Laforcade L, Bonin O, Laville M, Lermusiaux P, Long A. [Doppler ultrasonography of the renal artery: Guidelines and predictive factors for the presence of a tight stenosis. Retrospective analysis of 450 consecutive examinations]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:163-173. [PMID: 29754726 DOI: 10.1016/j.jdmv.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/24/2018] [Indexed: 10/16/2022]
Abstract
Duplex ultrasonography screening for renal artery stenosis has been the object of guidelines published by four societies designed to optimize the cost-effectiveness of the examination. OBJECTIVES To determine how well guideline indications for ultrasonography matched with requests and results in our university hospital; to determine whether compliance with guidelines was predictive of renal artery stenosis; to identify guidelines predictive of presence of stenosis; and to determine whether other predictive factors can be recognized. MATERIAL AND METHODS Requests and results of 450 Duplex ultrasonography examinations of the renal arteries performed from January 1st 2014 to December 31st 2015 were compared with published guidelines. RESULTS At least one guideline indication was identified for 212 of the 450 examinations performed (47.1%). Among these examinations, renal artery stenosis≥70% was identified in 18 patients (8.0%). No case of stenosis was identified during examinations performed outside guideline indications. Factors predictive of stenosis were: compliance with guidelines (OR=21.86 [2.88; 165.8]). Predictive guidelines were: resistant hypertension in spite of appropriate treatment (OR=3.85, [1.44; 10.33], P=0.011), accelerated hypertension (OR=7.30, [1.40; 37.99], P=0.049), sudden unexplained pulmonary edema (OR=7.30, [1.40; 37.99], P=0.049), unexplained renal insufficiency (OR=3.58, [1.37; 9.37], P=0.011), unexplained renal hypotrophy (OR=16.69, [4.38; 63.69], P<0.001), renal asymmetry (OR=4.32, [1.45; 12.85], P<0.016). No other factor was predictive of renal stenosis. These examinations had therapeutic consequences in only 50% of patients. CONCLUSION This study confirms the relevance of published guidelines. The diagnostic-effectiveness of Duplex ultrasonography examinations to search for renal artery stenosis depends upon compliance with these guidelines.
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Martinez RCP, Sathasivam HP, Cosway B, Paleri V, Fellows S, Adams J, Kennedy M, Pearson R, Long A, Sloan P, Robinson M. Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients. Br J Oral Maxillofac Surg 2018; 56:332-337. [PMID: 29628167 DOI: 10.1016/j.bjoms.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000-2014). Patients' clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV). The results were compared with those of a matching group of older patients. We identified 91 patients who were younger than 45 years old, and the 50 youngest patients were studied in detail. The male:female ratio was 2:1, with more tumours located in the oral cavity than in the oropharynx (35 compared with 15). HPV-related SCC was restricted to the oropharynx. When matched for site, stage and HPV status, five-year overall survival was similar in young and matched older patients (log-rank test, p=0.515). Our findings suggest that young patients with oral SCC have a disease profile similar to that of older patients with the condition. It is plausible that prognostic information generally available for oral cancers is applicable to young patients with the disease.
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Long A, Naff J, Handfield K, Banks T. P016 Drug rash with eosinophilia and systemic symptoms progressing to skin blistering without mucosal involvement. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ajani J, Udrea A, Sarosiek T, Shenker M, Morgan C, Pikiel J, Wojcik E, Swinson D, Joseph M, Luft A, Salek T, Tournigand C, Ferry D, Zhang Y, Long A, Kuo WL, Gao L, Kauh J, Mansoor W. A dose-response study of ramucirumab treatment in patients with gastric cancer/gastroesophageal junction adenocarcinoma: Primary results of 4 dosing regimens in the phase 2 trial I4T-MC-JVDB. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McClurg D, Coyle J, Long A, Moore K, Cottenden A, May C, Fader M. A two phased study on health care professionals' perceptions of single or multi-use of intermittent catheters. Int J Nurs Stud 2017; 72:83-90. [PMID: 28505559 DOI: 10.1016/j.ijnurstu.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
AIMS This two phase study aimed to explore health care professionals' teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization. INTRODUCTION Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals' perspectives is one of the keys to developing a multi-use intervention. DESIGN A qualitative research framework using in-depth interviews to inform an on line survey. METHOD In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions - continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters. RESULTS Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about 'minimising health risk' and maximising 'normalcy' for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered. CONCLUSIONS For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life. RELEVANCE TO CLINICAL PRACTICE This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users.
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Thiney M, Della Schiava N, Feugier P, Lermusiaux P, Ninet J, Millon A, Long A. How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease. Ann Vasc Surg 2017; 40:85-93. [DOI: 10.1016/j.avsg.2016.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 12/25/2022]
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Rouet L, Mory B, Attia E, Bredahl K, Long A, Ardon R. A minimally interactive and reproducible method for abdominal aortic aneurysm quantification in 3D ultrasound and computed tomography with implicit template deformations. Comput Med Imaging Graph 2016; 58:75-85. [PMID: 27939282 DOI: 10.1016/j.compmedimag.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/20/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The maximum diameter of abdominal aortic aneurysm (AAA) is a key quantification parameter for disease assessment. Although it is routinely measured on 2D-ultrasound images, using a volumetric approach is expected to improve measurement reproducibility. In this work, 3D-ultrasound or computed tomography imaging of patients with AAA was combined with a minimally interactive 3D segmentation based on implicit template deformation. Segmentation usability and reproducibility were evaluated on 81 patients, showing a mean measurement time of [2;8]min per case, and Dice coefficients of 0.87±0.12 for 3D-US and 0.81±0.08 for CT. Quantification parameters included a diameter measurement from 3D-US and CT volumes with respective confidence intervals of 0.51 [-2.5;3.52]mm and 1.00 [-1.68;3.67]mm. Additional volume measurements showed confidence intervals of 0.91 [-4.17;5.99]ml for 3D-US and 4.10 [-4.11;12.30]ml for CT.
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Lv H, Yin P, Long A, Gao Y, Zhao Z, Li J, Zhang L, Zhang L, Tang P. Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study. Osteoporos Int 2016; 27:3001-9. [PMID: 27241669 DOI: 10.1007/s00198-016-3624-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/28/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED In this study, we attempt to determine the clinical characteristic and risk factors of postoperative pneumonia (POP) after hip fracture surgery in a well-defined hip fracture cohort. We find that intrinsic factors as well as major clinical interventions were all important risk factors of POP. INTRODUCTION Postoperative pneumonia (POP) is one of the major complications following hip fractures surgery. However, the risk factors of POP are not well studied in hip fracture cohorts. We attempt to determine the clinical characteristic and risk factors of POP after hip fracture surgery in a well-defined hip fracture cohort. METHODS Datasets from a prospective hip fracture cohort study with a 2-year follow-up period, from 2000 to 2011, were reanalyzed for characteristics of POP. Multivariate Cox proportional regression was used to evaluate the association between the incidence of POP and all-cause mortality. Multivariate logistic regression was used to screen for potential risk factors of POP by analyzing demographic factors, comorbidities, major clinical interventions, and hematological parameters. RESULTS In 1429 patients who underwent hip surgery, the incidence of POP was 4.9 % (n = 70). All-cause mortality of patients with POP was significantly higher than that of patients without POP at 30 days (hazard ratio (HR) 3.05, 95 % confidence intervals (CI) 1.88-4.94), 1 year (HR 1.87, 95 % CI 1.41-2.48), and 2 years (HR 1.57, 95 % CI 1.23-1.99) postoperatively. Multivariate logistic regression showed that intrinsic factors (advanced age, anemia, diabetes, prior stroke, number of comorbidities, ASA score ≥III, and some laboratory biomarkers) as well as major clinical interventions were all significant risk factors for POP. CONCLUSION Intrinsic factors and major clinical interventions were all important risk factors of POP in patients after hip fracture surgery. Targeted preventive measures to mitigate the above risk factors may help in reducing the incidence of POP.
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