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Desai S, Croxford S, Brown AE, Mitchell H, Hughes G, Delpech V. An overview of the HIV epidemic among men who have sex with men in the United Kingdom, 1999-2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884147 DOI: 10.2807/1560-7917.es2015.20.14.21086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe epidemiological trends in HIV among men who have sex with men (MSM) in the United Kingdom (UK) to inform prevention strategies. National HIV surveillance data were analysed for trends. Multivariable analyses identified predictors of late diagnosis (<350 copies/µL) and mortality. Between 1999 and 2013, 37,560 MSM (≥15 years) were diagnosed with HIV in the UK. New diagnoses rose annually from 1,440 in 1999 to 3,250 in 2013. The majority of MSM were of white ethnicity (85%) and UK-born (68%). Median CD4 count increased steadily from 350 cells/µL to 463 cells/µL. HIV testing in England increased from 10,900 tests in 1999 to 102,600 in 2013. One-year death rates after diagnosis declined among late presenters (4.7% to 1.9%). Despite declining late diagnosis (50% to 31%), the number of men diagnosed late annually has remained high since 2004. Older age (≥50 years), and living outside London were predictors of late presentation; older age and late presentation were predictors of one-year mortality. Increases in new diagnoses reflect increased testing and ongoing transmission. Over 900 men present late each year and mortality in this group remains high and preventable. Appropriate prevention and testing strategies require strengthening to reduce HIV transmission and late diagnosis.
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Mitchell H, Porter J. The cost-effectiveness of identifying and treating malnutrition in hospitals: a systematic review. J Hum Nutr Diet 2015; 29:156-64. [DOI: 10.1111/jhn.12308] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pfau T, Jennings C, Mitchell H, Olsen E, Walker A, Egenvall A, Tröster S, Weller R, Rhodin M. Lungeing on hard and soft surfaces: Movement symmetry of trotting horses considered sound by their owners. Equine Vet J 2014; 48:83-9. [PMID: 25297461 DOI: 10.1111/evj.12374] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Lungeing is often part of the clinical lameness examination. The difference in movement symmetry, which is a commonly employed lameness measure, has not been quantified between surfaces. OBJECTIVES To compare head and pelvic movement symmetry between surfaces and reins during lungeing. STUDY DESIGN Quantitative gait analysis in 23 horses considered sound by their owners. METHODS Twenty-three horses were assessed in-hand and on the lunge on both reins on hard and soft surfaces with inertial sensors. Seven movement symmetry parameters were quantified and used to establish 2 groups, namely symmetrical (n = 9) and forelimb-lame horses (n = 14), based on values from straight-line assessment. Movement symmetry values for left rein measurements were side corrected to allow comparison of the amount of movement symmetry between reins. A mixed model (P<0.05) was used to study effects on movement symmetry of surface (hard/soft) and rein (inside/outside with respect to movement symmetry on the straight). RESULTS In forelimb-lame horses, surface and rein were identified as significantly affecting all head movement symmetry measures (rein, all P<0.0001; surface, all P<0.042). In the symmetrical group, no significant influence of surface or rein was identified for head movement symmetry (rein, all P>0.245; surface, all P>0.073). No significant influence of surface or rein was identified for any of the pelvic movement symmetry measures in either group. CONCLUSIONS While more symmetrical horses showed a consistent amount of movement symmetry across surfaces/reins, horses objectively quantified as lame on the straight showed decreased movement symmetry during lungeing, in particular with the lame limb on the inside of a hard circle. The variation within group questions straight-line movement symmetry as a sole measure of lameness without quantification of movement symmetry on the lunge, ideally on hard and soft surfaces to evaluate differences between reins and surfaces. In future, thresholds for lungeing need to be determined using simultaneous visual and objective assessment.
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Gordon AL, Mjojo J, Forrester-Paton C, Forrester-Paton J, Bracewell N, Mitchell H, Masud T, Gladman JRF, Blundell AG. 95 * UPDATING THE BRITISH GERIATRICS SOCIETY RECOMMENDED UNDERGRADUATE CURRICULUM AGAINST TOMORROW'S DOCTOR'S 3. Age Ageing 2014. [DOI: 10.1093/ageing/afu041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Taylor MJ, Gregory R, Mitchell H, Alblihed M, Alsabih A, Tomlins P, Sahota TS. Insulin pump users would not rule out using an implantable artificial pancreas. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Lunging on soft and hard ground: differences between sound and mildly lame horses. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Movement Symmetry Patterns During Lungeing in Trot on Hard and Soft Surface Differ Between Sound and Mildly Forelimb Lame Horses. Equine Vet J 2013. [DOI: 10.1111/evj.12145_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Culley L, Hudson N, Law C, Denny E, Mitchell H, Raine-Fenning N. Disrupted reproduction: the impact of endometriosis on couples’ plans for childbearing. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Parys H, Wyverkens E, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, De Sutter P, Pennings G, Buysse A, Anttila VS, Salevaara M, Suikkari AM, Listijono DR, Mooney S, Chapman MG, Res Muravec U, Pusica S, Lomsek M, Cizek Sajko M, Parames S, Semiao-Francisco L, Sato H, Ueno J, van den Wijngaard L, Mochtar MH, van Dam H, van der Veen F, van Wely M, Derks-Smeets IAP, Habets JJG, Tibben A, Tjan-Heijnen VCG, Meijer-Hoogeveen M, Geraedts JPM, van Golde R, Gomez-Garcia E, de Die-Smulders CEM, van Osch LADM, Habets JJG, Derks-Smeets IAP, Tibben A, Tjan-Heijnen VCG, Geraedts JPM, van Golde R, Gomez-Garcia E, Kets CM, de Die-Smulders CEM, van Osch LADM, Gullo S, Donarelli Z, Coco GL, Marino A, Volpes A, Sammartano F, Allegra A, Nekkebroeck J, Tournaye H, Stoop D, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Coffaro F, Allegra A, Diaz DG, Gonzalez MA, Tirado M, Chamorro S, Dolz P, Gil MA, Ballesteros A, Velilla E, Castello C, Moina N, Lopez-Teijon M, Chan CHY, Chan CLW, Leong MKH, Cheung IKM, Chan THY, Hui BNL, van Dongen AJCM, Huppelschoten AG, Kremer JAM, Nelen WLDM, Verhaak CM, Sun HG, Lee KH, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Cho JD, Yoo YJ, Frokjaer V, Pinborg A, Larsen EC, Heede M, Stenbaek DS, Henningsson S, Nielsen AP, Svarer C, Holst KK, Knudsen GM, Emery M, DeJonckheere L, Rothen S, Wisard M, Germond M, Stenbaek DS, Toftager M, Hjordt LV, Jensen PS, Holst K, Holland T, Bryndorf T, Bogstad J, Hornnes P, Frokjaer VG, Dornelles LMN, MacCallum F, Lopes RCS, Piccinini CA, Passos EP, Bruegge C, Thorn P, Daniels K, Imrie S, Jadva V, Golombok S, Arens Y, De Krom G, Van Golde RJT, Coonen E, Van Ravenswaaij-Arts CMA, Meijer-Hoogeveen M, Evers JLH, Geraedts JPM, De Die-Smulders CEM, Ghazeeri G, Awwad J, Fakih A, Abbas H, Harajly S, Tawidian L, Maalouf F, Ajdukovic D, Pibernik-Okanovic M, Alebic MS, Baccino G, Calatayud C, Ricciarelli E, de Miguel ERH, Stuyver I, Wierckx K, Verstraelen H, Van Glabeke L, Van den Abbeel E, Gerris J, T'Sjoen G, De Sutter P, Monica B, Calonge RN, Peregrin PC, Cserepes R, Kollar J, Wischmann T, Bugan A, Pinkard C, Harrison C, Bunting L, Boivin J, Fulford B, Boivin J, Theusink-Kirchhoff N, van Ravenswaaij-Arts CMA, Bakker MK, Volks C, Papaligoura Z, Papadatou D, Bellali TH, Thorn P, Wischmann T, Wischmann T, Thorn P, Jarvholm S, Broberg M, Thurin-Kjellberg A, Weitzman G, Van Der Putten-Landau TM, Chudnoff S, Panagopoulou E, Tarlatzis B, Tamhankar V, Jones GL, Magill P, Skull JD, Ledger W, Hvidman HW, Specht IO, Pinborg A, Schmidt KT, Larsen EC, Andersen AN, Freeman T, Zadeh S, Smith V, Golombok S, Whitaker LHR, Reid J, Wilson J, Critchley HOD, Horne AW, Zadeh S, Freeman T, Smith V, Golombok S, Peterson B, Pirritano M, Schmidt L, Volgsten H, Wyverkens E, Van Parys H, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, Pennings G, De Sutter P, Buysse A, Hudson N, Culley L, Law C, Denny E, Mitchell H, Baumgarten M, Raine-Fenning N, Blake L, Jadva V, Golombok S, Lee KH, Sun HG, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Kim KH. Psychology and counselling. Hum Reprod 2013. [DOI: 10.1093/humrep/det218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lybol C, Sweep F, Harvey R, Mitchell H, Short D, Thomas C, Ottevanger P, Savage P, Massuger L, Seckl M. Relapse rates after two versus three consolidation courses of methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Gynecol Oncol 2012; 125:576-9. [DOI: 10.1016/j.ygyno.2012.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/29/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A. Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res (Hoboken) 2012; 64:238-47. [PMID: 21954131 DOI: 10.1002/acr.20642] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). METHODS In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. RESULTS Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. CONCLUSION Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs.
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Farrell C, Mitchell H, Morrissey D. 4182 POSTER Nurse-led Clinics Benefit Patients on Adjuvant Herceptin. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Freyer G, You B, Harvey R, Golfier F, Mitchell H, Savage P, Tod M, Philip C, Hajri T, Seckl M. Validation of the predictive value of modeled hCG decline profiles in low-risk gestational trophoblastic neoplasia (GTN) treated with methotrexate (MTX). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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White S, Harvey R, Mitchell H, Schmid P, Seckl M, Savage P. Characterisation of transient benign hCG elevations in women following chemotherapy for GTT. J OBSTET GYNAECOL 2011; 31:169-72. [PMID: 21281036 DOI: 10.3109/01443615.2010.536859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The occurrence of post-chemotherapy transient low level hCG elevations has been observed in a number of women treated for gestational trophoblastic tumours (GTT). The authors reviewed the records of patients treated at Charing Cross Hospital over the last 10 years and identified those with a benign rise in hCG. Stored serum samples were assayed for hCG, LH, FSH and oestradiol at varying points during patient management. The endocrine profile in patients experiencing benign hCG elevation is comparable with that seen in post-menopausal women, with low oestradiol, combined with greatly elevated LH and FSH levels. In contrast, women with genuine disease relapse as the cause of their post-chemotherapy hCG elevation had normal or only minor elevations of LH and FSH. These findings support the observation that a major rise in LH and FSH can be used as an indicator for benign pituitary hCG production in patients experiencing a low level rise in hCG levels following chemotherapy for GTT.
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Ndosi M, Vinall K, Hale C, Bird H, Hill J, Cornell P, Westlake S, Richards S, Sanderson T, Calnan M, Morris M, Richards P, Hewlett S, Richards A, Taylor S, Porcheret M, Grime J, Jordan K, Dziedzic K, Hewlett S, Ambler N, Knops B, Cliss A, Almeida C, Pope D, Hammond A, Swinkels A, Kitchen K, Pollock J, Hurley M, Walsh N, Mitchell H, Nicholas J, Day SH, Butt S, Deighton C, Gadsby K. Concurrent Oral 5 - BHPR Audit/Service Delivery and Research [OP32-OP39]: OP32. Is Nurse-Led Care Effective in Rheumatology? a Systematic Review. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Norton S, Done J, Sacker A, Young A, Cox N, Treharne GJ, McGavock ZC, Tonks A, Kafka SA, Hale ED, Kitas GD, Fletcher D, Sanderson T, Baker G, Street P, Hewlett S, Stynes S, Peat G, Myers H, Croft P, Bosworth AM, Crake D, Hurley M, Patel A, Walsh N, Mitchell H, Kumar K, Gordhan C, Situnayake D, Raza K, Bacon P, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Stevenson K, Roddy E, Jordan K, Waldron N, Brown S, McCabe C, McHugh N, Hewlett S, Shelmerdine J, Ferenkeh-Koroma A, Breslin A, Sawyer S, Haas M, Elliott B, Law RJ, Breslin A, Oliver E, Mawn L, Markland D, Peter M, Thom J, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Cliss A, Morris M, Ambler N, Knops B, Hammond A, Almeida C, Hewlett S. BHPR: Research [278-290]: 278. What does the Hospital Anxiety and Depression Scale Measure? Evidence of a Bifactor Structure and Item Bias. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schmidt HMA, Andres S, Nilsson C, Kovach Z, Kaakoush NO, Engstrand L, Goh KL, Fock KM, Forman D, Mitchell H. The cag PAI is intact and functional but HP0521 varies significantly in Helicobacter pylori isolates from Malaysia and Singapore. Eur J Clin Microbiol Infect Dis 2010; 29:439-51. [PMID: 20157752 DOI: 10.1007/s10096-010-0881-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 01/05/2010] [Indexed: 12/16/2022]
Abstract
Helicobacter pylori-related disease is at least partially attributable to the genotype of the infecting strain, particularly the presence of specific virulence factors. We investigated the prevalence of a novel combination of H. pylori virulence factors, including the cag pathogenicity island (PAI), and their association with severe disease in isolates from the three major ethnicities in Malaysia and Singapore, and evaluated whether the cag PAI was intact and functional in vitro. Polymerase chain reaction (PCR) was used to detect dupA, cagA, cagE, cagT, cagL and babA, and to type vacA, the EPIYA motifs, HP0521 alleles and oipA ON status in 159 H. pylori clinical isolates. Twenty-two strains were investigated for IL-8 induction and CagA translocation in vitro. The prevalence of cagA, cagE, cagL, cagT, babA, oipA ON and vacA s1 and i1 was >85%, irrespective of the disease state or ethnicity. The prevalence of dupA and the predominant HP0521 allele and EPIYA motif varied significantly with ethnicity (p < 0.05). A high prevalence of an intact cag PAI was found in all ethnic groups; however, no association was observed between any virulence factor and disease state. The novel association between the HP0521 alleles, EPIYA motifs and host ethnicity indicates that further studies to determine the function of this gene are important.
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Abstract
Regular participation in a high-quality screening program by all 'at risk' women is necessary if Australia is to be maximally successful in preventing cervical cancer. This paper discusses the use of reminder letters as one method of facilitating participation. Options for the source of the letters are discussed. It is concluded that basing the recall letters on a register of previously screened women is the only feasible approach within the Australian health care system. The impact of reminder letters on achieving regular participation by Australian women remains to be tested.
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Hirst S, Mitchell H, Medley G. An evaluation of a campaign to increase cervical cancer screening in rural Victoria. COMMUNITY HEALTH STUDIES 2010; 14:263-8. [PMID: 2253461 DOI: 10.1111/j.1753-6405.1990.tb00625.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper reports on the second of four regionally-based campaigns co-ordinated in rural Victoria by the Anti-Cancer Council of Victoria. The campaign encompassed community-based activities, general practitioner involvement and screening clinics. The impact of the campaign on Pap test rates and on the profile of women whose tests were reported by the Victorian Cytology Gynaecological Service is examined. We conclude that the campaign was successful in achieving its primary objective of attracting older and relatively underscreened women into having a Pap test. The special screening clinics were considered particularly effective in reaching women in the target audience. As a result of this campaign, new initiatives, were incorporated into subsequent programs.
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Grimsley L, Horner W, White L, Mitchell H, Kennedy S, El-Dahr J, Cohn R, Sterling Y, Mvula M, Stephens K, Lichtveld M, Thornton E, Chulada P, Martin W. Trend Analysis Of New Orleans Outdoor Mold Spore Counts: A Comparison Of Heal Preliminary Data And Post-katrina Mold Concentrations. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.949] [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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Ryall B, Mitchell H, Mossialos D, Williams H. Cyanogenesis by the entomopathogenic bacteriumPseudomonas entomophila. Lett Appl Microbiol 2009; 49:131-5. [DOI: 10.1111/j.1472-765x.2009.02632.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kerkmeijer LG, Thomas CM, Harvey R, Sweep FC, Mitchell H, Massuger LF, Seckl MJ. External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease. Br J Cancer 2009; 100:979-84. [PMID: 19293810 PMCID: PMC2661779 DOI: 10.1038/sj.bjc.6604849] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Van Trommel et al have previously shown that serum human chorionic gonadotropin (hCG) cutoff levels can provide early prediction of resistance to first-line methotrexate (MTX) in patients with persistent trophoblastic disease (PTD). In this study, we validate this approach of prediction of resistance to single-agent chemotherapy in an independent and larger cohort of PTD patients using a different hCG assay. Receiver operating characteristics (ROC) curves were constructed to determine hCG cutoff levels and sensitivity between patients cured on single-agent chemotherapy (control group) and patients requiring change to combination chemotherapy (study group). Receiver operating characteristics analysis identified an hCG cutoff value of 737 IU l−1 that enabled us to predict the subsequent development of single-agent chemotherapy resistance in 52% of patients before their fourth MTX course at 97.5% specificity. This would have enabled an earlier switch to combination chemotherapy reducing the MTX exposure by an average of 2.5 courses. The present findings confirm that serum hCG cutoff levels predict resistance to single-agent therapy earlier than traditional methods. Change to combination chemotherapy should be considered for patients whose serum hCG levels exceed these hCG cutoff values. For patients not exceeding the hCG cutoff levels, static or rising hCG levels should still be included in the criteria for change of chemotherapy.
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Sharma R, Graham J, Mitchell H, Brooks A, Blagden S, Gabra H. Extended weekly dose-dense paclitaxel/carboplatin is feasible and active in heavily pre-treated platinum-resistant recurrent ovarian cancer. Br J Cancer 2009; 100:707-12. [PMID: 19223898 PMCID: PMC2653750 DOI: 10.1038/sj.bjc.6604914] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
There is increasing evidence of the efficacy of dose-dense therapy in the management of platinum-resistant/refractory ovarian cancer. We report our experience of extended weekly carboplatin and paclitaxel in this population group. Twenty patients with platinum-resistant/refractory ovarian cancer received carboplatin AUC 3 and paclitaxel 70 mg m−2 on day 1, 8, 15 q 4 weekly for six planned cycles. Toxicity was assessed using Common Toxicity Criteria. Response was evaluated using radiological and CA125 criteria. Median age was 61 years (range 40–74 years). Median number of prior therapies is three (range 1–8). Response rate was 60% by radiological criteria (RECIST) and 76% by CA125 assessment. Grade 3 toxicities consisted of neutropenia (29% of patients) and anaemia (5%). One patient experienced grade 4 neutropenia. No grade 3/4 thombocytopaenia was reported. Fatigue, nausea and peripheral neuropathy were the most frequent non-hematological side effects. Median progression-free survival was 7.9 months and overall survival was 13.3 months. The dynamics of response to dose-dense therapy were as rapid as with front-line therapy within the same patient. This dose-dense regimen can be extended to at least 18 weekly cycles over 6 months and is well tolerated with high response rates in heavily pre-treated, platinum-resistant ovarian cancer. It forms a highly active and tolerable cytotoxic scaffold to which molecular-targeted therapies can be added in platinum-resistant ovarian cancer.
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King E, Filep S, Smith B, Metwali N, Thorne P, Versteeg S, van Ree R, Arbes S, Calatroni A, Mitchell H. Performance Evaluation of Allergen Exposure Assessment using Fluorescent Multiplex Array Technology: - A Multi-Center Ring Trial. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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