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Tadman M, Charlton P, Jafar-Mohammadi B, Talbot D, Grossman AB. INITIATION OF PATIENTS ONTO LONG-ACTING SOMATOSTATIN ANALOGUE THERAPY FOR NEUROENDOCRINE TUMORS: A SINGLE-CENTER REVIEW OF PRACTICE. Endocr Pract 2018; 24:189-194. [PMID: 29466059 DOI: 10.4158/ep-2017-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Neuroendocrine tumors (NETs) are being seen increasingly frequently, and recent data show that long-acting somatostatin analogues have become a major initial treatment, regardless of whether the tumors are functioning or not. However, test dosing with subcutaneous (sc) octreotide is usually advised to assess longer-term tolerability, although this advice is mainly based on results with functioning tumors. The aim of the study was to assess the value of an initiating test dose of sc octreotide on the prediction of subsequent adverse events after treatment with the long-acting analogue. METHODS In a single, large Centre of Excellence for NETs, a first cohort of patients (n = 24) was admitted overnight after an sc injection of octreotide, and then administered the analogue; a subsequent group (n = 53) had the test dose performed on an outpatient basis. Side effects were recorded after the test dose and subsequent treatment with the long-acting analogue. RESULTS The test dose injection was of little value in predicting adverse events following the long-acting somatostatin analogue. CONCLUSION Unless there are serious symptoms associated with a functioning NET, it is unnecessary to carry out a test dose; a change to this procedure will improve resource allocation and should enhance early initiation onto maintenance therapy. ABBREVIATIONS CLARINET = Controlled study of lanreotide antiproliferative response in neuroendocrine tumors LAR = long-acting repeatable NET = neuroendocrine tumor PROMID = Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with meta-static neuroendocrine midgut tumors.
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102
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Ferguson S, Mansoor W, Talbot D. The incidence, diagnostic pathway and management of pulmonary carcinoid tumours in the UK: results from the National Lung NET pathway (‘LEAP’) Project. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30069-2] [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: 11/27/2022]
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103
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Talbot T, Dangoor A, Shah R, Naik J, Talbot D, Lester JF, Cipelli R, Hodgson M, Patel A, Summerhayes M, Newsom-Davis T. The burden of neutropenic sepsis in patients with advanced non-small cell lung cancer treated with single-agent docetaxel: A retrospective study. Lung Cancer 2017; 113:115-120. [PMID: 29110837 DOI: 10.1016/j.lungcan.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To describe rates of confirmed and suspected neutropenic sepsis (NS) and associated hospital resource utilisation in patients with non-small cell lung cancer (NSCLC) treated with docetaxel monotherapy following relapse after ≥1 line of chemotherapy in routine UK clinical practice. MATERIALS AND METHODS A multi-centre, retrospective, observational research study was conducted in seven centres across England and Wales. Adult patients with stage III/IV NSCLC initiated on docetaxel monotherapy between 2010 and 2016 in routine clinical practice (aged ≥18 years at initiation) following failure of first-line chemotherapy were eligible. Data were collected from hospital medical records between May 2016 and July 2016, on all episodes of confirmed or suspected NS related to docetaxel monotherapy, including patient characteristics. Episodes of confirmed NS were defined as documented absolute neutrophil count <1.0×109/L, plus temperature >38°C or other signs/symptoms of sepsis, otherwise episodes were classified as suspected NS. RESULTS 121 patients were included (median age 65.5 years; 57.9% male; median 4.0 cycles of docetaxel; 19.8% treated with prophylactic granulocyte-colony stimulating factor). Episodes of confirmed or suspected NS were recorded in 21/121 (17.4%) patients (11 confirmed episodes in 11 [9.1%] patients and 11 suspected episodes in 10 [8.3%] patients). Resource utilisation data were available for 21/22 episodes; the mean length of stay for confirmed NS admissions (n=11) was 9.2 (SD: 9.2) days and for suspected NS admissions (n=10) was 4.7 (SD: 4.6) days. The most commonly prescribed treatment for NS was piperacillin/tazobactam therapy (46.5% of all documented treatments). The mean total costs of managing patients with confirmed NS (n=11) and suspected NS (n=9) were £3163 (SD: £2921) and £1790 (SD: £1585) per patient, respectively. CONCLUSION Rates of confirmed NS in UK clinical practice were broadly similar to those reported in clinical trials; however, the burden of suspected NS, not routinely reported elsewhere, is also substantial.
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Affiliation(s)
- Toby Talbot
- Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, UK.
| | - Adam Dangoor
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK.
| | - Riyaz Shah
- Kent Oncology Centre, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, ME16 9QQ, UK.
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust,Aberford Road, Wakefield, WF1 4DG, UK.
| | - Denis Talbot
- Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LJ, UK.
| | - Jason F Lester
- Velindre Cancer Centre, Velindre NHS Trust, Velindre Road, Cardiff, CF14 2TL, UK.
| | - Riccardo Cipelli
- pH Associates Ltd, The Weighbridge, Brewery Courtyard, High Street, Marlow, SL7 2FF, UK.
| | | | | | | | - Thomas Newsom-Davis
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea, London, SW10 9NH, UK.
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104
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Vanasse A, Talbot D, Chebana F, Bélanger D, Blais C, Gamache P, Giroux JX, Dault R, Gosselin P. Effects of climate and fine particulate matter on hospitalizations and deaths for heart failure in elderly: A population-based cohort study. Environ Int 2017; 106:257-266. [PMID: 28709636 DOI: 10.1016/j.envint.2017.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There are limited data on the effects of climate and air pollutant exposure on heart failure (HF) within taking into account individual and contextual variables. OBJECTIVES We measured the lag effects of temperature, relative humidity, atmospheric pressure and fine particulate matter (PM2.5) on hospitalizations and deaths for HF in elderly diagnosed with this disease on a 10-year period in the province of Quebec, Canada. METHODS Our population-based cohort study included 112,793 elderly diagnosed with HF between 2001 and 2011. Time dependent Cox regression models approximated with pooled logistic regressions were used to evaluate the 3- and 7-day lag effects of daily temperature, relative humidity, atmospheric pressure and PM2.5 exposure on HF morbidity and mortality controlling for several individual and contextual covariates. RESULTS Overall, 18,309 elderly were hospitalized and 4297 died for the main cause of HF. We observed an increased risk of hospitalizations and deaths for HF with a decrease in the average temperature of the 3 and 7days before the event. An increase in atmospheric pressure in the previous 7days was also associated with a higher risk of having a HF negative outcome, but no effect was observed in the 3-day lag model. No association was found with relative humidity and with PM2.5 regardless of the lag period. CONCLUSIONS Lag effects of temperature and other meteorological parameters on HF events were limited but present. Nonetheless, preventive measures should be issued for elderly diagnosed with HF considering the burden and the expensive costs associated with the management of this disease.
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Affiliation(s)
- Alain Vanasse
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada; Research Center of the Centre hospitalier universitaire de Sherbrooke - Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada.
| | - Denis Talbot
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
| | - Fateh Chebana
- The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Diane Bélanger
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Claudia Blais
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada; Faculty of Pharmacy, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
| | - Philippe Gamache
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada.
| | - Jean-Xavier Giroux
- The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada.
| | - Roxanne Dault
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, J1H 5N4, QC, Canada.
| | - Pierre Gosselin
- Research Center of the Centre hospitalier universitaire de Québec - Université Laval, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada; The Eau Terre Environnement Research Center, Institut national de la recherche scientifique, 490 Rue de la Couronne, Québec, G1K 9A9, QC, Canada; Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, G1V 5B3, QC, Canada; Faculty of Pharmacy, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, G1V 0A6, QC, Canada.
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105
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Morgensztern D, Ong T, Dols MC, Aix SP, Postmus P, Lewanski C, Bennouna J, Fischer J, Vidal O, Stewart D, Fasola G, Ardizoni A, Weaver J, Wolfsteiner M, Talbot D, Govindan R. ABOUND.2L+: nab-paclitaxel (nab-P) +/- CC-486 or durvalumab in previously treated patients with advanced non-small cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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106
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Brassard D, Tessier-Grenier M, Allaire J, Rajendiran E, She Y, Ramprasath V, Gigleux I, Talbot D, Levy E, Tremblay A, Jones PJ, Couture P, Lamarche B. Comparison of the impact of SFAs from cheese and butter on cardiometabolic risk factors: a randomized controlled trial. Am J Clin Nutr 2017; 105:800-809. [PMID: 28251937 DOI: 10.3945/ajcn.116.150300] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 11/30/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Controversies persist concerning the association between intake of dietary saturated fatty acids (SFAs) and cardiovascular disease risk.Objective: We compared the impact of consuming equal amounts of SFAs from cheese and butter on cardiometabolic risk factors.Design: In a multicenter, crossover, randomized controlled trial, 92 men and women with abdominal obesity and relatively low HDL-cholesterol concentrations were assigned to sequences of 5 predetermined isoenergetic diets of 4 wk each separated by 4-wk washouts: 2 diets rich in SFAs (12.4-12.6% of calories) from either cheese or butter; a monounsaturated fatty acid (MUFA)-rich diet (SFAs: 5.8%, MUFAs: 19.6%); a polyunsaturated fatty acid (PUFA)-rich diet (SFAs: 5.8%, PUFAs: 11.5%); and a low-fat, high-carbohydrate diet (fat: 25%, SFAs: 5.8%).Results: Serum HDL-cholesterol concentrations were similar after the cheese and butter diets but were significantly higher than after the carbohydrate diet (+3.8% and +4.7%, respectively; P < 0.05 for both). LDL-cholesterol concentrations after the cheese diet were lower than after the butter diet (-3.3%, P < 0.05) but were higher than after the carbohydrate (+2.6%), MUFA (+5.3%), and PUFA (+12.3%) diets (P < 0.05 for all). LDL-cholesterol concentrations after the butter diet also increased significantly (from +6.1% to +16.2%, P < 0.05) compared with the carbohydrate, MUFA, and PUFA diets. The LDL-cholesterol response to treatment was significantly modified by baseline values (P-interaction = 0.02), with the increase in LDL cholesterol being significantly greater with butter than with cheese only among individuals with high baseline LDL-cholesterol concentrations. There was no significant difference between all diets on inflammation markers, blood pressure, and insulin-glucose homeostasis.Conclusions: The results of our study suggest that the consumption of SFAs from cheese and butter has similar effects on HDL cholesterol but differentially modifies LDL-cholesterol concentrations compared with the effects of carbohydrates, MUFAs, and PUFAs, particularly in individuals with high LDL cholesterol. In contrast, SFAs from either cheese or butter have no significant effects on several other nonlipid cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT02106208.
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Affiliation(s)
- Didier Brassard
- Institute of Nutrition and Functional Foods.,School of Nutrition
| | | | - Janie Allaire
- Institute of Nutrition and Functional Foods.,School of Nutrition
| | - Ethendhar Rajendiran
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Canada; and
| | - Yongbo She
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Canada; and
| | - Vanu Ramprasath
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Canada; and
| | - Iris Gigleux
- Institute of Nutrition and Functional Foods.,School of Nutrition
| | | | - Emile Levy
- Institute of Nutrition and Functional Foods.,CHU Sainte-Justine Research Center, Montréal, Canada
| | - Angelo Tremblay
- Institute of Nutrition and Functional Foods.,Department of Kinesiology, Faculty of Medicine, and
| | - Peter Jh Jones
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Canada; and
| | - Patrick Couture
- Institute of Nutrition and Functional Foods.,Centre Hospitalier Universitaire (CHU) de Quebec Research Center, Laval University, Quebec, Canada
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods, .,School of Nutrition
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107
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Ndjaboue R, Brisson C, Talbot D, Vézina M. Chronic exposure to adverse psychosocial work factors and high psychological distress among white-collar workers: A 5-year prospective study. J Psychosom Res 2017; 94:56-63. [PMID: 28183403 DOI: 10.1016/j.jpsychores.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/13/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prospective studies which evaluated whether the effects of chronic exposure to psychosocial work factors on mental health persisted over time are scarce. For the first time, this study evaluated: 1) the effect of chronic exposure to effort-reward imbalance over 5years on the prevalence of high psychological distress among men and women, and 2) the persistence of this effect over time. METHODS Overall, 1747 white-collar workers from three public organizations participated in a prospective study. Psychological distress and effort-reward imbalance were measured using validated questionnaires at baseline, and at 3- and 5-year follow-ups. Prevalence ratios (PRs) of high psychological distress were estimated using log-binomial regression according to baseline and repeated exposure. RESULTS Compared to unexposed workers, those with repeated exposure to effort-reward imbalance had a higher prevalence of high psychological distress. Workers exposed only at some time-points also had a higher prevalence. The deleterious effect of repeated exposure observed at the 3-year follow-up persisted at the 5-year follow-up among women (PR=2.48 95% confidence interval (CI) 1.97-3.11) and men (PR=1.91 95% CI 1.20-3.04). These effects were greater than those found using a single baseline measurement. CONCLUSION The current study supported a deleterious effect of repeated exposure to effort-reward imbalance on psychological distress, and a lack of adaptation to these effects over time among men and women. Since psychological distress may later lead to severe mental problems, current results highlight the need to consider exposure to these adverse work factors in primary and secondary preventions aimed at reducing mental health problems at work.
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Affiliation(s)
- Ruth Ndjaboue
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada.
| | - Chantal Brisson
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada
| | - Denis Talbot
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada
| | - Michel Vézina
- Institut National de Santé Publique du Québec, Canada
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108
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Hamblin A, Wordsworth S, Fermont JM, Page S, Kaur K, Camps C, Kaisaki P, Gupta A, Talbot D, Middleton M, Henderson S, Cutts A, Vavoulis DV, Housby N, Tomlinson I, Taylor JC, Schuh A. Clinical applicability and cost of a 46-gene panel for genomic analysis of solid tumours: Retrospective validation and prospective audit in the UK National Health Service. PLoS Med 2017; 14:e1002230. [PMID: 28196074 PMCID: PMC5308858 DOI: 10.1371/journal.pmed.1002230] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/04/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Single gene tests to predict whether cancers respond to specific targeted therapies are performed increasingly often. Advances in sequencing technology, collectively referred to as next generation sequencing (NGS), mean the entire cancer genome or parts of it can now be sequenced at speed with increased depth and sensitivity. However, translation of NGS into routine cancer care has been slow. Healthcare stakeholders are unclear about the clinical utility of NGS and are concerned it could be an expensive addition to cancer diagnostics, rather than an affordable alternative to single gene testing. METHODS AND FINDINGS We validated a 46-gene hotspot cancer panel assay allowing multiple gene testing from small diagnostic biopsies. From 1 January 2013 to 31 December 2013, solid tumour samples (including non-small-cell lung carcinoma [NSCLC], colorectal carcinoma, and melanoma) were sequenced in the context of the UK National Health Service from 351 consecutively submitted prospective cases for which treating clinicians thought the patient had potential to benefit from more extensive genetic analysis. Following histological assessment, tumour-rich regions of formalin-fixed paraffin-embedded (FFPE) sections underwent macrodissection, DNA extraction, NGS, and analysis using a pipeline centred on Torrent Suite software. With a median turnaround time of seven working days, an integrated clinical report was produced indicating the variants detected, including those with potential diagnostic, prognostic, therapeutic, or clinical trial entry implications. Accompanying phenotypic data were collected, and a detailed cost analysis of the panel compared with single gene testing was undertaken to assess affordability for routine patient care. Panel sequencing was successful for 97% (342/351) of tumour samples in the prospective cohort and showed 100% concordance with known mutations (detected using cobas assays). At least one mutation was identified in 87% (296/342) of tumours. A locally actionable mutation (i.e., available targeted treatment or clinical trial) was identified in 122/351 patients (35%). Forty patients received targeted treatment, in 22/40 (55%) cases solely due to use of the panel. Examination of published data on the potential efficacy of targeted therapies showed theoretically actionable mutations (i.e., mutations for which targeted treatment was potentially appropriate) in 66% (71/107) and 39% (41/105) of melanoma and NSCLC patients, respectively. At a cost of £339 (US$449) per patient, the panel was less expensive locally than performing more than two or three single gene tests. Study limitations include the use of FFPE samples, which do not always provide high-quality DNA, and the use of "real world" data: submission of cases for sequencing did not always follow clinical guidelines, meaning that when mutations were detected, patients were not always eligible for targeted treatments on clinical grounds. CONCLUSIONS This study demonstrates that more extensive tumour sequencing can identify mutations that could improve clinical decision-making in routine cancer care, potentially improving patient outcomes, at an affordable level for healthcare providers.
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Affiliation(s)
- Angela Hamblin
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Wordsworth
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jilles M. Fermont
- Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Suzanne Page
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Kulvinder Kaur
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Carme Camps
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Pamela Kaisaki
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Avinash Gupta
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Denis Talbot
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Mark Middleton
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Shirley Henderson
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Anthony Cutts
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Dimitrios V. Vavoulis
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Nick Housby
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Ian Tomlinson
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Jenny C. Taylor
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Anna Schuh
- Molecular Diagnostics Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
- Department of Oncology, University of Oxford, Oxford, United Kingdom
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109
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Krebs M, Spicer J, Steele N, Talbot D, Brada M, Wilson R, Jones R, Basu B, Dawes J, Parmar M, Purchase B, Turner A, Hall E, Tovey H, Banerji U, Yap T. P3.02c-003 TAX-TORC: The Novel Combination of Weekly Paclitaxel and the Dual mTORC1/2 Inhibitor AZD2014 for the Treatment of Squamous NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1798] [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: 10/20/2022]
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110
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Ndjaboue R, Brisson C, Talbot D, Vézina M. Combined exposure to adverse psychosocial work factors and medically certified absence for mental health problems: A 5-year prospective study. J Psychosom Res 2017; 92:9-15. [PMID: 27998514 DOI: 10.1016/j.jpsychores.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ruth Ndjaboue
- Centre de Recherche du CHU de Québec, Médecine Sociale et Préventive, 1050, chemin Sainte-Foy, G1V 4L8 Quebec, Qc, Canada.
| | - Chantal Brisson
- Centre de Recherche du CHU de Québec, Médecine Sociale et Préventive, 1050, chemin Sainte-Foy, G1V 4L8 Quebec, Qc, Canada
| | - Denis Talbot
- Centre de Recherche du CHU de Québec, Médecine Sociale et Préventive, 1050, chemin Sainte-Foy, G1V 4L8 Quebec, Qc, Canada
| | - Michel Vézina
- Centre de Recherche du CHU de Québec, Médecine Sociale et Préventive, 1050, chemin Sainte-Foy, G1V 4L8 Quebec, Qc, Canada
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111
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Talbot D, Rossi AM, Bacon SL, Atherton J, Lefebvre G. A graphical perspective of marginal structural models: An application for the estimation of the effect of physical activity on blood pressure. Stat Methods Med Res 2016; 27:2428-2436. [PMID: 27920366 DOI: 10.1177/0962280216680834] [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] [Indexed: 11/16/2022]
Abstract
Estimating causal effects requires important prior subject-matter knowledge and, sometimes, sophisticated statistical tools. The latter is especially true when targeting the causal effect of a time-varying exposure in a longitudinal study. Marginal structural models are a relatively new class of causal models that effectively deal with the estimation of the effects of time-varying exposures. Marginal structural models have traditionally been embedded in the counterfactual framework to causal inference. In this paper, we use the causal graph framework to enhance the implementation of marginal structural models. We illustrate our approach using data from a prospective cohort study, the Honolulu Heart Program. These data consist of 8006 men at baseline. To illustrate our approach, we focused on the estimation of the causal effect of physical activity on blood pressure, which were measured at three time points. First, a causal graph is built to encompass prior knowledge. This graph is then validated and improved utilizing structural equation models. We estimated the aforementioned causal effect using marginal structural models for repeated measures and guided the implementation of the models with the causal graph. By employing the causal graph framework, we also show the validity of fitting conditional marginal structural models for repeated measures in the context implied by our data.
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Affiliation(s)
- Denis Talbot
- 1 Département de Mathématiques, Université du Québec à Montréal, Québec, Canada.,2 Département de Médecine Sociale et préventive, Université Laval, Québec, Canada.,3 Unité Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Amanda M Rossi
- 4 Department of Exercise Science, Concordia University, Québec, Canada.,5 Montreal Behavioural Medicine Centre, CIUSS-NIM, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.,6 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Québec, Canada
| | - Simon L Bacon
- 4 Department of Exercise Science, Concordia University, Québec, Canada.,5 Montreal Behavioural Medicine Centre, CIUSS-NIM, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Juli Atherton
- 1 Département de Mathématiques, Université du Québec à Montréal, Québec, Canada
| | - Geneviève Lefebvre
- 1 Département de Mathématiques, Université du Québec à Montréal, Québec, Canada
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Schaefer E, Braiteh F, Forster M, Talbot D, Chandler J, Richards D, Andre V, Estrem S, Pitou C, Tiu R, Brail L, Nikolinakos P. Phase 1b/2 trial of taladegib (LY2940680), a Hh/Smo inhibitor, in combination with carboplatin and etoposide followed by taladegib maintenance in extensive-stage small-cell lung cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32990-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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113
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Sevinc M, Stamp S, Ling J, Carter N, Talbot D, Sheerin N. Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival. Transplant Proc 2016; 48:3251-3260. [DOI: 10.1016/j.transproceed.2016.09.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
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114
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Pacey S, Blackhall F, Garcia-Corbacho J, Lipplaa A, Fusi A, Kumar S, Hategan M, Derham J, Laviste G, Halford S, Foxton C, McLeod R, Wan S, Talbot D. A phase I dose escalation study of the tolerability of the oral VEGFR and EGFR inhibitor vandetanib in combination with the oral MEK1/2 inhibitor selumetinib in solid tumors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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115
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Meyer T, Qian W, Valle J, Talbot D, Cunningham D, Reed N, Wall L, Waters J, Ross P, Anthoney A, Sumpter K, Sarwar N, Crosby T, Begum N, Young G, Hardy R, Corrie P. Capecitabine and streptozocin ± cisplatin for gastroenteropancreatic neuroendocrine tumours: predictors of long-term survival in the NET01 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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116
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Wallington M, Saxon EB, Bomb M, Smittenaar R, Wickenden M, McPhail S, Rashbass J, Chao D, Dewar J, Talbot D, Peake M, Perren T, Wilson C, Dodwell D. 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study. Lancet Oncol 2016; 17:1203-16. [PMID: 27599138 PMCID: PMC5027226 DOI: 10.1016/s1470-2045(16)30383-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 11/13/2022]
Abstract
Background 30-day mortality might be a useful indicator of avoidable harm to patients from systemic anticancer treatments, but data for this indicator are limited. The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England allows the assessment of factors affecting 30-day mortality in a national patient population. The aim of this first study based on the SACT dataset was to establish national 30-day mortality benchmarks for breast and lung cancer patients receiving SACT in England, and to start to identify where patient care could be improved. Methods In this population-based study, we included all women with breast cancer and all men and women with lung cancer residing in England, who were 24 years or older and who started a cycle of SACT in 2014 irrespective of the number of previous treatment cycles or programmes, and irrespective of their position within the disease trajectory. We calculated 30-day mortality after the most recent cycle of SACT for those patients. We did logistic regression analyses, adjusting for relevant factors, to examine whether patient, tumour, or treatment-related factors were associated with the risk of 30-day mortality. For each cancer type and intent, we calculated 30-day mortality rates and patient volume at the hospital trust level, and contrasted these in a funnel plot. Findings Between Jan 1, and Dec, 31, 2014, we included 23 228 patients with breast cancer and 9634 patients with non-small cell lung cancer (NSCLC) in our regression and trust-level analyses. 30-day mortality increased with age for both patients with breast cancer and patients with NSCLC treated with curative intent, and decreased with age for patients receiving palliative SACT (breast curative: odds ratio [OR] 1·085, 99% CI 1·040–1·132; p<0·0001; NSCLC curative: 1·045, 1·013–1·079; p=0·00033; breast palliative: 0·987, 0·977–0·996; p=0·00034; NSCLC palliative: 0·987, 0·976–0·998; p=0·0015). 30-day mortality was also significantly higher for patients receiving their first reported curative or palliative SACT versus those who received SACT previously (breast palliative: OR 2·326 99% CI 1·634–3·312; p<0·0001; NSCLC curative: 3·371, 1·554–7·316; p<0·0001; NSCLC palliative: 2·667, 2·109–3·373; p<0·0001), and for patients with worse general wellbeing (performance status 2–4) versus those who were generally well (breast curative: 6·057, 1·333–27·513; p=0·0021; breast palliative: 6·241, 4·180–9·319; p<0·0001; NSCLC palliative: 3·384, 2·276–5·032; p<0·0001). We identified trusts with mortality rates in excess of the 95% control limits; this included seven for curative breast cancer, four for palliative breast cancer, five for curative NSCLC, and seven for palliative NSCLC. Interpretation Our findings show that several factors affect the risk of early mortality of breast and lung cancer patients in England and that some groups are at a substantially increased risk of 30-day mortality. The identification of hospitals with significantly higher 30-day mortality rates should promote review of clinical decision making in these hospitals. Furthermore, our results highlight the importance of collecting routine data beyond clinical trials to better understand the factors placing patients at higher risk of 30-day mortality, and ultimately improve clinical decision making. Our insights into the factors affecting risk of 30-day mortality will help treating clinicians and their patients predict the balance of harms and benefits associated with SACT. Funding Public Health England.
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Affiliation(s)
| | | | | | | | | | | | | | - David Chao
- Department of Oncology, Royal Free Hospital, London, UK
| | - John Dewar
- Department of Oncology, Ninewells Hospital & Medical School, Dundee, UK
| | - Denis Talbot
- University of Oxford, Department of Oncology, Oxford, UK
| | - Michael Peake
- Public Health England, London, UK; University of Leicester, Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
| | - Timothy Perren
- Leeds Institute of Cancer Research and Pathology, St James's University Hospital, Leeds, UK
| | | | - David Dodwell
- Institute of Oncology, St James's Hospital, Leeds, UK.
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117
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Allaire J, Couture P, Leclerc M, Charest A, Marin J, Lépine MC, Talbot D, Tchernof A, Lamarche B. A randomized, crossover, head-to-head comparison of eicosapentaenoic acid and docosahexaenoic acid supplementation to reduce inflammation markers in men and women: the Comparing EPA to DHA (ComparED) Study. Am J Clin Nutr 2016; 104:280-7. [PMID: 27281302 DOI: 10.3945/ajcn.116.131896] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [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: 02/01/2016] [Accepted: 05/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To date, most studies on the anti-inflammatory effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in humans have used a mixture of the 2 fatty acids in various forms and proportions. OBJECTIVES We compared the effects of EPA supplementation with those of DHA supplementation (re-esterified triacylglycerol; 90% pure) on inflammation markers (primary outcome) and blood lipids (secondary outcome) in men and women at risk of cardiovascular disease. DESIGN In a double-blind, randomized, crossover, controlled study, healthy men (n = 48) and women (n = 106) with abdominal obesity and low-grade systemic inflammation consumed 3 g/d of the following supplements for periods of 10 wk: 1) EPA (2.7 g/d), 2) DHA (2.7 g/d), and 3) corn oil as a control with each supplementation separated by a 9-wk washout period. Primary analyses assessed the difference in cardiometabolic outcomes between EPA and DHA. RESULTS Supplementation with DHA compared with supplementation with EPA led to a greater reduction in interleukin-18 (IL-18) (-7.0% ± 2.8% compared with -0.5% ± 3.0%, respectively; P = 0.01) and a greater increase in adiponectin (3.1% ± 1.6% compared with -1.2% ± 1.7%, respectively; P < 0.001). Between DHA and EPA, changes in CRP (-7.9% ± 5.0% compared with -1.8% ± 6.5%, respectively; P = 0.25), IL-6 (-12.0% ± 7.0% compared with -13.4% ± 7.0%, respectively; P = 0.86), and tumor necrosis factor-α (-14.8% ± 5.1% compared with -7.6% ± 10.2%, respectively; P = 0.63) were NS. DHA compared with EPA led to more pronounced reductions in triglycerides (-13.3% ± 2.3% compared with -11.9% ± 2.2%, respectively; P = 0.005) and the cholesterol:HDL-cholesterol ratio (-2.5% ± 1.3% compared with 0.3% ± 1.1%, respectively; P = 0.006) and greater increases in HDL cholesterol (7.6% ± 1.4% compared with -0.7% ± 1.1%, respectively; P < 0.0001) and LDL cholesterol (6.9% ± 1.8% compared with 2.2% ± 1.6%, respectively; P = 0.04). The increase in LDL-cholesterol concentrations for DHA compared with EPA was significant in men but not in women (P-treatment × sex interaction = 0.046). CONCLUSIONS DHA is more effective than EPA in modulating specific markers of inflammation as well as blood lipids. Additional studies are needed to determine the effect of a long-term DHA supplementation per se on cardiovascular disease risk. This trial was registered at clinicaltrials.gov as NCT01810003.
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Affiliation(s)
- Janie Allaire
- Institute of Nutrition and Functional Foods, Pavillon des Services
| | - Patrick Couture
- Institute of Nutrition and Functional Foods, Pavillon des Services, University Hospital Center (CHU) of Québec Research Center, and
| | - Myriam Leclerc
- Institute of Nutrition and Functional Foods, Pavillon des Services
| | - Amélie Charest
- Institute of Nutrition and Functional Foods, Pavillon des Services
| | - Johanne Marin
- Institute of Nutrition and Functional Foods, Pavillon des Services
| | | | - Denis Talbot
- University Hospital Center (CHU) of Québec Research Center, and Department of Social and Preventive Medicine, Laval University, Quebec, Canada; and
| | - André Tchernof
- Institute of Nutrition and Functional Foods, Pavillon des Services, University Hospital Center (CHU) of Québec Research Center, and Quebec Heart and Lung Institute, Quebec, Canada
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods, Pavillon des Services,
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118
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Christopoulos P, Faryal A, Dosani M, Rix D, Talbot D. A case of a living-related kidney transplantation after ex-vivo repair of the donor renal artery aneurysm. Hippokratia 2016; 20:90-92. [PMID: 27895453 PMCID: PMC5074409] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kidney transplantation is the definite surgical treatment for end-stage renal disease. Shortage of organs and the increasing number of patients with end-stage renal disease has led to an expansion of the selection criteria promoting the use of organs from marginal donors. Use of kidneys with renal artery aneurysm (RAA) is one such example. Description of the case: We report a case of living-related kidney transplantation from a 46-year-old female donor with unilateral RAA to her 68-year-old father. The pre-operative donor's assessment with a computed tomography angiogram revealed a saccular aneurysm of the left renal artery. The transplant team proceeded to the left nephrectomy, surgical ex vivo repair of the aneurysm and transplantation of this kidney to the recipient, with the total ischemic time of 130 minutes. At revascularization, there was no anastomotic leak with good perfusion of the organ and normal postoperative kidney function. CONCLUSION RAA is a rare renal anatomical abnormality with unproven clinical significance. Advanced microvascular surgical techniques can be used to repair the aneurysm with subsequent successful use for transplantation. Hippokratia 2016, 20(1): 90-92.
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Affiliation(s)
- P Christopoulos
- Hepatobiliary and Transplant Surgery, Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - A Faryal
- Hepatobiliary and Transplant Surgery, Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - M Dosani
- Hepatobiliary and Transplant Surgery, Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - D Rix
- Hepatobiliary and Transplant Surgery, Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - D Talbot
- Hepatobiliary and Transplant Surgery, Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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119
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Karina M, Lees C, Tadman M, Wang L, Talbot D. 1210 A retrospective study of 400 patients with neuroendocrine tumours treated in Oxford University hospitals since 2011. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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120
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Talbot D, Atherton J, Lefebvre G, Rossi AM, Bacon SL. Authors' reply to comments on “a cautionary note concerning the use of stabilized weights in marginal structural models”. Stat Med 2015; 34:2676-7. [DOI: 10.1002/sim.6512] [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] [Received: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Denis Talbot
- Département de Mathématiques; Université du Québec à Montréal; Montreal Quebec Canada
- Département de Médecine Sociale et Préventive; Université Laval; Quebec Canada
| | - Juli Atherton
- Département de Mathématiques; Université du Québec à Montréal; Montreal Quebec Canada
| | - Geneviève Lefebvre
- Département de Mathématiques; Université du Québec à Montréal; Montreal Quebec Canada
| | - Amanda M. Rossi
- Department of Exercise Science; Concordia University; Montreal Quebec Canada
- Montreal Behavioural Medicine Centre; Hôpital du Sacré-Coeur de Montréal; Montreal Quebec Canada
| | - Simon L. Bacon
- Department of Exercise Science; Concordia University; Montreal Quebec Canada
- Montreal Behavioural Medicine Centre; Hôpital du Sacré-Coeur de Montréal; Montreal Quebec Canada
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121
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Aawsaj Y, Dosani T, Talbot D. Dual kidney transplantation: a single-center experience. Transplant Proc 2015; 47:1125-7. [PMID: 26036535 DOI: 10.1016/j.transproceed.2015.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/12/2015] [Accepted: 03/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dual kidney transplantation (DKT) is an alternate approach to use marginal kidneys not suitable to be allocated for single kidney transplant. This retrospective study reviewed the short- and long-term outcomes regarding graft and patient survivals over a 9-year period at a single center. METHODS From 2005 to 2013, 33 DKTs were performed in our unit, where allocation was guided by clinical parameters mainly. The mean ages for recipients and donors were 58.6 ± 12.5 and 54.8 ± 13.6 years, respectively. Cold ischemia time was 21.4 ± 4 hours, and mean HLA mismatch for HLA-A, HLA-B, and HLA-DR was 3.06 ± 1.07. Immunosuppression regime was tacrolimus based. RESULTS Median follow-up time of 56 months showed patient and death-censored graft survivals at 1, 3, and 5 years to be 90% and 84%, 90% and 81%, and 84% and 81%, respectively. The rate of delayed graft function was 46.9% (n = 15), the rate of primary graft function was 46.9% (n = 15), the rate of and primary graft nonfunction was 6.2% (n = 2). Nineteen patients (59.4%) required biopsy: 12 of them showed acute tubular necrosis and 7 had rejection (1 needed graft removal, 4 were treated successfully with steroid and/or antithymocyte globulin, and 2 did not require treatment). CONCLUSIONS Outcomes of DKT in our center were satisfactory and similar to those of other transplant centers regarding patient and graft survivals.
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Affiliation(s)
- Y Aawsaj
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
| | - T Dosani
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - D Talbot
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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122
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Krishnan N, Coates R, Daga S, Carter V, Talbot D, Briggs D, Higgins R. ABO-incompatible renal transplantation without antibody removal using conventional immunosuppression alone. Am J Transplant 2015; 15:1728-9. [PMID: 25912420 DOI: 10.1111/ajt.13255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N Krishnan
- Renal Unit, University Hospitals Coventry and Warwickshire, UK
| | - R Coates
- Renal Unit, The Newcastle upon Tyne Hospitals, UK
| | - S Daga
- Renal Unit, University Hospitals Coventry and Warwickshire, UK
| | - V Carter
- Department of Histocompatibility and Immunogenetics, NHS Blood and Transplant, Newcastle, UK
| | - D Talbot
- Renal Unit, The Newcastle upon Tyne Hospitals, UK
| | - D Briggs
- Department of Histocompatibility and Immunogenetics, NHS Blood and Transplant, Birmingham, UK
| | - R Higgins
- Renal Unit, University Hospitals Coventry and Warwickshire, UK
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123
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Talbot D, Atherton J, Rossi AM, Bacon SL, Lefebvre G. A cautionary note concerning the use of stabilized weights in marginal structural models. Stat Med 2015; 34:812-23. [PMID: 25410264 DOI: 10.1002/sim.6378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 04/25/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 11/07/2022]
Abstract
Marginal structural models are commonly used to estimate the causal effect of a time-varying treatment in presence of time-dependent confounding. When fitting an MSM to data, the analyst must specify both the structural model for the outcome and the treatment models for the inverse-probability-of-treatment weights. The use of stabilized weights is recommended because they are generally less variable than the standard weights. In this paper, we are concerned with the use of the common stabilized weights when the structural model is specified to only consider partial treatment history, such as the current or most recent treatments. We present various examples of settings where these stabilized weights yield biased inferences while the standard weights do not. These issues are first investigated on the basis of simulated data and subsequently exemplified using data from the Honolulu Heart Program. Unlike common stabilized weights, we find that basic stabilized weights offer some protection against bias in structural models designed to estimate current or most recent treatment effects.
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Affiliation(s)
- Denis Talbot
- Département de mathématiques, Université du Québec à Montréal, Montréal, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
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124
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Ferraro D, Lin Y, Teste B, Talbot D, Malaquin L, Descroix S, Abou-Hassan A. Continuous chemical operations and modifications on magnetic γ-Fe2O3 nanoparticles confined in nanoliter droplets for the assembly of fluorescent and magnetic SiO2@γ-Fe2O3. Chem Commun (Camb) 2015; 51:16904-7. [DOI: 10.1039/c5cc07044a] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
An automated droplet microfluidic platform is described for the manipulation of magnetic nanoparticles and their assembly with fluorescent silica nanoparticles.
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Affiliation(s)
- D. Ferraro
- Laboratoire Physicochimie Curie
- CNRS/UMR 168
- Paris
- France
| | - Y. Lin
- Laboratoire Physicochimie Curie
- CNRS/UMR 168
- Paris
- France
- Sorbonne Universités
| | - B. Teste
- Laboratoire Physicochimie Curie
- CNRS/UMR 168
- Paris
- France
| | - D. Talbot
- Sorbonne Universités
- Laboratoire de PHysico-chimie des Electrolytes et NanosystèmesInterfaciauX (PHENIX)
- F-75252 Paris Cedex 05
- France
| | - L. Malaquin
- Laboratoire Physicochimie Curie
- CNRS/UMR 168
- Paris
- France
| | - S. Descroix
- Laboratoire Physicochimie Curie
- CNRS/UMR 168
- Paris
- France
| | - A. Abou-Hassan
- Sorbonne Universités
- Laboratoire de PHysico-chimie des Electrolytes et NanosystèmesInterfaciauX (PHENIX)
- F-75252 Paris Cedex 05
- France
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125
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Reynolds BC, Talbot D, Baines L, Brown A. Use of belatacept to maintain adequate early immunosuppression in calcineurin-mediated microangiopathic hemolysis post-renal transplant. Pediatr Transplant 2014; 18:E140-5. [PMID: 24815506 DOI: 10.1111/petr.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
We report a 17-yr-old boy who developed a microangiopathic hemolytic anemia presumed secondary to tacrolimus shortly following a living-related donor renal transplant. This was initially managed by plasmapheresis. Reinstitution of calcineurin inhibition using cyclosporine led to recurrence of hemolysis, so an alternative agent was needed. He was commenced on monthly intravenous belatacept, with no further recurrence of the hemolysis, and subsequent stable graft function. Modulation via CTLA-4 offers an alternative immunosuppressive tactic if current regimens produce graft threatening adverse effects. The method of administration and frequency of dosage of belatacept also lends itself well to the high-risk period of adolescence and transition. We propose that belatacept may therefore also have utility in difficult cases complicated by poor concordance, common in the adolescent age group.
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Affiliation(s)
- B C Reynolds
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
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126
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Mownah OA, Dosani T, Wilson C, Wyrley-Birch H, Talbot D. The impact of virtual crossmatching in the shortening of cold ischaemic times in renal transplantation. Ann R Coll Surg Engl 2013. [DOI: 10.1308/rcsann.2013.95.5.e9] [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: 11/22/2022] Open
Abstract
Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah.
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Affiliation(s)
- OA Mownah
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - T Dosani
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - C Wilson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - D Talbot
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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127
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Nolan RP, Floras JS, Ahmed L, Harvey PJ, Hiscock N, Hendrickx H, Talbot D. Response to comment from Dr. Sloan: 'look what's going down'. J Intern Med 2013; 273:217-8. [PMID: 22998372 DOI: 10.1111/j.1365-2796.2012.02590.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R. P. Nolan
- University Health Network and University of Toronto; Toronto ON Canada
| | - J. S. Floras
- University Health Network and University of Toronto; Toronto ON Canada
| | - L. Ahmed
- University Health Network and University of Toronto; Toronto ON Canada
| | - P. J. Harvey
- Women's College Hospital; University of Toronto; Toronto ON Canada
| | - N. Hiscock
- Unilever Discover; Colworth Science Park; Bedford UK
| | - H. Hendrickx
- Unilever Discover; Colworth Science Park; Bedford UK
| | - D. Talbot
- Unilever Discover; Colworth Science Park; Bedford UK
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128
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Abstract
Extensive research has shown that psychosocial stress can induce cognitive impairment. However, few studies have explored impairment following acute stress exposure in individuals with central obesity. Central obesity co-occurs with glucocorticoid excess and can lead to elevated cortisol responses to stress. It is not clear whether centrally obese individuals exhibit greater cognitive impairment following acute stress. Cortisol responses to stress versus no-stress control were compared in 66 high- and low waist to hip ratio (WHR) middle-aged adults (mean age of 46 ± 7.17 years). Cognitive performance post exposure was assessed using Cambridge Automated Neuropsychological Test Battery. It was hypothesised that high WHR would exhibit greater cortisol in response to stress exposure and would show poorer cognitive performance. Males, particularly of high WHR, tended to secrete greater cortisol during stress exposure. Exposure to stress and increasing WHR were specifically associated with poorer performance on declarative memory tasks (spatial recognition memory and paired associates learning). These data tentatively suggest a reduction in cognitive performance in those with central obesity following exposure to acute stress. Further research is needed to elucidate the effects of stress on cognition in this population.
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Affiliation(s)
- N Lasikiewicz
- Department of Psychology, Leeds Metropolitan University, Leeds, UK.
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129
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Carter P, Gray LJ, Talbot D, Morris DH, Khunti K, Davies MJ. Fruit and vegetable intake and the association with glucose parameters: a cross-sectional analysis of the Let's Prevent Diabetes Study. Eur J Clin Nutr 2012; 67:12-7. [PMID: 23299789 DOI: 10.1038/ejcn.2012.174] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dietary recommendations for the prevention of type 2 diabetes mellitus include the message to consume 400 g fruit and vegetables per day. Measurement of habitual diet is inherently difficult, yet errors due to self-report can be eliminated by the use of nutritional biomarkers. The aim of this study was to determine plasma vitamin C concentrations as a biomarker for fruit and vegetable intake in individuals identified at high risk of diabetes. Fruit and vegetables may confer benefit via their antioxidant capacity, thus we also measured urinary F₂-isoprostanes as a marker for oxidative stress. SUBJECTS/METHODS Participants recruited from a high-risk population as part of a diabetes prevention trial provided fasting blood samples and a spot urine sample for the quantification of plasma vitamin C and F₂-isoprostanes, respectively. We compared glycaemic parameters by the increments of the standard deviation of plasma vitamin C using multiple regression models. RESULTS Mean plasma vitamin C of participants was 39.3 μmol/l (s.d. 21.8). In the unadjusted model, 1 s.d. plasma vitamin C was significantly and inversely associated with HbA1c, fasting and 2 h blood glucose (P ≤ 0.0001). Relationships remained significant after adjustment for demographic variables and confounding factors. No significant association was observed between plasma vitamin C and urinary F₂-isoprostanes. CONCLUSION The data adds to the evidence that small lifestyle changes may influence glucose regulation. The role that fruit and vegetables independently have should be investigated further.
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Affiliation(s)
- P Carter
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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130
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Nolan RP, Floras JS, Ahmed L, Harvey PJ, Hiscock N, Hendrickx H, Talbot D. Behavioural modification of the cholinergic anti-inflammatory response to C-reactive protein in patients with hypertension. J Intern Med 2012; 272:161-9. [PMID: 22292421 DOI: 10.1111/j.1365-2796.2012.02523.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 12/13/2022]
Abstract
OBJECTIVES A central hypothesis of the cholinergic anti-inflammatory reflex model is that innate immune activity is inhibited by the efferent vagus. We evaluated whether changes in markers of tonic or reflex vagal heart rate modulation following behavioural intervention were associated inversely with changes in high-sensitivity C-reactive protein (hsCRP) or interleukin-6 (IL-6). DESIGN Subjects diagnosed with hypertension (n = 45, age 35-64 years, 53% women) were randomized to an 8-week protocol of behavioural neurocardiac training (with heart rate variability biofeedback) or autogenic relaxation. Assessments before and after intervention included pro-inflammatory factors (hsCRP, IL-6), markers of vagal heart rate modulation [RR high-frequency (HF) power within 0.15-0.40 Hz, baroreflex sensitivity and RR interval], conventional measures of lipoprotein cholesterol and 24-h ambulatory systolic and diastolic blood pressure. RESULTS Changes in hsCRP and IL-6 were not associated with changes in lipoprotein cholesterol or blood pressure. After adjusting for anti-inflammatory drugs and confounding factors, changes in hsCRP related inversely to changes in HF power (β = -0.25±0.1, P = 0.02), baroreflex sensitivity (β = -0.33±0.7, P = 0.04) and RR interval (β = -0.001 ± 0.0004, P = 0.02). Statistically significant relationships were not observed for IL-6. CONCLUSIONS Changes in hsCRP were consistent with the inhibitory effect of increased vagal efferent activity on pro-inflammatory factors predicted by the cholinergic anti-inflammatory reflex model. Clinical trials for patients with cardiovascular dysfunction are warranted to assess whether behavioural interventions can contribute independently to the chronic regulation of inflammatory activity and to improved clinical outcomes.
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Affiliation(s)
- R P Nolan
- University Health Network and University of Toronto, ON, Canada.
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131
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Moir JAG, Simms RJ, Wood KM, Talbot D, Kanagasundaram NS. Posttransplant lymphoproliferative disorder presenting as multiple cystic lesions in a renal transplant recipient. Am J Transplant 2012; 12:245-9. [PMID: 22244123 DOI: 10.1111/j.1600-6143.2011.03761.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report a case of a 67-year-old man who experienced allograft dysfunction following a renal transplantation from a donation after cardiac death. The postoperative course was initially complicated by episodes of E. coli urinary sepsis causing pyrexia and a raised creatinine level. Ultrasound scanning 5 weeks posttransplant revealed mild hydronephrosis with several parenchymal cystic areas measuring up to 2 cm with appearances suggestive of fungal balls. Aspirated fluid again grew Escherichia coli, and this was treated with the appropriate antimicrobial therapy. The patient continued to have episodes of culture-negative sepsis; therefore, a computed tomography scan was performed 6 months posttransplant, which revealed multiple lesions in the renal cortex as well as liver and spleen. Subsequent biopsy revealed an Epstein-Barr virus-driven lymphoproliferation consistent with a polymorphic posttransplantation lymphoproliferative disorder (PTLD). This rare case of PTLD presenting as multiple renal, hepatic and splenic lesions emphasizes the need for a high index of clinical suspicion for this condition. Abnormal para-renal allograft masses should be biopsied to allow swift and effective management of a disease that can disseminate and become significantly more challenging to manage.
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Affiliation(s)
- J A G Moir
- Renal Transplant Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK.
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132
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Abah U, Church D, Saka W, Talbot D, Kattach H, Sayeed R, Black E. 184 VATS lobectomy facilitates delivery of adjuvant chemotherapy following NSCLC resection. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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133
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Darlison L, Beckett P, Calman L, Mulatero C, O'Byrne K, Peake M, Talbot D. 91 Follow-up of patients with advanced NSCLC following 1st line chemotherapy. A British Thoracic Oncology Group national survey. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70092-2] [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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134
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Stenberg B, Talbot D, Khurram M, Kanwar A, Ray C, Mownah O, White K, Elliott ST. A new technique for assessing renal transplant perfusion preoperatively using contrast-enhanced ultrasound (CEUS) and three-dimensional ultrasound (3DUS)--a porcine model pilot study. Ultraschall Med 2011; 32 Suppl 2:E8-E13. [PMID: 22179806 DOI: 10.1055/s-0031-1281650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE This pilot study aims to assess the viability of using contrast-enhanced ultrasound (CEUS) in renal grafts while they are on hypothermic perfusion machines prior to transplantation. We assessed the vascularity and renal perfusion of machine-perfused porcine kidneys (Maastricht category II) using CEUS. MATERIALS AND METHODS Five kidneys were placed on hypothermic machine perfusion for up to 24 hours after retrieval. The kidneys were then scanned with a low MI contrast-specific preset and a bolus of 0.5 ml of Sonovue contrast agent was administered. Contrast-specific ultrasound images of the kidney were acquired in 2D and 3D. RESULTS The five kidneys demonstrated variable flow rates on the perfusion machine (10 - 37 ml/min at 30 mmHg). The CEUS technique demonstrated good perfusion and flow patterns, similar to those seen in vivo, in four kidneys. One kidney had patent arteries up to the interlobar region but no contrast filling in the cortex or medulla. Small perfusion defects were seen in two of the perfused kidneys. CONCLUSION CEUS appears to be a viable technique for assessing global perfusion and small defects within kidneys prior to transplantation. The flow patterns seen in vitro appear to correspond to those seen in vivo. Further work is required to evaluate the relevance of the flow dynamics measured.
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Affiliation(s)
- B Stenberg
- Radiology, Freeman Hospital, Newcastle upon Tyne, England, UK.
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135
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Talbot D, Duchesne T, Brisson J, Vandal N. Variance estimation and confidence intervals for the standardized mortality ratio with application to the assessment of a cancer screening program. Stat Med 2011; 30:3024-37. [PMID: 22009761 DOI: 10.1002/sim.4334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/08/2011] [Accepted: 06/20/2011] [Indexed: 11/07/2022]
Abstract
The effect of a cancer screening program can be measured through the standardized mortality ratio (SMR) statistic. The numerator of the SMR is the observed number of deaths from the screened disease among participants in the screening program, whereas the denominator of the SMR is an estimate of the expected number of deaths in these participants under the assumption that the screening program has no effect. In this article, we propose a variance estimator for the denominator of the SMR when this expected number of deaths is estimated with Sasieni's method. We give both a general formula for this variance as well as formulas for specific disease incidence and survival estimators. We show how this new variance estimator can be used to build confidence intervals for the SMR. We investigate the coverage properties of various types of confidence intervals by simulation and find that intervals that make use of the proposed variance estimator perform well. We illustrate the method by applying it to the Québec Breast Cancer Screening program.
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Affiliation(s)
- Denis Talbot
- Département de mathématiques et de statistique, Université Laval, Canada
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136
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Saleem A, Matthews JC, Ranson M, Callies S, André V, Lahn M, Dickinson C, Prenant C, Brown G, McMahon A, Talbot D, Jones T, Price PM. Molecular Imaging and Pharmacokinetic Analysis of Carbon-11 Labeled Antisense Oligonucleotide LY2181308 in Cancer Patients. Am J Cancer Res 2011; 1:290-301. [PMID: 21772926 PMCID: PMC3139194 DOI: 10.7150/thno/v01p0290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 05/27/2011] [Indexed: 11/05/2022] Open
Abstract
Antisense oligonucleotides (ASOs) have potential as anti-cancer agents by specifically modulating genes involved in tumorigenesis. However, little is known about ASO biodistribution and tissue pharmacokinetics (PKs) in humans, including whether sufficient delivery to target tumor tissue may be achieved. In this preliminary study in human subjects, we used combined positron emission and computed tomography (PET-CT) imaging and subsequent modeling analysis of acquired dynamic data, to examine the in vivo biodistribution and PK properties of LY2181308 - a second generation ASO which targets the apoptosis inhibitor protein survivin. Following radiolabeling of LY2181308 with methylated carbon-11 ([(11)C]methylated-LY2181308), micro-doses (<1mg) were administered to three patients with solid tumors enrolled in a phase I trial. Moderate uptake of [(11)C]methylated-LY2181308 was observed in tumors (mean=32.5ng*h /mL, per mg administered intravenously). Highest uptake was seen in kidney and liver and lowest uptake was seen in lung and muscle. One patient underwent repeat analysis on day 15 of multiple dose therapy, during administration of LY2181308 (750mg), when altered tissue PKs and a favorable change in biodistribution was seen. [(11)C]methylated-LY2181308 exposure increased in tumor, lung and muscle, whereas renal and hepatic exposure decreased. This suggests that biological barriers to ASO tumor uptake seen at micro-doses were overcome by therapeutic dosing. In addition, (18)F-labeled fluorodeoxyglucose (FDG) scans carried out in the same patient before and after treatment showed up to 40% decreased tumor metabolism. For the development of anti-cancer ASOs, the results provide evidence of LY2181308 tumor tissue delivery and add valuable in vivo pharmacological information. For the development of novel therapeutic agents in general, the study exemplifies the merits of applying PET imaging methodology early in clinical investigations.
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137
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Balupuri S, Buckley P, Mohamad M, Chidambaram V, Gerstenkorn C, Sen B, Kirby J, Manas D, Talbot D. Early results of a non-heartbeating donor (NHBD) programme with machine perfusion. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02031.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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138
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Bawa S, Vickers J, Barakat O, Bennett M, Ridealgh A, Talbot D, Manas D. Does a visual analogue colour chart carried by the retrieval team help in assessment of the fat content of donor livers? Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02005.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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139
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Yates T, Davies MJ, Gorely T, Talbot D, Bull F, Sattar N, Khunti K. The effect of increased ambulatory activity on markers of chronic low-grade inflammation: evidence from the PREPARE programme randomized controlled trial. Diabet Med 2010; 27:1256-63. [PMID: 20950383 DOI: 10.1111/j.1464-5491.2010.03091.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS To investigate whether an exercise intervention programme, with or without pedometer use, is effective at reducing chronic low-grade inflammation in those with impaired glucose tolerance. METHODS Using baseline and 12-month data from the Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme randomized controlled trial, we investigated whether the pedometer or the standard version of the PREPARE programme is associated with reduced chronic low-grade inflammation. Outcomes included interleukin-6, C-reactive protein, fasting and 2 h post-challenge glucose values and objectively measured ambulatory activity. RESULTS Seventy-four participants (31% female; mean age, 65 years; body mass index, 29.3 ± 4.8 kg/m(2) ) were included, of which 26 were in the control group and 24 were in each intervention group. At 12 months there was an increase in ambulatory activity of 1351 and 1849 steps/day in the standard and pedometer group, respectively, compared with control conditions; however, there was no significant change in markers of chronic low-grade inflammation. Across the pooled study sample, change in ambulatory activity was significantly correlated with change in interleukin-6 (r = -0.32, P = 0.01) after adjustment for group, age, sex, ethnicity, aspirin and statin medication, baseline body mass index and change in body mass index. Change in interleukin-6 was also significantly correlated with change in 2 h glucose after adjustment for the same variables (r = 0.26, P = 0.03). CONCLUSIONS This study failed to show reductions in markers of chronic low-grade inflammation following an intervention that promoted modest increases in ambulatory activity; however, across the study sample, increased ambulatory activity was associated with reduced interleukin-6, independent of obesity.
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Affiliation(s)
- T Yates
- Department of Cardiovascular Sciences, University of Leicester, UK School of Sport and Exercise Sciences, Loughborough University, UK.
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140
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Morel A, Mishra E, Medley L, Rahman NM, Wrightson J, Talbot D, Davies RJO. Chemotherapy should not be withheld from patients with an indwelling pleural catheter for malignant pleural effusion. Thorax 2010; 66:448-9. [DOI: 10.1136/thx.2009.133504] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [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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141
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Tan S, Lawler J, Foster K, Hall L, Talbot D, Torpey N, Raza M, Gould F. Nosocomial transmission of Salmonella typhimurium in renal transplant recipients. J Hosp Infect 2010; 75:241-2. [DOI: 10.1016/j.jhin.2009.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 11/19/2009] [Indexed: 10/19/2022]
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142
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Morel A, Talbot D. Critical evaluation of vinflunine in the treatment of refractory metastatic urothelial carcinoma. Open Access J Urol 2010; 2:99-108. [PMID: 24198619 PMCID: PMC3819039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Urothelial carcinoma (UC) accounts for 5% to 10% of malignancies in men in Europe and the United States. For locally advanced or metastatic disease, there are two standard firstline chemotherapy regimens: MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and gemcitabine/cisplatin. For refractory disease, there is currently no standard treatment. Vinflunine, a second-generation Vinca alkaloid, is the first chemotherapeutic agent to be evaluated in a large UC second-line population. This review discusses the pre-clinical and clinical data published, and compares vinflunine to alternative single agents and combination regimens tested in this setting. Based on the results of the phase II and III clinical trials, there appears to be sufficient evidence to support the use of vinflunine in the second-line setting.
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Affiliation(s)
- Armand Morel
- Department of Medical Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Denis Talbot
- Department of Medical Oncology, University of Oxford, Oxford, Oxfordshire, UK,Correspondence: Denis Talbot, University of Oxford Department of Medical Oncology, Cancer and Haematology Centre, Level 2, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ, UK, Tel +44 1865 235312, Fax +44 1865 235981, Email
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143
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Talbot D, Morel A. Critical evaluation of vinflunine in the treatment of refractory metastatic urothelial carcinoma. Res Rep Urol 2010. [DOI: 10.2147/rru.s7234] [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: 11/23/2022] Open
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144
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Talbot D, Morel A. Critical evaluation of vinflunine in the treatment of refractory metastatic urothelial carcinoma. Open Access J Urol 2010. [DOI: 10.2147/oaju.s7234] [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: 11/23/2022] Open
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145
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Shrestha PC, Dominguez-Escrig J, Gowardhan B, Rix D, Talbot D. Practices and Results of Two Years Service from a single UK Renal Transplant Center. JNMA J Nepal Med Assoc 2010. [DOI: 10.31729/jnma.122] [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: 11/01/2022] Open
Abstract
INTRODUCTION:
End stage renal failure is a common condition requiring renal replacement therapy in the form of haemodialysis or peritoneal dialysis as a short-term measure with renal transplantation as a more definitive treatment option. The aim of this study was to evaluate the set up of arenal transplant unit in a developed country and compare its results with other centers of the world.
METHODS:
A retrospective observational study was conducted to see the results of two years activities of a well known renal transplant unit in the United Kingdom. A description of the setup of a renal transplant unit has been made and its results have been discussed.
RESULTS:
Of the total patients, who had transplants in the renal transplant unit in year 2006 and 2007, 209 were renal, 14 were simultaneous kidneypancreas and two were pancreas after kidney transplants. Our one year graft survival rate was 93%, delayed graft function was 15%, early rejection rate was 11% and mortality rate was 3% in one year follow up.
CONCLUSIONS:
To attain good results in renal transplantation surgery, a multi-disciplinary team approach is crucial. Our set up is an example where the results are comparable to published and unpublished data from other established units world-wide.
Keywords: complications, immunosuppression, renal transplant.
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146
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Shrestha PC, Dominguez-Escrig J, Gowardhan B, Rix D, Talbot D. Practices and results of two years service from a single U.K. renal transplant center. JNMA J Nepal Med Assoc 2010; 49:6-9. [PMID: 21180212] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION End stage renal failure is a common condition requiring renal replacement therapy in the form of haemodialysis or peritoneal dialysis as a short-term measure with renal transplantation as a more definitive treatment option. The aim of this study was to evaluate the set up of a renal transplant unit in a developed country and compare its results with other centers of the world. METHODS A retrospective observational study was conducted to see the results of two years activities of a well known renal transplant unit in the United Kingdom. A description of the setup of a renal transplant unit has been made and its results have been discussed. RESULTS Of the total patients, who had transplants in the renal transplant unit in year 2006 and 2007, 209 were renal, 14 were simultaneous kidney pancreas and two were pancreas after kidney transplants. Our one year graft survival rate was 93%, delayed graft function was 15%, early rejection rate was 11% and mortality rate was 3% in one year follow up. CONCLUSIONS To attain good results in renal transplantation surgery, a multi-disciplinary team approach is crucial. Our set up is an example where the results are comparable to published and unpublished data from other established units world-wide.
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Affiliation(s)
- P C Shrestha
- Department of Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
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147
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Adams RF, Parulekar V, Hughes C, Kadour MJ, Talbot D. Radiologic characteristics and management of screen-detected metastatic carcinoid tumor of the breast: a case report. Clin Breast Cancer 2009; 9:189-92. [PMID: 19661045 DOI: 10.3816/cbc.2009.n.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Carcinoid tumors are known to metastasize to the breast, but their appearance can mimic a primary breast carcinoma, making biopsy essential in order to give the correct preoperative diagnosis. It has been suggested that core biopsy might precipitate a carcinoid crisis and should be avoided. We describe a case of screen-detected carcinoid tumor metastasis in the breast safely diagnosed by core biopsy and present the imaging findings, including magnetic resonance imaging and elastography. This case illustrates the importance of preoperative histologic diagnosis in enabling the appropriate surgical or medical management of these patients. Review of the literature also supports the policy that biopsy of nonhormonally active tumors may be safely performed.
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Affiliation(s)
- Rosie F Adams
- Breast Care Unit, Churchill Hospital, Headington, Oxford, OX3 7LJ, UK.
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148
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O'Connor DB, Hendrickx H, Dadd T, Elliman TD, Willis TA, Talbot D, Mayes AE, Thethi K, Powell J, Dye L. Cortisol awakening rise in middle-aged women in relation to psychological stress. Psychoneuroendocrinology 2009; 34:1486-94. [PMID: 19520518 DOI: 10.1016/j.psyneuen.2009.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/01/2009] [Accepted: 05/03/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The cortisol awakening rise (CAR) is defined as cortisol secretory activity in the first 45-60 min immediately post-awakening. It has been suggested that psychological factors may disrupt the normal awakening rise. Recent research has shown that psychological stress may influence the magnitude of the CAR, however the findings have been mixed. This study examined the impact of stress on the CAR and the diurnal mean in a sample of middle-aged women. METHOD One hundred and eighteen healthy female participants who reported experiencing high or low stress were recruited. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) and at 3, 6, 9 and 12 h on two consecutive days. A number of metabolic and inflammatory biomarkers were also assessed together with measures of mood disturbance and health behaviour. RESULTS The magnitude of the CAR, assessed by the area under the response curve (AURC) estimate, was significantly lower in the high stress group compared to the low stress group indicating that participants who experienced high stress secreted lower levels of cortisol. The effect was largely accounted for by differences 30 min after waking. The diurnal mean was also lower for the high stress group. Although participants in the high stress group had a slightly worse inflammatory profile, only low-density lipoprotein levels were found to be significantly higher, compared to the low stress group. Lifestyle indicators and mood were also found to be significantly poorer in the high stress group. CONCLUSIONS The results suggest that psychological stress may be associated with a smaller cortisol awakening rise, a lower diurnal mean, poor lifestyle choices and high levels of psychological distress. These findings may have broader implications for future health risk and for an individual's ability to cope with imminent daily stressors and demands.
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Affiliation(s)
- D B O'Connor
- Institute of Psychological Sciences, University of Leeds, Leeds, UK. d.b.o'
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149
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Navarro AP, Asher J, Sohrabi S, Reddy M, Stamp S, Carter N, Talbot D. Peritoneal cooling may provide improved protection for uncontrolled donors after cardiac death: an exploratory porcine study. Am J Transplant 2009; 9:1317-23. [PMID: 19459821 DOI: 10.1111/j.1600-6143.2009.02633.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3 degrees C versus 16.9 degrees C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs.
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Affiliation(s)
- A P Navarro
- Liver, Renal and Pancreatic Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
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150
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Navarro A, Sohrabi S, Colechin E, Griffiths C, Talbot D, Soomro N. Evaluation of the Ischemic Protection Efficacy of a Laparoscopic Renal Cooling Device Using Renal Transplantation Viability Assessment Criteria in a Porcine Model. J Urol 2008; 179:1184-9. [DOI: 10.1016/j.juro.2007.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Indexed: 11/28/2022]
Affiliation(s)
- A.P. Navarro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - S. Sohrabi
- Department of Medical Physics, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - E. Colechin
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - C. Griffiths
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - D. Talbot
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - N.A. Soomro
- Liver and Renal Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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