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Liu S, Sharp A, Lu Z, Ma ZF. Maternal iodine intake and adherence to iodine supplement recommendations in a group of Chinese women: the results from the WIN cohort study - CORRIGENDUM. Proc Nutr Soc 2023; 82:492. [PMID: 37078399 DOI: 10.1017/s0029665123002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- S Liu
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - A Sharp
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Z Lu
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Z F Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
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2
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Mayer AW, Sharp A, Aziz S, Balasubramanian SP. Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism. J Laryngol Otol 2023; 137:1226-1232. [PMID: 36876328 DOI: 10.1017/s002221512300035x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. METHODS A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. RESULTS Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). CONCLUSION Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.
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Affiliation(s)
- A W Mayer
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Sharp
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Aziz
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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3
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Stampalija T, Bhide A, Heazell AEP, Sharp A, Lees C. Computerized cardiotocography and Dawes-Redman criteria: how should we interpret criteria not met? Ultrasound Obstet Gynecol 2023; 61:661-666. [PMID: 36905681 DOI: 10.1002/uog.26198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/03/2023]
Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - C Lees
- Institute of Developmental and Reproductive Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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4
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Gent J, Oliver E, Quigley H, Sharp A. Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2023; 286:23-27. [PMID: 37167810 DOI: 10.1016/j.ejogrb.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. STUDY DESIGN Retrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. RESULTS A total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant. DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003-0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28-0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25-0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. CONCLUSION Our data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.
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Affiliation(s)
- J Gent
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom.
| | - E Oliver
- University of Liverpool, United Kingdom
| | - H Quigley
- University of Liverpool, United Kingdom
| | - A Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom
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Oliver E, Navaratnam K, Gent J, Khalil A, Sharp A. Comparison of International Guidelines on the Management of Twin Pregnancy. Eur J Obstet Gynecol Reprod Biol 2023; 285:97-104. [PMID: 37087836 DOI: 10.1016/j.ejogrb.2023.04.002] [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] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To review current international clinical guidelines on the antenatal and intrapartum management of twin pregnancies, examining areas of consensus and conflict. METHODS We conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted. RESULTS We identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS). For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring. The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management. CONCLUSIONS This review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.
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Bullough S, Lip GYH, Fauchier G, Herbert J, Sharp A, Bisson A, Ducluzeau PH, Fauchier L. A nationwide cohort study on the impact of gestational diabetes on future cardiovascular events. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The link between hypertensive disease in pregnancy and future cardiovascular events is well established, as is the increased risk of developing type 2 diabetes mellitus after gestational diabetes (GDM). What is less well understood is the impact of GDM on future cardiovascular events. The literature is conflicting although suggestive that the risk of cardiovascular events with a history of GDM is 2 fold higher.
Purpose
Using the largest cohort to date and utilising robust data acquisition procedures and follow up we assessed the prognostic value of GDM for future cardiovascular events.
Methods
All female patients discharged from French hospitals in 2013 with at least 5 years of subsequent follow-up were identified. Those with a previous major adverse cardiovascular event, history of hypertensive disease, pre-existing diabetes or under the age of 18 years old were excluded. They were grouped depending on their history of GDM. After propensity score matching, patients with GDM were matched 1:1 with patients with no GDM. Hazard ratios for cardiovascular events during follow-up were adjusted by age at baseline.
Results
A total of, 1,738,101 women were included in the analysis, leaving 1,141,743 women (mean age 52.2, SD 19.7) once exclusion criteria were applied: 6998 (0.6%) had a history of GDM and the mean follow-up was 5.1 years (SD 1.3 years). Those with a history of GDM had a lower risk of new onset heart failure (HF) (hazard ratio [HR] 0.66, 95% confidence interval [CI]: 0.45–0.98) and all-cause death (HR 0.61, 95% CI 0.47–0.79). There was no significant difference in risk for myocardial infarction (HR 0.88, 95% CI 0.38–2.03), ischaemic stroke (HR 0.94, 95% CI 0.55–1.63), new onset atrial fibrillation (AF) (HR 0.61, 95% CI 0.33–1.11), cardiovascular death (HR 1.25, 95% CI 0.47–3.36) and major cardiovascular events (i.e. in-hospital cardiovascular death, myocardial infarction, ischaemic stroke or new-onset HF (MACE-HF)) (HR 0.75, 95% CI 0.56–1.01).
Conclusions
In a large contemporary analysis of female patient seen in French hospitals and utilising a robust data set we present the largest population analysis of the association between GDM and future cardiovascular events. Those with a history of GDM do not have a higher risk of myocardial infarction, ischaemic stroke, new onset AF, cardiovascular death or MACE-HF. Contrary to what is widely thought, a history of GDM confers a lower risk of new onset HF and all-cause death when compared to those women with no history of GDM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Bullough
- Liverpool Womens Hospital , Liverpool , United Kingdom
| | - G Y H Lip
- Liverpool Centre for Cardiovascular Science , Liverpool , United Kingdom
| | - G Fauchier
- University of Tours - Faculty of Medicine , Tours , France
| | - J Herbert
- University of Tours - Faculty of Medicine , Tours , France
| | - A Sharp
- Liverpool Womens Hospital , Liverpool , United Kingdom
| | - A Bisson
- University of Tours - Faculty of Medicine , Tours , France
| | - P H Ducluzeau
- University of Tours - Faculty of Medicine , Tours , France
| | - L Fauchier
- University of Tours - Faculty of Medicine , Tours , France
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Al Bahhawi T, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Abbasizanjani H, Akbari A, Torabi F, Halcox J, Lip GYH. Role of multiple- and single-pregnancy complications with incident cardiovascular diseases: a nationwide data linkage study in Wales. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prior evidence has suggested that pregnancy complications are associated with a higher risk of cardiovascular disease in women. However, associations between coexisting multiple pregnancy complications and incident cardiovascular disease remains unclear.
Purpose
To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of multiple pregnancy complications and women with a history of single-pregnancy complications, compared to women without pregnancy complications.
Methods
This retrospective cohort included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Cox proportional hazard regression was used to evaluate the association between multiple or specific single pregnancy complications and incidence of cardiovascular disease.
Results
A total of 298,515 women were included in the study, of which 64,794 (21.7%) women experienced a single pregnancy complication, and 10,038 (3.38%) women experienced more than one complication during their first pregnancy. During the a median of 9.7 years of follow-up, 2,484 women developed incident cardiovascular disease. IHD had the highest incidence rate among women with multiple pregnancy complications at 9.06 (7.36–11.15) per 10,000 person-years, compared to 4.24 (3.77–4.78) among women with a single pregnancy complication and 2.40 (2.20–2.61) among women without any pregnancy complications. After adjusting for potential confounding factors, compared to no previous pregnancy complications, a history of multiple pregnancy complications was associated with a higher risk of heart failure [hazard ratio (HR) 3.18 (95% confidence interval (CI) 2.34–4.32)], IHD [HR 2.88 (95% CI 2.27–3.67)], stroke [HR 2.03 (95% CI 1.55–2.65)] and atrial fibrillation [HR 1.80 (95% CI 1.20–2.72)]. There was also a consistent trend for a higher risk of all outcomes in women with a history of single-pregnancy complications compared to women without complications during the first pregnancy (Figure 1).
Conclusion
This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. In almost 300,000 women with a previous pregnancy, multiple pregnancy complications were associated with a higher risk of incident cardiovascular disease, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Women who experience multiple pregnancy complications may benefit from targeted intervention strategies to reduce their risk of incident cardiovascular disease.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Saudi Arabia governmental PhD studentship
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences , Liverpool , United Kingdom
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg , Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre , Liverpool , United Kingdom
| | - H Abbasizanjani
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - A Akbari
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - F Torabi
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - J Halcox
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
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Al Bahhawi T, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Abbasizanjani H, Akbari A, Torabi F, Halcox J, Lip GYH. Associations between pregnancy complications and incident cardiovascular disease: a nationwide data linkage study in Wales. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have associated pregnancy complications with a higher risk of cardiovascular disease. However, previous studies have not sufficiently evaluated the impact of broad range of pregnancy complications or common cardiovascular conditions individually. Furthermore, most previous studies have relied on data from hospital admission records only, which may not have adequately accounted for conditions that may not result in an inpatient hospital admission, such as atrial fibrillation.
Purpose
To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of pregnancy complications compared to women without pregnancy complications in a large nationwide study using linked routinely collected data.
Methods
A retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank and included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Survival analyses were conducted using Cox proportional hazard regression models adjusted for hypertension, diabetes, hyperlipidaemia, congenital and valvular heart diseases, multifetal pregnancy ethnicity, maternal age, calendar year of first birth and index of multiple deprivation.
Results
A total of 298,515 women were included in the study, of which 74,832 (25.1%) had a history of any pregnancy complication during their first pregnancy. During a median of 9.7 years follow-up time, 2,484 women developed at least one cardiovascular condition. Among women with a history of pregnancy complication in their first pregnancy, IHD had the highest incidence rate at 4.94 (95% confidence interval (CI) 4.44–5.49) per 10,000 person-years, and atrial fibrillation was the lowest at 1.92 (95% CI 1.62–2.28). The history of any pregnancy complication during the first pregnancy was associated with a higher risk of all cardiovascular conditions examined, including heart failure [hazard ratio (HR) 1.93 95% CI 1.61–2.31)], IHD [HR 1.82 (95% CI 1.58–2.10)], stroke [HR 1.39 (95% CI 1.20–1.61)] and atrial fibrillation [HR 1.33 (95% CI 1.08–1.65) (Figure 1).
Conclusion
This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. A history of pregnancy complications during first pregnancy was associated with a higher risk of incident cardiovascular conditions, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Applying primary preventive measures and risk assessments for cardiovascular disease after the first pregnancy may mitigate the higher risk among these women.
Funding Acknowledgement
Type of funding sources: Other.
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences , Liverpool , United Kingdom
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg , Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre , Liverpool , United Kingdom
| | - H Abbasizanjani
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - A Akbari
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - F Torabi
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - J Halcox
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
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9
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Latorre G, Pizarro M, Ford J, Gándara V, Muñoz G, Araya J, Bellolio E, Villaseca MÁ, Fuentes-López E, Cortés P, Rollán A, Bufadel M, Araya R, Vargas J, Espino A, Sharp A, Agüero C, Donoso A, Bresky G, Pedrero P, Rueda C, Calvo A, Odagaki T, Moriyama T, Ishida T, Parra-Blanco A, Camargo M, González R, Corvalán A, Riquelme A. Evaluation of Trefoil Factor 3 as a Non-Invasive Biomarker of Gastric Intestinal Metaplasia and Gastric Cancer in a High-Risk Population. Gastroenterología y Hepatología 2022; 46:411-418. [DOI: 10.1016/j.gastrohep.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 01/06/2023]
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Beck EJ, Loncar D, Mandalia S, Patel NH, Lwanga J, Sharp A, Fox J. Hospital and community care costs for people newly diagnosed of living with HIV in London, UK. AIDS Care 2022; 35:719-728. [PMID: 35277095 DOI: 10.1080/09540121.2022.2038362] [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: 10/18/2022]
Abstract
This study of people newly diagnosed of living with HIV (ND-PLHIV) calculated the use, cost and outcome of HIV services at a London HIV centre. ND-PLHIV were followed July 2017-October 2018. Hospital data included inpatient days (IP), outpatient (OP), dayward (DW) visits, tests and procedures, and anti-retroviral drugs (ARVs). Community services were recorded in daily diaries. Mean per patient-year (MPPY) use was multiplied by unit costs. 13.6 MPPY (95%CI 12.4-14.9) OP visits, 0.4 MPPY (95%CI 0.1-0.7) IP days, 0.09 MPPY (95%CI 0.01-0.2) DW visits and 4.6 MPPY community services (95%CI 3.4-5.8). Total annual costs per patient-year (CPPY) was £11,483 (95%CI £10,369-12,597): ARVs comprised 63% and community services 2%. White participants used fewer hospital and more community services compared with minority ethnic community (MEC) participants. Costs for White ND-PLHIV was £10,778 CPPY (95%CI £9629-11,928); £13,214 (95%CI £10,656-15,772) for MEC ND-PLHIV (p < 0.06). Annual costs were inversely related to CD4 count at entry (r = -5.58, p = 0.02); mean CD4 count was 476 cells/mm3 (95%CI 422-531) versus 373 cells/mm3 (95%CI 320-425) for White and MEC participants respectively (p = 0.03). Annual costs for ND-PLHIV with CD4 ≤ 350 cells/mm3 was £2478 PPY higher compared with CD4 count >350 cells/mm3 (p = 0.04).
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | - D Loncar
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - N H Patel
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Lwanga
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Sharp
- Kings College London, London, UK
| | - J Fox
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Kings College London, London, UK
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12
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Chauvette L, Fournier P, Sharp A. The frequency-following response to assess the neural representation of spectral speech cues in older adults. Hear Res 2022; 418:108486. [DOI: 10.1016/j.heares.2022.108486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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13
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Sharp A, Mehmood Z, Haque F, Schofield R. Disruptive Power Of CTCA In A DGH’s Endeavour Towards Value Based Health Care. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.156] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Goodfellow L, Verwijs MC, Care A, Sharp A, Ivandic J, Poljak B, Roberts D, Bronowski C, Gill AC, Darby AC, Alfirevic A, Muller-Myhsok B, Alfirevic Z, van de Wijgert J. Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study. BJOG 2021; 128:2061-2072. [PMID: 34139060 DOI: 10.1111/1471-0528.16816] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM). DESIGN Nested case-control study. SETTING UK tertiary referral hospital. SAMPLE High-risk women with previous sPTB/PPROM <34+0 weeks' gestation who had a recurrence (n = 22) or delivered at ≥37+0 weeks without PPROM (n = 87). METHODS Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR. MAIN OUTCOME MEASURE Recurrent early sPTB/PPROM. RESULTS Of the 109 high-risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (Lactobacillus iners 36/109, Lactobacillus crispatus 23/109, or other 22/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log10 cells/mcl, adjusted odds ratio [aOR] 1.90, 95% CI 1.01-3.56, P = 0.047) and estimated Lactobacillus concentration (8.59 versus 7.48 log10 cells/mcl, aOR 2.35, (95% CI 1.20-4.61, P = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners domination (aOR 3.44, 95% CI 1.06-11.15, P = 0.040). Women with anaerobic dysbiosis or L. iners domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log10 cells/mcl, respectively). CONCLUSIONS Vaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts. TWEETABLE ABSTRACT Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
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Affiliation(s)
- L Goodfellow
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - M C Verwijs
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A Care
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - A Sharp
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - J Ivandic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - B Poljak
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - D Roberts
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - C Bronowski
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A C Gill
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A C Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - A Alfirevic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - B Muller-Myhsok
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK.,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Z Alfirevic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - Jhhm van de Wijgert
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Al Bahhawi T, Aqeeli A, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Lip GYH. Pregnancy-related complications and incidence of atrial fibrillation: a systematic review and meta-analysis. Europace 2021. [DOI: 10.1093/europace/euab116.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pregnancy-related complications have been previously associated with incident cardiovascular disease. However, data are scarce on the association between pregnancy-related complications and incident atrial fibrillation (AF). This systematic review examines associations between pregnancy-related complications and incident AF.
Methods
A systematic search of the literature utilising MEDLINE and EMBASE (Ovid) was conducted from 1990 to 6 April 2020. Observational studies examining the association between pregnancy-related complications including hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, low birth weight, small-for-gestational-age and stillbirth, and incidence of AF were included. Screening and data extraction were conducted independently by two reviewers. Inverse-variance random-effects models were used to pool hazard ratios.
Results: Six observational studies met the inclusion criteria
one case-control study and five retrospective cohort studies, with four studies eligible for meta-analysis. Sample sizes ranged from 1,839-1,303,365. Mean/median follow-up for the cohort studies ranged from 7-36 years. Most studies reported an increased risk of incident AF associated with pregnancy-related complications. The pooled summary statistic from four studies reflected a greater risk of incident AF for HDP (hazard ratio (HR) 1.47, 95% confidence intervals (CI) 1.18-1.84; I2 = 84%) and from three studies for pre-eclampsia (HR 1.71, 95% CI 1.41-2.06; I2 = 64%; Figure).
Conclusions
The results of this review suggest that pregnancy-related complications particularly pre-eclampsia appear to be associated with higher risk of incident AF. The small number of included studies and the significant heterogeneity in the pooled results suggest further large-scale prospective studies are required to confirm the association between pregnancy-related complications and AF. Abstract Figure.
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Aqeeli
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg, Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
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16
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Sharp A, Patient C, Pickett J, Belham M. Pregnancy related inappropriate sinus tachycardia: a distinct arrhythmia? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The syndrome of inappropriate sinus tachycardia (IST) is well recognized and affects ∼1% of the population. We believe IST in pregnancy is a relatively frequent yet under-recognized phenomenon that may represent a distinct arrhythmia. To date, there are only three case reports in the literature.
Purpose
To further understand the natural history of IST in pregnancy, and to explore maternal outcomes.
Methods
A retrospective, observational cohort analysis.
Results
19 pregnant women presented to our institute with a definitive diagnosis of IST (as defined by task force criteria) between January 2016 and January 2017. Symptom onset was 4–36 weeks gestation (mean 20 weeks). Of those in their second or subsequent pregnancy (n=8), 50% described symptoms compatible with IST in previous pregnancies. 42% attended the emergency department on ≥1 occasion with symptoms of IST. 32% required hospital admission. 26% required pharmacological therapy (beta-blockers in all). There were no maternal deaths, instances of heart failure or acute coronary syndrome, no thromboembolic or haemorrhagic complications during pregnancy. Rates of Caesarean section were similar to the background rate of our unit; however, rates of induction were notably elevated (58% vs 25%), with 55% of these women being induced purely for symptoms of IST. Following delivery, symptoms resolved within one week for 17 of the women in the cohort, 1 had symptoms resolve after 4 month and 1 had persistent symptoms as she became pregnant again.
Conclusion
IST in pregnancy likely represents a distinct arrhythmia; the majority of individuals here had symptoms only during pregnancy, which resolved rapidly postpartum. Additionally, half of the women in a second or subsequent pregnancy had suffered IST symptoms during previous pregnancies, with no symptoms in between pregnancies. It is biologically plausible and may represent an exaggerated cardio-autonomic response to the physiological changes of pregnancy such as increased sympathetic tone and change in baroreceptor reflex sensitivity. Recognition of the condition is important given it is associated with significant morbidity, the distressing nature of symptoms leading to high rates of hospitalization and induction of labour.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Sharp
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C Patient
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Pickett
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Belham
- Addenbrooke's Hospital, Cambridge, United Kingdom
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17
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Diez P, Bourner J, Sharp A, Hoskin P, McCormack M. OC-1037: Real world interpretation of GEC-ESTRO image-guided brachytherapy recommendations for cervix cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01976-9] [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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18
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Hackett J, Hall L, Sadiq M, Putheran M, Hall B, Burn S, Sharp A, Alfirevic Z, Agarwal U. Vein of Galen aneurysmal malformation affecting cotwin in dichorionic diamniotic pregnancy. Ultrasound Obstet Gynecol 2020; 56:474-475. [PMID: 32484251 DOI: 10.1002/uog.22108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/10/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - L Hall
- University of Birmingham, Birmingham, UK
| | - M Sadiq
- Warrington Hospital, Warrington, UK
| | - M Putheran
- Alder Hey Children's Hospital, Liverpool, UK
| | - B Hall
- Aintree University Hospital, Liverpool, UK
| | - S Burn
- Alder Hey Children's Hospital, Liverpool, UK
| | - A Sharp
- University of Liverpool, Liverpool, UK
| | | | - U Agarwal
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
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Kolinsky MP, Rescigno P, Bianchini D, Zafeiriou Z, Mehra N, Mateo J, Michalarea V, Riisnaes R, Crespo M, Figueiredo I, Miranda S, Nava Rodrigues D, Flohr P, Tunariu N, Banerji U, Ruddle R, Sharp A, Welti J, Lambros M, Carreira S, Raynaud FI, Swales KE, Plymate S, Luo J, Tovey H, Porta N, Slade R, Leonard L, Hall E, de Bono JS. A phase I dose-escalation study of enzalutamide in combination with the AKT inhibitor AZD5363 (capivasertib) in patients with metastatic castration-resistant prostate cancer. Ann Oncol 2020; 31:619-625. [PMID: 32205016 PMCID: PMC7217345 DOI: 10.1016/j.annonc.2020.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Activation of the PI3K/AKT/mTOR pathway through loss of phosphatase and tensin homolog (PTEN) occurs in approximately 50% of patients with metastatic castration-resistant prostate cancer (mCRPC). Recent evidence suggests that combined inhibition of the androgen receptor (AR) and AKT may be beneficial in mCRPC with PTEN loss. PATIENTS AND METHODS mCRPC patients who previously failed abiraterone and/or enzalutamide, received escalating doses of AZD5363 (capivasertib) starting at 320 mg twice daily (b.i.d.) given 4 days on and 3 days off, in combination with enzalutamide 160 mg daily. The co-primary endpoints were safety/tolerability and determining the maximum tolerated dose and recommended phase II dose; pharmacokinetics, antitumour activity, and exploratory biomarker analysis were also evaluated. RESULTS Sixteen patients were enrolled, 15 received study treatment and 13 were assessable for dose-limiting toxicities (DLTs). Patients were treated at 320, 400, and 480 mg b.i.d. dose levels of capivasertib. The recommended phase II dose identified for capivasertib was 400 mg b.i.d. with 1/6 patients experiencing a DLT (maculopapular rash) at this level. The most common grade ≥3 adverse events were hyperglycemia (26.7%) and rash (20%). Concomitant administration of enzalutamide significantly decreased plasma exposure of capivasertib, though this did not appear to impact pharmacodynamics. Three patients met the criteria for response (defined as prostate-specific antigen decline ≥50%, circulating tumour cell conversion, and/or radiological response). Responses were seen in patients with PTEN loss or activating mutations in AKT, low or absent AR-V7 expression, as well as those with an increase in phosphorylated extracellular signal-regulated kinase (pERK) in post-exposure samples. CONCLUSIONS The combination of capivasertib and enzalutamide is tolerable and has antitumour activity, with all responding patients harbouring aberrations in the PI3K/AKT/mTOR pathway. CLINICAL TRIAL NUMBER NCT02525068.
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Affiliation(s)
- M P Kolinsky
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Cross Cancer Institute, Edmonton, Canada
| | - P Rescigno
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Department of Clinical Medicine and Surgery, Department of Translational Medical Sciences, AOU Federico II, Naples, Italy
| | - D Bianchini
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Z Zafeiriou
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - N Mehra
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Mateo
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - V Michalarea
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Riisnaes
- The Institute of Cancer Research, London, UK
| | - M Crespo
- The Institute of Cancer Research, London, UK
| | | | - S Miranda
- The Institute of Cancer Research, London, UK
| | | | - P Flohr
- The Institute of Cancer Research, London, UK
| | - N Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Ruddle
- The Institute of Cancer Research, London, UK
| | - A Sharp
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Welti
- The Institute of Cancer Research, London, UK
| | - M Lambros
- The Institute of Cancer Research, London, UK
| | - S Carreira
- The Institute of Cancer Research, London, UK
| | - F I Raynaud
- The Institute of Cancer Research, London, UK
| | - K E Swales
- The Institute of Cancer Research, London, UK
| | - S Plymate
- University of Washington School of Medicine, Seattle, USA
| | - J Luo
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - H Tovey
- The Institute of Cancer Research, London, UK
| | - N Porta
- The Institute of Cancer Research, London, UK
| | - R Slade
- The Institute of Cancer Research, London, UK
| | - L Leonard
- The Institute of Cancer Research, London, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - J S de Bono
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Mwizerwa E, Shaver C, McNatt J, Williams A, Robbins I, Norfolk S, McCloskey K, Moore R, Sharp A, Klein K. Formal Pulmonary Rehabilitation after Lung Transplantation Improves Six Minute Walk Distance. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.708] [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: 10/24/2022] Open
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Khalil A, Sharp A, Cornforth C, Jackson R, Mousa H, Stock S, Harrold J, Turner MA, Kenny LC, Baker PN, Johnstone ED, Von Dadelszen P, Magee L, Papageorghiou AT, Alfirevic Z. Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo-controlled double-blind trial. Ultrasound Obstet Gynecol 2020; 55:198-209. [PMID: 31432556 DOI: 10.1002/uog.20851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/07/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type-5 inhibitor, potentiates the actions of nitric oxide, and it has been suggested that it alters maternal hemodynamics, potentially improving placental perfusion. Recently, the Dutch STRIDER trial was stopped prematurely owing to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early-onset FGR. METHODS This was a cardiovascular substudy within a UK multicenter, placebo-controlled trial, in which 135 women with a singleton pregnancy and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10th centile and absent/reversed end-diastolic flow in the umbilical artery on Doppler velocimetry, diagnosed between 22 + 0 and 29 + 6 weeks' gestation) were assigned randomly to receive either 25 mg sildenafil three times daily or placebo until 32 + 0 weeks' gestation or delivery. Maternal blood pressure (BP), heart rate (HR), augmentation index, pulse wave velocity (PWV), cardiac output, stroke volume (SV) and total peripheral resistance were recorded before randomization, 1-2 h and 48-72 h post-randomization, and 24-48 h postnatally. For continuous data, analysis was performed using repeated measures ANOVA methods including terms for timepoint, treatment allocation and their interaction. RESULTS Included were 134 women assigned randomly to sildenafil (n = 69) or placebo (n = 65) who had maternal BP and HR recorded at baseline. At 1-2 h post-randomization, compared with baseline values, sildenafil increased maternal HR by 4 bpm more than did placebo (mean difference, 5.00 bpm (95% CI, 1.00-12.00 bpm) vs 1.25 bpm (95% CI, -5.38 to 7.88 bpm); P = 0.004) and reduced systolic BP by 1 mmHg more (mean difference, -4.13 mmHg (95% CI, -9.94 to 1.44 mmHg) vs -2.75 mmHg (95% CI, -7.50 to 5.25 mmHg); P = 0.048). Even after adjusting for maternal mean arterial pressure, sildenafil reduced aortic PWV by 0.60 m/s more than did placebo (mean difference, -0.90 m/s (95% CI, -1.31 to -0.51 m/s) vs -0.26 m/s (95% CI, -0.75 to 0.59 m/s); P = 0.001). Sildenafil was associated with a non-significantly greater decrease in SV index after 1-2 h post-randomization than was placebo (mean difference, -5.50 mL/m2 (95% CI, -11.00 to -0.50 mL/m2 ) vs 0.00 mL/m2 (95% CI, -5.00 to 4.00 mL/m2 ); P = 0.056). CONCLUSIONS Sildenafil in a dose of 25 mg three times daily increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by severe early-onset FGR. These changes are short term, modest and consistent with the anticipated vasodilatory effect. They have no short- or long-term clinical impact on the mother. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - C Cornforth
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - H Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - S Stock
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J Harrold
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - L C Kenny
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - P N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
| | - E D Johnstone
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - P Von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Mejorada RL, Lorente D, Castro E, Bianchini D, Nombela P, Sandhu S, Laorden NR, Cendón Y, Sharp A, Casado EA, Pacheco M, Rescigno P, LLácer C, Saez M, Rivera L, Vitrone F, Moreno C, Mateo J, de Bono J, Hidalgo DO. Circulating tumour cells (CTC) count and prostate-specific antigen (PSA) response measures in metastatic castration-resistant prostate cancer (mCRPC) patients (pts) treated with docetaxel (Doc). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Goodfellow L, Care A, Sharp A, Ivandic J, Poljak B, Roberts D, Alfirevic Z. Effect of QUiPP prediction algorithm on treatment decisions in women with a previous preterm birth: a prospective cohort study. BJOG 2019; 126:1569-1575. [PMID: 31339631 DOI: 10.1111/1471-0528.15886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions. DESIGN A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks' gestation. SETTING A UK tertiary referral hospital. SAMPLE In all, 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks' gestation. METHODS Cervical length and qfFN were measured at 19+0 to 23+0 weeks' gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken. MAIN OUTCOME MEASURES Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34+0 weeks as treatment threshold. RESULTS Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these, 53% (8/15) had QUiPP risk of sPTB before 34+0 weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20 versus 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76-2.18), and negative LR of 0.8 (95% CI 0.45-1.40) for predicting sPTB before 34+0 weeks. CONCLUSIONS Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group. TWEETABLE ABSTRACT Independent study finds that the QUiPP algorithm could lead to substantial increases in treatment without evidence of benefit.
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Affiliation(s)
- L Goodfellow
- University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - A Care
- University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - A Sharp
- University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - J Ivandic
- University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - B Poljak
- Liverpool Health Partners, Liverpool, UK.,Liverpool Women's Hospital, Liverpool, UK
| | - D Roberts
- Liverpool Health Partners, Liverpool, UK.,Liverpool Women's Hospital, Liverpool, UK
| | - Z Alfirevic
- University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
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25
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Sharp A, Faluyi D, Alfirevic Z. Misoprostol vaginal insert (Mysodelle) versus Dinoprostone intravaginal gel (Prostin) for induction of labour. Eur J Obstet Gynecol Reprod Biol 2019; 240:41-44. [PMID: 31226576 DOI: 10.1016/j.ejogrb.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/01/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study is the compare the effectiveness and safety of Misoprostol Vaginal Insert (Mysodelle) versus Dinoprostone intravaginal gel (Prostin) for induction of labour. STUDY DESIGN We performed a prospective cohort study of the use of misoprostol vaginal inserts (Mysodelle) in the induction of pregnancy and compared it to a historical cohort of women induced with the Dinoprostone intravaginal gel (Prostin) at the Liverpool Women's Hospital, a large UK teaching hospital. RESULTS A total of 4102 women were induced between December 2016 and September 2018 of whom 2540 were induced with dinoprostone gel until September 2017. Since October 2017 1562 were induced using misoprostol vaginal inserts (MVI). The MVI demonstrated a significantly quicker median time to delivery compared with dinoprostone gel (18.2 h versus 21.8 h; p < 0.0001). There was a 32% reduced risk of Caesarean section with MVI (7.5% vs 10.9%; RR 0.62 95%CI 0.56-0.84) There was no significant difference in any of the key maternal or neonatal adverse outcomes. CONCLUSIONS The results of this study suggest that misoprostol vaginal inserts, compared with dinoprostone intravaginal gel, achieve quicker delivery times, and a reduction in caesarean sections with no increased rate of adverse maternal or neonatal outcomes.
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Affiliation(s)
- A Sharp
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom.
| | - D Faluyi
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom
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Waudby HP, Petit S, Matthews B, Sharp A, Pradhan R, Dale B. Investigation of ticks and red blood cell parasites of a population of reintroduced mainland tammar wallabies (Notamacropus eugenii eugenii). Aust Mammalogy 2019. [DOI: 10.1071/am18033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ticks and blood smears were collected from a reintroduced population of threatened tammar wallabies (Notamacropus eugenii eugenii). Ixodes hirsti was common during autumn/winter, and Amblyomma spp. in spring/summer, reflecting the seasonal density of questing A. triguttatum triguttatum. Red blood cell parasites were not detected in the 90 smears analysed.
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27
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Care A, Ingleby L, Alfirevic Z, Sharp A. The influence of the introduction of national guidelines on preterm birth prevention practice: UK experience. BJOG 2018; 126:763-769. [PMID: 30461172 PMCID: PMC6590292 DOI: 10.1111/1471-0528.15549] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 12/04/2022]
Abstract
Objective To identify the current status of specialist preterm labour (PTL) clinics and identify changes in management trends over the last 5 years following release of the NICE preterm birth (PTB) guidance. Design Postal Survey of Clinical Practice. Setting UK. Population All consultant‐led obstetric units. Methods A questionnaire was sent by post to all 187 NHS consultant‐led obstetric units. Units with a specialist PTL clinic were asked to answer a further six questions defining their protocol for risk stratification and management. Main outcome measures Current practice in specialist PTL clinics. Changes in treatment trends over 5 years. Results Thirty‐three PTL prevention clinics were identified, with 73% running weekly. NHS staff (84%) have replaced university staff as the lead clinicians (from 69% in 2012 to 21% in 2017), suggesting this clinic has become increasingly integrated with standard care for women at the highest risk of PTB. There has been a large shift from nearly half of clinics offering cerclage as primary treatment for short cervix to offering more choice (30%) between at least two of cerclage, vaginal progesterone or pessary and combinations of primary treatments (18%), demonstrating more equipoise among clinicians regarding therapies for short cervix. Conclusions Over 5 years, there has been a 44% increase in the number of specialist PTL clinics in the UK. Although there is a better consensus over the target high‐risk population, there is increasing heterogeneity among first‐line treatments for short cervix. Tweetable abstract UK PTB prevention clinics have increased by 44% over 5 years, with increasing clinical equipoise to best Rx for short cervix. UK PTB prevention clinics have increased by 44% over 5 years, with increasing clinical equipoise to best Rx for short cervix.
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Affiliation(s)
- A Care
- Harris-Wellbeing Preterm Birth Research Group, Centre for Women and Children's Health Research, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - L Ingleby
- Harris-Wellbeing Preterm Birth Research Group, Centre for Women and Children's Health Research, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - Z Alfirevic
- Harris-Wellbeing Preterm Birth Research Group, Centre for Women and Children's Health Research, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - A Sharp
- Harris-Wellbeing Preterm Birth Research Group, Centre for Women and Children's Health Research, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
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Sharp A, Duong C, Agarwal U, Alfirevic Z. Screening and management of the small for gestational age fetus in the UK: A survey of practice. Eur J Obstet Gynecol Reprod Biol 2018; 231:220-224. [PMID: 30415129 DOI: 10.1016/j.ejogrb.2018.10.039] [Citation(s) in RCA: 6] [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: 07/30/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antenatal detection of the small for gestational (SGA) fetus has become an important indicator of quality of antenatal care in the UK. This has been driven by a desire to reduce stillbirth in this at risk group. METHODS We conducted a postal survey of 187 NHS consultant units within the UK to determine what the current practice for the detection and subsequent management of the suspected SGA fetus was following the guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2013. RESULTS The survey was performed in 3 rounds between 2016 and 2017 with a response rate of 65%. 85% of units assessed risk factors for SGA at booking. 81% of units used a customized symphysis fundal height (SFH) chart to screen for SGA with 95% of them using a cut off of <10th centile to refer for ultrasound assessment. When ultrasound is used to detect SGA, 80% of units used estimated fetal weight (EFW), with 89% of these using a cut off of <10th centile to diagnose SGA. Umbilical artery (UA) Doppler monitoring was undertaken in 97% of management and 94% delivered after 37 weeks. Only 24% of units had a dedicated fetal growth clinic, whilst 48% of units were able to offer computerised CTG to monitor the SGA fetus. CONCLUSIONS Overall there is consistency in the screening methods for SGA (customised SFH charts) and identification of suspected SGA (SFH <10th centile, EFW <10th centile, UA monitoring and induction of labour at term). There was a low uptake of computerized CTG to monitor SGA babies and a low number of specialised fetal growth clinics.
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Affiliation(s)
- A Sharp
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom.
| | - C Duong
- Department of Women's and Children's Health, University of Liverpool, United Kingdom
| | - U Agarwal
- Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
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Rescigno P, Rediti M, Dolling D, Rodrigues D, Bianchini D, Riisnaes R, Messina C, Barrero M, Petremolo A, Sharp A, Sumanasuriya S, Seed G, Figueiredo I, Miranda S, Goodall J, Mateo J, Chandler R, Yuan W, Carreira S, de Bono J. PI3K/AKT pathway deleterious mutations in lethal prostate cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Landsberger S, Sharp A, Wang S, Pontikes Y, Tkaczyk AH. Characterization of bauxite residue (red mud) for 235U, 238U, 232Th and 40K using neutron activation analysis and the radiation dose levels as modeled by MCNP. J Environ Radioact 2017; 173:97-101. [PMID: 28049554 DOI: 10.1016/j.jenvrad.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/08/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 06/06/2023]
Abstract
This study employs thermal and epithermal neutron activation analysis (NAA) to quantitatively and specifically determine absorption dose rates to various body parts from uranium, thorium and potassium. Specifically, a case study of bauxite residue (red mud) from an industrial facility was used to demonstrate the feasibility of the NAA approach for radiological safety assessment, using small sample sizes to ascertain the activities of 235U, 238U, 232Th and 40K. This proof-of-concept was shown to produce reliable results and a similar approach could be used for quantitative assessment of other samples with possible radiological significance. 238U and 232Th were determined by epithermal and thermal neutron activation analysis, respectively. 235U was determined based on the known isotopic ratio of 238U/235U. 40K was also determined using epithermal neutron activation analysis to measure total potassium content and then subtracting its isotopic contribution. Furthermore, the work demonstrates the application of Monte Carlo Neutral-Particle (MCNP) simulations to estimate the radiation dose from large quantities of red mud, to assure the safety of humans and the surrounding environment. Phantoms were employed to observe the dose distribution throughout the human body demonstrating radiation effects on each individual organ.
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Affiliation(s)
- S Landsberger
- Nuclear and Radiation Engineering Program, University of Texas, Pickle Research Campus, R-9000, Austin, TX 78712, USA.
| | - A Sharp
- Nuclear and Radiation Engineering Program, University of Texas, Pickle Research Campus, R-9000, Austin, TX 78712, USA
| | - S Wang
- Nuclear and Radiation Engineering Program, University of Texas, Pickle Research Campus, R-9000, Austin, TX 78712, USA
| | - Y Pontikes
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - A H Tkaczyk
- Institute of Physics, University of Tartu, Ostwaldi 1, 50411 Tartu, Estonia
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31
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Popplewell MA, Davies HOB, Narayanswami J, Renton M, Sharp A, Bate G, Patel S, Deeks J, Bradbury AW. A Comparison of Outcomes in Patients with Infrapopliteal Disease Randomised to Vein Bypass or Plain Balloon Angioplasty in the Bypass vs. Angioplasty in Severe Ischaemia of the Leg (BASIL) Trial. Eur J Vasc Endovasc Surg 2017; 54:195-201. [PMID: 28602580 DOI: 10.1016/j.ejvs.2017.04.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/20/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim was to compare outcomes in a subgroup of patients with infrapopliteal (IP) disease randomised to infrapopliteal vein bypass (VB) or plain balloon angioplasty (PBA) in the original BASIL trial. METHODS A comparison of outcomes from patients randomised to VB or PBA undergoing revascularisation for severe limb ischaemia (SLI) because of IP disease with or without femoropopliteal disease. Data were extracted from case report forms from the BASIL trial. The primary outcome was amputation free survival (AFS); secondary outcomes included overall survival (OS), 30 day mortality and morbidity, freedom from arterial re-intervention, immediate technical success, repeat and crossover interventions, length of hospital stay, and quality of revascularisation. RESULTS A total of 104 patients were identified in the BASIL study with IP disease, 56 randomised to IP VB, and 48 to IP PBA. Groups were similar at baseline except for more chronic kidney disease and non-steroidal anti-inflammatory drug use in the VB group, and more previous surgical arterial intervention and antihypertensive use in the PBA group. There were no statistically significant differences in AFS or OS; however, clinically important trends were apparent in favour of a VB first strategy. Patients allocated to VB demonstrated significantly quicker relief of rest pain when compared with PBA (p = .005), but no significant differences in improved tissue healing. Median length of index hospital admission was significantly greater in the VB than in the PBA group (18 vs. 10 days, p < .0001) but there was no difference between the two groups in median total hospital stay between randomisation and the primary endpoint (VB 43.5 vs. PBA 42 days). CONCLUSIONS Further randomised trials, like BASIL-2 and BEST-CLI, are required to determine whether patients with severe limb ischaemia who require IP revascularisation and who are suitable for VB should have bypass or endovascular intervention as their primary revascularisation procedure.
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Affiliation(s)
- M A Popplewell
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK.
| | - H O B Davies
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - J Narayanswami
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - M Renton
- Heart of England Foundation Trust, Birmingham, UK
| | - A Sharp
- Heart of England Foundation Trust, Birmingham, UK
| | - G Bate
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
| | - S Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - J Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A W Bradbury
- Department of Vascular Surgery, University of Birmingham, Birmingham, UK
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Redana S, Papadimitraki E, Mohammed K, Lote H, Sharp A, Capelan M. Pathologic Response Rates Following Neoadjuvant Anthracycline and Taxane-based Chemotherapy for Early Breast Cancer (EBC). Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.033] [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: 10/19/2022]
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Seymour AS, Tarrant MR, Gerber BD, Sharp A, Woollam J, Cox R. Effects of El Niño on the population dynamics of the Malay civet east of the Wallace line. J Zool (1987) 2017. [DOI: 10.1111/jzo.12469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. S. Seymour
- University of the West of England; Bristol UK
- Operation Wallacea; Old Bolingbroke Lincolnshire UK
| | | | - B. D. Gerber
- Department of Fish, Wildlife, and Conservation Biology; Colorado State University; Fort Collins CO USA
| | - A. Sharp
- Operation Wallacea; Old Bolingbroke Lincolnshire UK
| | - J. Woollam
- Operation Wallacea; Old Bolingbroke Lincolnshire UK
| | - R. Cox
- Operation Wallacea; Old Bolingbroke Lincolnshire UK
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Poljak B, Agarwal U, Jackson R, Alfirevic Z, Sharp A. Diagnostic accuracy of individual antenatal tools for prediction of small-for-gestational age at birth. Ultrasound Obstet Gynecol 2017; 49:493-499. [PMID: 27486031 DOI: 10.1002/uog.17211] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 03/11/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the accuracy of fetal and newborn growth charts for the prediction of small-for-gestational age (SGA) at birth (birth weight < 10th centile). METHODS This was a prospective cohort study performed within a UK specialist fetal growth clinic. A total of 105 consecutive pregnant women referred for a suspected SGA fetus were included. All pregnancies were managed according to a standard protocol using estimated fetal weight (EFW) plotted on customized Gestation Related Optimal Weight (GROW) charts. The last antenatal estimates of EFW (according to charts of GROW, Hadlock et al. and Mikolajczyk et al.), abdominal circumference (AC) (according to charts of Hadlock et al., INTERGROWTH-21st Project and Chitty et al.) or change in AC over time (calculated according to Pregnancy Outcome Prediction (POP) study) were compared against four birth-weight charts (GROW, INTERGROWTH-21st , Mikolajczyk et al. and World Health Organization (WHO)). The ability of each antenatal test to predict adverse perinatal outcome (APO) was assessed. RESULTS Birth weight < 10th centile was assigned in 62 (59%) neonates using the GROW chart, 57 (54%) using the Mikolajczyk et al. chart, 55 (52%) using the INTERGROWTH-21st chart and 51 (49%) using the WHO chart. AC-Hadlock had the best negative likelihood ratio (range, 0.3-0.4) and sensitivity (range, 74%-82%) for predicting SGA as defined by all four postnatal birth-weight charts. AC-INTERGROWTH-21st had the best positive likelihood ratio (range, 5.9-10.9) and specificity (94%-96%). For prediction of APO, AC-Hadlock and EFW-GROW had the best sensitivities (57% and 52%, respectively), whereas AC-POP had the best positive likelihood ratio (2.2) and specificity (88%). Antenatal prediction of APO increased to a sensitivity of 61% when AC-POP and EFW-GROW were combined; however, specificity was only 56%. CONCLUSIONS We have identified wide variation in the diagnostic accuracy of various antenatal tools for the prediction of both SGA and APO, dependent on the choice of chart. Suboptimal diagnostic accuracy of commonly used antenatal tests may lead to increasing medicalization without prevention of APO. Researchers should focus their attention on a combination of fetal biometry and biomarkers for better prediction of SGA and prevention of APO. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Poljak
- Department of Women's and Children's Health Research, University of Liverpool, Liverpool, UK
| | - U Agarwal
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - R Jackson
- Liverpool Cancer Trials Unit, Liverpool, UK
| | - Z Alfirevic
- Department of Women's and Children's Health Research, University of Liverpool, Liverpool, UK
| | - A Sharp
- Department of Women's and Children's Health Research, University of Liverpool, Liverpool, UK
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Redana S, Sharp A, Lote H, Mohammed K, Papadimitraki E, Capelan M, Ring A. Rates of major complications during neoadjuvant and adjuvant chemotherapy for early breast cancer: An off study population. Breast 2016; 30:13-18. [DOI: 10.1016/j.breast.2016.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/13/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022] Open
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Mehra N, Seed G, Lambros M, Sharp A, Fontes MS, Crespo M, Sumanasuriya S, Yuan W, Boysen G, Riisnaes R, Calcinotto A, Carreira S, Goodall J, Zafeiriou Z, Bianchini D, Morilla A, Morilla R, Alimonti A, de Bono J. Myeloid-derived suppressor cells (MDSCs) in metastatic castration-resistant prostate cancer (CRPC) patients (PTS). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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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Lote H, Sharp A, Redana S, Papadimitraki E, Capelan M, Ring A. Febrile Neutropenia Rates According to Body Mass Index and Dose Capping in Women Receiving Chemotherapy for Early Breast Cancer. Clin Oncol (R Coll Radiol) 2016; 28:597-603. [DOI: 10.1016/j.clon.2016.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022]
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Lote H, Sharp A, Redana S, Papadimitraki E, Capelan M, Ring A. Febrile Neutropenia Rates According to BMI and Dose-capping: a Retrospective Analysis in a Tertiary Referral Centre. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.01.027] [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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Redana S, Sharp A, Papadimitraki E, Lote H, Capelan M, Ring A. Rates of Venous Thromboembolism (VTE) and Other Major Complications During Peri-operative Chemotherapy (CT) for Early Breast Cancer (EBC) in an Off-study Population. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Drummond JD, Davies-Colley RJ, Stott R, Sukias JP, Nagels JW, Sharp A, Packman AI. Retention and remobilization dynamics of fine particles and microorganisms in pastoral streams. Water Res 2014; 66:459-472. [PMID: 25243658 DOI: 10.1016/j.watres.2014.08.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 05/09/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 06/03/2023]
Abstract
Both microbial metabolism and pathogen retention and remobilization are dependent on downstream transport of fine particles, which migrate in a series of deposition and resuspension events. All fine particles, including clay minerals, particulate organic carbon, nutrients and microbes, are often considered to be transported similarly in the environment because of a lack of specific observations comparing their relative transport. We conducted a tracer injection study to compare the transport and retention of the fecal indicator bacterium Escherichia coli, synthetic inert fluorescent fine particles, and a dissolved conservative tracer. We found that the fluorescent fine particles and bacteria were transported similarly, with both having greater retention than the solute tracer. We used a stochastic model to evaluate in-stream retention and migration of the solute, fluorescent particles, and E. coli. The best-fit model parameters indicate that different stream reaches had varied retention characteristics, but always showed greater retention of fluorescent particles and E. coli compared to the solute tracer. Direct measurements within known retention areas after the injection showed that the majority of the fluorescent particles and E. coli were retained near the sediment-water interface in macrophyte stands or filtered within the top 3 cm of the streambed sediment. Both the tracer particles and E. coli were retained within these regions for multiple months following the injection experiment. The stochastic model properly captured the wide range of storage timescales and processes we observed in the stream. Our results demonstrate the importance of the streambed sediment and in-stream macrophytes as short- and long-term reservoirs for fine organic particles and microbes in streams.
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Affiliation(s)
- J D Drummond
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA; NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand.
| | - R J Davies-Colley
- NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand
| | - R Stott
- NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand
| | - J P Sukias
- NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand
| | - J W Nagels
- NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand
| | - A Sharp
- NIWA (National Institute of Water & Atmospheric Research Ltd.), Hamilton 3216, New Zealand; University of Waikato, Hamilton 3216, New Zealand
| | - A I Packman
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
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Douglas J, Sharp A, Chau C, Head J, Drake T, Wheater M, Geldart T, Mead G, Crabb SJ. Serum total hCGβ level is an independent prognostic factor in transitional cell carcinoma of the urothelial tract. Br J Cancer 2014; 110:1759-66. [PMID: 24556622 PMCID: PMC3974095 DOI: 10.1038/bjc.2014.89] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/13/2014] [Accepted: 01/23/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables. Methods: We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan–Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ⩾2 IU l−1. Results: A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set. Conclusions: Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.
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Affiliation(s)
- J Douglas
- 1] Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK [2] Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - A Sharp
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - C Chau
- 1] Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK [2] Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK [3] NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - J Head
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - T Drake
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - M Wheater
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - T Geldart
- 1] Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK [2] Dorset Cancer Centre, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK
| | - G Mead
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - S J Crabb
- 1] Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK [2] Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Sharp A. 289 Mortality Rate Weekdays versus Weekends for Adult Patients Presenting to US Emergency Departments. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alsaadi M, Italia J, Mullen A, Kumar MR, Candlish A, Williams R, Shaw C, Al Gawhari F, Coombs G, Wiese M, Thomson A, Puig-Sellart M, Wallace J, Sharp A, Wheeler L, Warn P, Carter K. The efficacy of aerosol treatment with non-ionic surfactant vesicles containing amphotericin B in rodent models of leishmaniasis and pulmonary aspergillosis infection. J Control Release 2012; 160:685-91. [DOI: 10.1016/j.jconrel.2012.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/23/2012] [Accepted: 04/02/2012] [Indexed: 11/24/2022]
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Majithiya J, Sharp A, Parmar A, Denning DW, Warn PA. Efficacy of isavuconazole, voriconazole and fluconazole in temporarily neutropenic murine models of disseminated Candida tropicalis and Candida krusei. J Antimicrob Chemother 2008; 63:161-6. [PMID: 19008255 DOI: 10.1093/jac/dkn431] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the dose-response of isavuconazole, voriconazole and fluconazole in disseminated Candida tropicalis and Candida krusei infections. METHODS Mice were immunosuppressed using either one dose [temporarily neutropenic (TN)] or two doses [persistently neutropenic (PN)] of cyclophosphamide. Treatment was started 5 h after infection with oral isavuconazole (6, 15, 30, 60, 90, 120 or 150 mg/kg equivalent active compound), intravenous voriconazole (5, 20 or 40 mg/kg plus grapefruit gavage twice daily) or oral fluconazole (15, 50 or 150 mg/kg) all administered twice daily. Kidney burden was assessed for C. tropicalis, and kidney and brain burden for C. krusei. RESULTS Vehicle controls developed a non-lethal infection with high burdens in both models. In the TN models, isavuconazole, voriconazole and fluconazole (>50 mg/kg) reduced kidney burden compared with controls; >60 mg/kg isavuconazole and 50 mg/kg fluconazole were superior to alternative treatments (other than voriconazole 40 mg/kg). Isavuconazole (all doses) reduced brain burden (P<0.05) in the C. krusei model; fluconazole (all doses) and voriconazole (5 and 20 mg/kg) did not. In the C. krusei kidney burden model, isavuconazole 120 and 150 mg/kg and voriconazole 40 mg/kg were superior to controls and fluconazole. In the C. tropicalis model, PN isavuconazole (all doses), voriconazole (>5 mg/kg) and fluconazole (all doses) reduced kidney burden (P<0.05). Only isavuconazole (all doses) and 40 mg/kg voriconazole were effective against C. krusei in the brain, isavuconazole and voriconazole reduced tissue burden (P<0.05). Fluconazole had no significant effect on brain burden even at 150 mg/kg. CONCLUSIONS Isavuconazole significantly reduced kidney burden in mice infected with C. tropicalis and both kidney and brain burdens in mice infected with C. krusei. Isavuconazole was as effective as voriconazole and much more effective than fluconazole at reducing brain burden.
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Affiliation(s)
- J Majithiya
- School of Medicine, University of Manchester, 1.800 Stopford Building, Oxford Road, Manchester M13 9PT, UK
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Gray K, Legg K, Sharp A, Mackie N, Olarinde F, De Souza C, Weber J, Peters B. Participation in two phase II prophylactic HIV vaccine trials in the UK. Vaccine 2008; 26:2919-24. [PMID: 18450339 DOI: 10.1016/j.vaccine.2008.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 03/14/2008] [Accepted: 03/19/2008] [Indexed: 10/22/2022]
Abstract
There will be a continued imperative to recruit large numbers of healthy volunteers to early phase prophylactic HIV vaccine (PHV) trials. We studied mechanisms associated with participation in two related phase II PHV trials. The most cited reasons for volunteering were altruism and a personal connection to HIV. The most successful recruiting strategies targeted organisations dealing with HIV, health or social issues, or were directed to large audiences through the mass media. However, circulated emails and word of mouth were the most resource-effective approaches. Group discussions and the collection of a pool of potential volunteers were much less effective than one-to-one discussions and immediate screening after recruitment. We utilised our findings to devise key recommendations to assist PHV trial teams who are planning future studies.
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Affiliation(s)
- Kimberly Gray
- King's College London, Guy's and St. Thomas' Hospitals, UK.
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Warn P, Parmar A, Sharp A, Heep M, Spickermann J, Denning D. P1950 In vivo efficacy of the triazole BAL8557 against disseminated Candida albicans in mice assessed by survival and tissue bur-den in temporarily and persistently neutropenic mice treated with 1 -7 doses of drug over a dose range of 20 -80%of Emax. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71789-2] [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: 12/01/2022]
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Sharp A, Kusz K, Jaruzelska J, Tapper W, Szarras-Czapnik M, Wolski J, Jacobs P. Variability of sexual phenotype in 46,XX(SRY+) patients: the influence of spreading X inactivation versus position effects. J Med Genet 2006; 42:420-7. [PMID: 15863672 PMCID: PMC1736057 DOI: 10.1136/jmg.2004.022053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharp A, Norton M, Marks A. Demography of a yellow-footed rock-wallaby Petrogale xanthopus colony in the threatened New South Wales sub-population. Aust Mammalogy 2006. [DOI: 10.1071/am06030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The remnant New South Wales (NSW) yellow-footed rock-wallaby (Petrogale xanthopus) population underwent a substantial decline between 1985 and 1992 and remained at dangerously low levels until 1995. To determine the processes underlying this decline, a population study was conducted at one colony, between winter 1995 and winter 1998. The colony was observed to remain relatively constant in size, consisting of between 12 or 13 individuals throughout the study. Reproductive rates were found to be relatively high. Both reproduction and pouch young survival were comparable with those reported for other P. xanthopus colonies, while adult survival rates were higher than those noted in other studies. Because population size remained constant during the study and adult survivorship was consistently high, this suggested that juvenile recruitment into the colony was low. Such low levels of recruitment may have had a substantive role in the slow decline of the entire NSW P. xanthopus population. The results of this study suggest that any management actions undertaken in the NSW P. xanthopus population should focus on increasing juvenile survival rates. Further research is required to determine whether juvenile survival is constrained by predation or competition with other herbivores.
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Barnes JD, Arhel NJ, Lee SS, Sharp A, Al-Okail M, Packham G, Hague A, Paraskeva C, Williams AC. Nuclear BAG-1 expression inhibits apoptosis in colorectal adenoma-derived epithelial cells. Apoptosis 2005; 10:301-11. [PMID: 15843891 DOI: 10.1007/s10495-005-0804-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BAG-1 is an anti-apoptotic protein that is frequently deregulated in a variety of malignancies including colorectal cancer. There are three isoforms: BAG-1L is located in the nucleus, BAG-1M and BAG-1S are located both in the nucleus and the cytoplasm. In colon cancer, the expression of nuclear BAG-1 is associated with poorer prognosis and is potentially a useful predictive factor for distant metastasis. However, the function of BAG-1 in colonic epithelial cells has not been studied. Having previously shown a predominant nuclear localisation of BAG-1 in adenoma-derived cell lines, we wanted to determine the function of nuclear BAG-1 in these non-tumourigenic cells, to identify whether nuclear BAG-1 was implicated in tumour progression in the colon. In the current report we established that nuclear BAG-1 inhibits apoptosis in a colorectal adenoma-derived cell line. We demonstrate that apoptosis induced by gamma-radiation or the vitamin D analogue EB1089 in the non-tumourigenic human colorectal adenoma-derived S/RG/C2 cell line, was preceded by a decrease in nuclear and an increase in cytoplasmic BAG-1 expression. This change in subcellular localisation of BAG-1 was due to the redistribution of the BAG-1M isoform. In addition, we have shown that the maintenance of high nuclear BAG-1 through enforced expression of the nuclear localised BAG-1L isoform enhanced cellular survival after gamma-radiation or exposure to EB1089. Furthermore the expression of cytoplasmic BAG-1S isoform fused with a nuclear localisation signal protected against gamma-radiation induced apoptosis. This demonstrates that nuclear localisation of the BAG-1 protein confers a survival advantage in colorectal adenoma-derived cells and that nuclear BAG-1 could potentially be an important survival factor in colorectal carcinogenesis.
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Affiliation(s)
- J D Barnes
- Cancer Research UK Colorectal Tumour Biology Research Group, Department of Pathology and Microbiology, School of Medical Sciences, University of Bristol, Bristol, UK
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