1
|
Spencer A, Nicholls I, Onianwa O, Furneaux J, Grieves J, Pottage T, Gould S, Fletcher T, Dunning J, Bennett AM, Atkinson B. Mpox virus DNA contamination can still be detected by qPCR analysis after autoclaving. J Hosp Infect 2023; 139:217-219. [PMID: 37459916 DOI: 10.1016/j.jhin.2023.07.006] [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] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A Spencer
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - I Nicholls
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T Pottage
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - B Atkinson
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| |
Collapse
|
2
|
Turner R, Quach H, Horvath N, Kerridge I, Lee E, Morris E, Kalff A, Khong T, Reynolds J, Spencer A. Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial. Br J Haematol 2023. [PMID: 37332079 DOI: 10.1111/bjh.18914] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m2 days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.
Collapse
Affiliation(s)
- R Turner
- Alfred Health, Melbourne, Victoria, Australia
| | - H Quach
- St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
| | - N Horvath
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Kerridge
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - E Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - E Morris
- Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Kalff
- Alfred Health, Melbourne, Victoria, Australia
| | - T Khong
- Alfred Health, Melbourne, Victoria, Australia
| | - J Reynolds
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - A Spencer
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| |
Collapse
|
3
|
Atkinson B, Spencer A, Onianwa O, Furneaux J, Grieves J, Nicholls I, Gould S, Fletcher T, Dunning J, Bennett AM, Patel S, Asboe D, Whitlock G. Longitudinal mpox virus surface sampling in an outpatient setting. J Hosp Infect 2023; 135:196-198. [PMID: 36842538 DOI: 10.1016/j.jhin.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Affiliation(s)
- B Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - A Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - I Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Patel
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - D Asboe
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - G Whitlock
- Chelsea & Westminster Hospital NHS Trust, London, UK
| |
Collapse
|
4
|
Atkinson B, Gould S, Spencer A, Onianwa O, Furneaux J, Grieves J, Summers S, Crocker-Buqué T, Fletcher T, Bennett A, Dunning J. Monkeypox virus contamination in an office-based workplace environment. J Hosp Infect 2022; 130:141-143. [PMID: 36055524 PMCID: PMC9428113 DOI: 10.1016/j.jhin.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 10/25/2022]
Affiliation(s)
- B. Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK,Corresponding author. Address: Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - S. Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A. Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O. Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S. Summers
- High Containment Microbiology, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T. Crocker-Buqué
- Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, UK
| | - T. Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A.M. Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Pentz B, Pilkington M, Daodu O, Lam J, Howlett A, Stephen L, Spencer A, Unrau J, Theam M, Brindle M. Implementation of a neonatal Enhanced Recovery After Surgery® (ERAS®) guideline and the effect on communication within the neonatal intensive care unit. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Pilkington M, Pentz B, Lam J, Howlett A, Stephen L, Spencer A, Brindle M. Small doses, big changes: Impact of neonatal Enhanced Recovery After Surgery® on opioid use. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.055] [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: 10/14/2022]
|
7
|
Spencer A, Watchorn RE, Kravvas G, Ben-Salha I, Haider A, Francis N, Freeman A, Alnajjar HM, Muneer A, Bunker CB. Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases. J Eur Acad Dermatol Venereol 2022; 36:1851-1856. [PMID: 35695159 DOI: 10.1111/jdv.18328] [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] [Received: 10/14/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. OBJECTIVES To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. METHODS This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. RESULTS Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. CONCLUSIONS Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.
Collapse
Affiliation(s)
- A Spencer
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK.,Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - R E Watchorn
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK.,Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - G Kravvas
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK
| | - I Ben-Salha
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - A Haider
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - N Francis
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - H M Alnajjar
- Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - A Muneer
- Department of Urology, University College London Hospitals NHS Trust, London, UK.,National Institute of Health Research Centre, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - C B Bunker
- Department of Dermatology, University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
8
|
Sardinha M, Simão D, Gil L, Spencer A, Reis A, Leão J, Montenegro A, Ferreira R, Furtado I, Verdasca F, Escaleira R, Miguens M, Winckler P, Luz R. P-191 Ampullary neoplasms – how to treat in real-world practice? A retrospective study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
9
|
Liu X, Spencer A, Long Y, Greenhalgh C, Steeg S, Verma A. A systematic review and meta-analysis of disease burden of healthcare-associated infections in China: an economic burden perspective from general hospitals. J Hosp Infect 2022; 123:1-11. [PMID: 35182684 DOI: 10.1016/j.jhin.2022.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/20/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a global public health issue. However, the economic burden attributable to HAIs at a national level is unknown in China. The aim of this systematic review was to estimate the direct economic burden caused by HAIs in China. METHODS Medline, EMBASE and Chinese Journals Online databases were searched, including studies published from 2009 to 2019. The pooled estimates with 95% Confidential Interval were calculated with Quantile Estimation. The random effect model of the DerSimonian-Laird method was used. The statistical significance was set as P<0.05. RESULTS 2,756 publications were identified; 6 studies were included in a meta-analysis to calculate the pooled estimates of direct economic burden, while 5 were included in the pooled estimates of the additional economic burden. The pooled median estimates of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient of patients with HAIs were ¥34,415.62, ¥20,065.21 and 34.01 days, respectively (P <0.0001). The pooled median estimates of the differences of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient between patients with HAIs and patients without HAIs were ¥24,881.37, ¥9,438.46 and 13.89 days, respectively (P < 0.01). CONCLUSIONS The cost of care for patients with HAIs was significantly higher than that for those without HAIs. This excess economic burden is likely to impact on patients and their families as well as health service providers and the health care system as a whole. Effective surveillance systems and cost-effective interventions are needed to control HAIs.
Collapse
Affiliation(s)
- X Liu
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - A Spencer
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Y Long
- Global Health Institute/School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
| | - C Greenhalgh
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - S Steeg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - A Verma
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| |
Collapse
|
10
|
Spencer A, Rivero-Arias O, Wong R, Tsuchiya A, Bleichrodt H, Edward R, Norman R, Lloyd A, Clarke P. The QALY at 50: One story many voices. Soc Sci Med 2021; 296:114653. [DOI: 10.1016/j.socscimed.2021.114653] [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] [Received: 05/28/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
|
11
|
Kikhtyanin O, Korolova V, Spencer A, Dubnová L, Shumeiko B, Kubička D. On the influence of acidic admixtures in furfural on the performance of MgAl mixed oxide catalysts in aldol condensation of furfural and acetone. Catal Today 2021. [DOI: 10.1016/j.cattod.2020.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
12
|
Moore G, Rickard H, Stevenson D, Aranega-Bou P, Pitman J, Crook A, Davies K, Spencer A, Burton C, Easterbrook L, Love HE, Summers S, Welch SR, Wand N, Thompson KA, Pottage T, Richards KS, Dunning J, Bennett A. Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. J Hosp Infect 2021; 108:189-196. [PMID: 33259882 PMCID: PMC7831847 DOI: 10.1016/j.jhin.2020.11.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [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: 10/01/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. METHODS The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. FINDINGS SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. CONCLUSIONS Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
Collapse
Affiliation(s)
- G Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - H Rickard
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - D Stevenson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - P Aranega-Bou
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Pitman
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Crook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Davies
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Spencer
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Burton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L Easterbrook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - H E Love
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Summers
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S R Welch
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - N Wand
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K-A Thompson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - T Pottage
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K S Richards
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, Liverpool, UK
| | - A Bennett
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| |
Collapse
|
13
|
Bunker CB, Kravvas G, Watchorn R, Spencer A, Ong E, Haider A, Freeman A, Francis NA, Alnajjar H, Muneer A, Dinneen M. Reply to: ‘Does routine histology alter management post-circumcision?’. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820982755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- CB Bunker
- Department of Dermatology, University College London Hospitals, UK
| | - G Kravvas
- Department of Dermatology, University College London Hospitals, UK
| | - R Watchorn
- Department of Dermatology, Imperial College Healthcare, UK
| | - A Spencer
- Department of Dermatology, Imperial College Healthcare, UK
| | - E Ong
- Department of Dermatology, University College London Hospitals, UK
| | - A Haider
- Department of Histopathology, University College London Hospitals, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals, UK
| | - NA Francis
- Department of Histopathology, Chelsea and Westminster Hospital, UK
| | - H Alnajjar
- Department of Urology, University College London Hospitals, UK
| | - A Muneer
- Department of Urology, University College London Hospitals, UK
| | - M Dinneen
- Department of Urology, Chelsea and Westminster Hospital, UK
| |
Collapse
|
14
|
Quach H, Nooka A, Samoylova O, Venner C, Facon T, Spencer A, Usmani S, Weisel K, Mateos M, Kim K, Grosicki S, Suzuki K, Delimpasi S, Obreja M, Zahlten-Kumeli A. CARFILZOMIB, DEXAMETHASONE, AND DARATUMUMAB VERSUS CARFILZOMIB AND DEXAMETHASONE IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA: SUBGROUP ANALYSIS OF THE PHASE 3 CANDOR STUDY BY NUMBER OF PRIOR LINES OFTHERAPY AND PRIOR THERAPIES. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.425] [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: 10/23/2022] Open
|
15
|
Tomás T, Nogueira-Costa G, Eiriz I, Vitorino M, Vicente R, Oliveira A, Luz P, Baleiras M, Spencer A, Costa LLD, Liu P, Cadavez E, Correia M, Atalaia G, Silva M, Fiúza T. P-278 Neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictive markers of pathological response to FLOT neoadjuvant strategy in locally advanced gastric/gastroesophageal junction cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.360] [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: 10/23/2022] Open
|
16
|
Simão D, Parmanande A, Barreira J, Sardinha M, Reis A, Spencer A, Oliveira S, Luz RD. P-95 Non-metastatic anal cancer outcomes: A single-center experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.177] [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: 10/23/2022] Open
|
17
|
Spencer A, Gazzani P, Gadvi R, Hughes S, Stevens A, Shah F, Scarisbrick J. Computed tomography scanning in mycosis fungoides: optimizing the balance between benefit and harm. Br J Dermatol 2017; 178:563-564. [DOI: 10.1111/bjd.15657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- A. Spencer
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - P. Gazzani
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - R. Gadvi
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - S.J. Hughes
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - A. Stevens
- Department of Oncology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - F. Shah
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - J. Scarisbrick
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| |
Collapse
|
18
|
Spencer A, Hanson J. Associations between Apolipoprotein B and Disease Risk Factors among Worksite Wellness Participants. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Lentzsch S, Weisel K, Mateos M, Hungria V, Munder M, Nooka A, Mark T, Quach H, Scott E, Lee J, Sonneveld P, Casneuf T, Chiu C, Qin X, Amin H, Thiyagarajah P, Schecter J, Qi M, Spencer A. DARATUMUMAB, BORTEZOMIB AND DEXAMETHASONE (DVD) VS BORTEZOMIB AND DEXAMETHASONE (VD) IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA (RRMM): EFFICACY AND SAFETY UPDATE (CASTOR). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Lentzsch
- Division of Hematology/Oncology; Columbia University; New York NY USA
| | - K. Weisel
- Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmonologie; Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II; Tuebingen Germany
| | - M.V. Mateos
- Department of Haematology; University Hospital of Salamanca/IBSAL; Salamanca Spain
| | - V. Hungria
- Department Hematology and Oncology; Irmandade Da Santa Casa De Misericordia De São Paulo; São Paulo Brazil
| | - M. Munder
- Third Department of Medicine (Hematology, Oncology, and Pneumology); University Medical Center of the Johannes Gutenberg-University; Mainz Germany
| | - A. Nooka
- Division of Bone Marrow Transplant, Winship Cancer Institute; Emory University; Atlanta GA USA
| | - T. Mark
- Department of Medicine; Weill Cornell Medical College; New York NY USA
| | - H. Quach
- Department of Haematology; University of Melbourne, St. Vincent's Hospital; Victoria Australia
| | - E. Scott
- Division of Hematology and Medical Oncology, Knight Cancer Institute; Oregon Health and Science University; Portland OR USA
| | - J. Lee
- Department of Hematology-Oncology; Chonnam National University Hwasun Hospital, Hwasun Jeollanamdo; Republic of Korea
| | - P. Sonneveld
- Department of Hematology, Erasmus MC; Rotterdam The Netherlands
| | - T. Casneuf
- Research & Development, Janssen; Beerse Belgium
| | - C. Chiu
- Research & Development, Janssen; Spring House PA USA
| | - X. Qin
- Research & Development, Janssen; Spring House PA USA
| | - H. Amin
- Research & Development, Janssen; Raritan NJ USA
| | | | - J. Schecter
- Research & Development, Janssen; Raritan NJ USA
| | - M. Qi
- Research & Development, Janssen; Spring House PA USA
| | - A. Spencer
- Division of Blood Cancers, Malignant Haematology and Stem Cell Transplantation Service; Alfred Health-Monash University; Melbourne Australia
| |
Collapse
|
20
|
Fowler N, Gopal A, Schuster S, Trotman J, Hess G, Hou J, Yacoub A, Lill M, Martin P, Vitolo U, Spencer A, Radford J, Jurczak W, Morton J, Osmanov D, Caballero D, Deshpande S, Vermeulen J, Damle R, Schaffer M, Balasubramanian S, Cheson B, Salles G. Biomarker analysis of patients with follicular lymphoma treated with ibrutinib in the phase 2 DAWN study. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- N. Fowler
- Department of Lymphoma/Myeloma; The University of Texas MD Anderson Cancer Center; Houston USA
| | - A.K. Gopal
- Seattle Cancer Care Alliance; The University of Washington/Fred Hutchison Cancer Research Center; Seattle USA
| | - S.J. Schuster
- Lymphoma Program; Abramson Cancer Center of the University of Pennsylvania; Philadelphia USA
| | - J. Trotman
- Concord Hospital; University of Sydney, Haematology Department; Sydney Australia
| | - G. Hess
- Department of Hematology/Oncology; Johannes Gutenberg University; Mainz Germany
| | - J. Hou
- Division of Hematology/Oncology; University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute; Pittsburgh USA
| | - A. Yacoub
- Hematologic Malignancies and Cellular Therapeutics; University of Kansas Medical Center; Kansas City USA
| | - M. Lill
- Stem Cell and Bone Marrow Transplant Program, Cedars-Sinai Medical Center; Los Angeles USA
| | - P. Martin
- Weill Cornell Medical College; Cornell University; New York USA
| | - U. Vitolo
- Hematology; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino; Turin Italy
| | - A. Spencer
- Central Clinical School; Alfred Hospital-Monash University; Melbourne Australia
| | - J. Radford
- University of Manchester and the Christie NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - W. Jurczak
- Department of Hematology; Jagiellonian University; Krakow Poland
| | - J. Morton
- Clinical Haemato-Oncology; Haematology and Oncology Clinics of Australia; Milton Australia
| | - D. Osmanov
- Blokhin Cancer Research Center; Russian Academy of Medical Sciences; Moscow Russian Federation
| | - D. Caballero
- Instituto Biosanitario de Salamanca; Hospital Clínico Universitario; Salamanca Spain
| | | | - J. Vermeulen
- Research & Development, Janssen; Leiden The Netherlands
| | - R. Damle
- Research & Development, Janssen; Raritan USA
| | - M. Schaffer
- Research & Development, Janssen; Raritan USA
| | | | - B. Cheson
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia USA
| | - G. Salles
- Haematology Department; Hospices Civils de Lyon-Université de Lyon; Lyon France
| |
Collapse
|
21
|
Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
Collapse
Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| |
Collapse
|
22
|
Mithraprabhu S, Khong T, Ramachandran M, Chow A, Klarica D, Mai L, Walsh S, Broemeling D, Marziali A, Wiggin M, Hocking J, Kalff A, Durie B, Spencer A. Circulating tumour DNA analysis demonstrates spatial mutational heterogeneity that coincides with disease relapse in myeloma. Leukemia 2016; 31:1695-1705. [DOI: 10.1038/leu.2016.366] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/05/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
|
23
|
von Moos R, Costa L, Scagliotti G, Sleeboom H, Goldwasser F, Hirsh V, Spencer A, Radcliffe HS, Niepel D, Henry D. Symptomatic skeletal events (SSEs) versus skeletal-related events (SREs) in patients with advanced cancer and bone metastases treated with denosumab or zoledronic acid. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
White MP, Elliott LR, Taylor T, Wheeler BW, Spencer A, Bone A, Depledge MH, Fleming LE. Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England. Prev Med 2016; 91:383-388. [PMID: 27658650 DOI: 10.1016/j.ypmed.2016.08.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/25/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. METHODS A cross-sectional analysis of six waves (2009/10-2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n=280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n=112,422), including: a) duration; b) activity; and c) environment type. RESULTS Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one 'active visit' (i.e. ≥30min, ≥3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) 'active visits' annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥5×30min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. CONCLUSIONS Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes.
Collapse
Affiliation(s)
- M P White
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L R Elliott
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - T Taylor
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - B W Wheeler
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - A Spencer
- Health Economics Group, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, United Kingdom.
| | - A Bone
- Public Health England, Environmental Change Department, 133-135 Waterloo Road, London SE1 8UG, United Kingdom.
| | - M H Depledge
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L E Fleming
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| |
Collapse
|
25
|
Weisel K, Palumbo A, Chanan-Khan A, Nooka A, Spicka I, Masszi T, Beksac M, Hungria V, Munder M, Mateos MV, Mark T, Spencer A, Qi M, Schecter J, Amin H, Qin X, Deraedt W, Ahmadi T, Sonneveld P. Phase 3 randomised study of daratumumab, bortezomib and dexamethasone (DVd) vs bortezomib and dexamethasone (Vd) in patients (pts) with relapsed or refractory multiple myeloma (RRMM): CASTOR. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
White MP, Elliott LR, Taylor T, Wheeler BW, Spencer A, Bone A, Depledge MH, Fleming LE. Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England. Prev Med 2016. [PMID: 27658650 DOI: 10.1016/j.ypmed.2016.08.023.(baltim)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. METHODS A cross-sectional analysis of six waves (2009/10-2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n=280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n=112,422), including: a) duration; b) activity; and c) environment type. RESULTS Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one 'active visit' (i.e. ≥30min, ≥3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) 'active visits' annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥5×30min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. CONCLUSIONS Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes.
Collapse
Affiliation(s)
- M P White
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L R Elliott
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - T Taylor
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - B W Wheeler
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - A Spencer
- Health Economics Group, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, United Kingdom.
| | - A Bone
- Public Health England, Environmental Change Department, 133-135 Waterloo Road, London SE1 8UG, United Kingdom.
| | - M H Depledge
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| | - L E Fleming
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom.
| |
Collapse
|
27
|
Weber N, Mollee P, Augustson B, Brown R, Catley L, Gibson J, Harrison S, Ho PJ, Horvath N, Jaksic W, Joshua D, Quach H, Roberts AW, Spencer A, Szer J, Talaulikar D, To B, Zannettino A, Prince HM. Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2016; 45:371-82. [PMID: 25169210 DOI: 10.1111/imj.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 06/06/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.
Collapse
Affiliation(s)
- N Weber
- Clinical Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Spencer A, Spruell C, Nandi S, Wong M, Creixell M, Baker AB. A high-throughput mechanofluidic screening platform for investigating tumor cell adhesion during metastasis. Lab Chip 2016; 16:142-52. [PMID: 26584160 PMCID: PMC4691538 DOI: 10.1039/c5lc00994d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The metastatic spread of cancer is a major barrier to effective and curative therapies for cancer. During metastasis, tumor cells intravasate into the vascular system, survive in the shear forces and immunological environment of the circulation, and then extravasate into secondary tumor sites. Biophysical forces are potent regulators of cancer biology and are key in many of the steps of metastasis. In particular, the adhesion of circulating cells is highly dependent upon competing forces between cell adhesion receptors and the shear stresses due to fluid flow. Conventional in vitro assays for drug development and the mechanistic study of metastasis are often carried out in the absence of fluidic forces and, consequently, are poorly representative of the true biology of metastasis. Here, we present a novel high-throughput approach to studying cell adhesion under flow that uses a multi-well, mechanofluidic flow system to interrogate adhesion of cancer cell to endothelial cells, extracellular matrix and platelets under physiological shear stresses. We use this system to identify pathways and compounds that can potentially be used to inhibit cancer adhesion under flow by screening anti-inflammatory compounds, integrin inhibitors and a kinase inhibitor library. In particular, we identify several small molecule inhibitors of FLT-3 and AKT that are potent inhibitors of cancer cell adhesion to endothelial cells and platelets under flow. In addition, we found that many kinase inhibitors lead to increased adhesion of cancer cells in flow-based but not static assays. This finding suggests that even compounds that reduce cell proliferation might also enhance cancer cell adhesion during metastasis. Overall, our results validate a novel platform for investigating the mechanisms of cell adhesion under biophysical flow conditions and identify several potential inhibitors of cancer cell adhesion during metastasis.
Collapse
Affiliation(s)
- A Spencer
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
| | - C Spruell
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
| | - S Nandi
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
| | - M Wong
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
| | - M Creixell
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
| | - A B Baker
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA. and Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
29
|
Moore E, Bergin K, McQuilten Z, Wood E, Augustson B, Blacklock H, Ho P, Horvath N, King T, McNeil J, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Spencer A. Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Spencer A, Spencer A, Badros A, Laubach J, Harrison S, Zonder J, Chauhan D, Anderson K, Reich S, Trikha M, Richardson P. Phase 1, multicenter, open-label, dose-escalation, combination study (NCT02103335) of pomalidomide (POM), marizomib (MRZ, NPI-0052), and dexamethasone (DEX) in patients with relapsed and refractory multiple myeloma (MM); study NPI-0052-107 preliminary results. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Harrison S, Catley L, Price T, Millward M, Padrik P, Underhill C, Cannell P, Burrows F, Reich S, Trikha M, Spencer A. Phase 1 clinical trial of marizomib (MRZ, NPI-0052) in patients with advanced malignancies including multiple myeloma: study NPI-0052-102 (NCT00629473) final results. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
32
|
Bortz H, Coutsouvelis J, Corallo CE, Spencer A, Patil S. Modifying chemotherapeutic management of a patient with Burkitt's lymphoma and pre-existing motor neurone disease. J Clin Pharm Ther 2015; 40:483-5. [PMID: 26073601 DOI: 10.1111/jcpt.12293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Intensive chemotherapy for treatment of Burkitt's lymphoma (BL) - a high-grade lymphoproliferative disorder (LPD) - can cause neurotoxicity. An association between motor neurone disease (MND) and LPDs has previously been described, but there is a lack of recommendations available to guide management of such patients. This report aims to describe suitable management of BL in a patient with MND. CASE DESCRIPTION A 66-year-old woman with a history of MND affecting her limbs was diagnosed with bulky, extranodal, high-risk gastric BL. Standard chemotherapy is with multiple non-cross-resistant cytotoxic agents. To avoid exacerbation of neuropathy, six cycles of a modified regimen was planned, aiming to minimize exposure to the most neurotoxic agents. A PET-FDG-negative remission was obtained at 12 months, without the signs of central neurotoxicity, peripheral neuropathy or muscle weakness. WHAT IS NEW AND CONCLUSION High-intensity chemotherapy, minimizing known neurotoxic agents, was delivered safely and effectively in a patient with BL and pre-existing MND. More case descriptions are required to guide management decisions.
Collapse
Affiliation(s)
- H Bortz
- Pharmacy Department, Alfred Health, The Alfred Hospital, Melbourne, Vic., Australia
| | - J Coutsouvelis
- Pharmacy Department, Alfred Health, The Alfred Hospital, Melbourne, Vic., Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, The Alfred Hospital, Melbourne, Vic., Australia
| | - C E Corallo
- Pharmacy Department, Alfred Health, The Alfred Hospital, Melbourne, Vic., Australia
| | - A Spencer
- Department of Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, Melbourne, Vic., Australia
| | - S Patil
- Department of Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, Melbourne, Vic., Australia
| |
Collapse
|
33
|
Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:335-43. [DOI: 10.1111/imj.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Ho
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Harrison
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. Roberts
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talaulikar
- Department of Haematology; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| |
Collapse
|
34
|
Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison SJ, Mollee P, Roberts AW, Horvath N, Talulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are eligible for stem cell transplantation: position statement of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:94-105. [DOI: 10.1111/imj.12640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. J. Harrison
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. W. Roberts
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talulikar
- Department of Haematology; Canberra Hospital; Canberra ACT Australia
- Australian National University; Canberra ACT Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| |
Collapse
|
35
|
Spencer A, Cawood T, Frampton C, Jardine D. Heparin-based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence. Intern Med J 2014; 44:1054-65. [DOI: 10.1111/imj.12574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Spencer
- Department of General Medicine; Christchurch Hospital; Christchurch New Zealand
| | - T. Cawood
- Department of General Medicine; Christchurch Hospital; Christchurch New Zealand
- Department of Endocrinology; Christchurch Hospital; Christchurch New Zealand
| | - C. Frampton
- Department of Medicine, Christchurch School of Medicine and Health Sciences; University of Otago; Christchurch New Zealand
| | - D. Jardine
- Department of General Medicine; Christchurch Hospital; Christchurch New Zealand
- Department of Medicine, Christchurch School of Medicine and Health Sciences; University of Otago; Christchurch New Zealand
| |
Collapse
|
36
|
Macesic N, Morrissey CO, Cheng AC, Spencer A, Peleg AY. Changing microbial epidemiology in hematopoietic stem cell transplant recipients: increasing resistance over a 9-year period. Transpl Infect Dis 2014; 16:887-96. [PMID: 25298044 DOI: 10.1111/tid.12298] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 06/03/2014] [Accepted: 07/12/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Infections remain important contributors to mortality in hematopoietic stem cell transplantation (HSCT). METHOD We studied the evolving epidemiology and trends in susceptibility of bacterial and Candida isolates at an Australian HSCT center. A total of 528 HSCTs in 508 patients were performed from April 2001 to May 2010. A total of 605 isolates were eligible for study inclusion; 318 (53%) were gram-positive, 268 (44%) were gram-negative, and 19 (3%) were Candida species. RESULTS The most common site for isolates was blood (380 isolates, 63%). Staphylococcus aureus was the most common gram-positive organism (n = 107, 34%), but trends to increasing coagulase-negative staphylococci (P = 0.002) and vancomycin-resistant Enterococcus (P < 0.001) were observed. Escherichia coli was the most common gram-negative isolate (n = 74, 28%). Fluoroquinolone resistance increased with widespread use of protocol fluoroquinolone prophylaxis (P = 0.001). Carbapenem resistance was found in 44% of Pseudomonas or Acinetobacter isolates. Bloodstream infection with a multidrug-resistant organism (odds ratio 3.61, 95% confidence interval: 1.40-9.32, P = 0.008) was an independent predictor of mortality at 7 days after a positive blood culture. CONCLUSIONS Antimicrobial resistance is an increasing problem in this vulnerable patient population, and not only has an impact on choice of empiric therapy for febrile neutropenia but also on mortality.
Collapse
Affiliation(s)
- N Macesic
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
37
|
Fedele PL, Avery S, Patil S, Spencer A, Haas M, Wei A. Health economic impact of high-dose versus standard-dose cytarabine induction chemotherapy for acute myeloid leukaemia. Intern Med J 2014; 44:757-63. [DOI: 10.1111/imj.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P. L. Fedele
- Department of Clinical Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Avery
- Department of Clinical Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Patil
- Department of Clinical Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Clinical Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - M. Haas
- Centre for Health Economics Research and Evaluation; University of Technology; Sydney New South Wales Australia
| | - A. Wei
- Department of Clinical Haematology; The Alfred Hospital; Melbourne Victoria Australia
- Australian Centre for Blood Diseases; Monash University; Melbourne Victoria Australia
| |
Collapse
|
38
|
Quraishi NA, Ramoutar D, Sureshkumar D, Manoharan SR, Spencer A, Arealis G, Edwards KL, Boszczyk BM. Metastatic spinal cord compression as a result of the unknown primary tumour. Eur Spine J 2014; 23:1502-7. [PMID: 24691912 DOI: 10.1007/s00586-014-3274-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients presenting with metastatic spinal cord compression (MSCC) due to an unknown primary tumour (UPT) present an interesting problem with limited literature available to provide guidance on management. Our aim was twofold-first, to analyse all our patients with MSCC due to a UPT pre-operatively, to review their treatment and outcome; second, make comparisons with those patients who presented with MSCC due to a known primary tumour (KPT) during the same period. METHODS All data was collected retrospectively from October 2004 to October 2009, then prospectively from October 2009 to October 2012 (8 years). We reviewed all patient records held on the database, including patient demographics, primary tumour, neurological outcome (Frankel grade), complications and survival. RESULTS During the 8-year study period, out of the 382 patients who underwent emergency surgery for MSCC, 285 patients were included in whom complete information was available. Of these, 17 patients presented with MSCC due to a UPT (6 %; mean age 61 years, 5 M, 12 F). When compared to those with a known primary, the UPT group trended to a longer duration of symptoms prior to surgery (200 vs. 156 days, p = 0.86). They had a similar neurological outcome (88 % remained the same or improved post-operatively vs. 90 % in KPT group; p = 0.42), similar complication rate (23.5 vs. 33.6 %; p = 0.32) and survival (222 vs. 251 days, p = 0.42). The primary site in the UPT group was confirmed in 10/17 (58.8 %)-all 10 were adenocarcinoma [lung (6) and GI (4)]. DISCUSSION In our series, the incidence of MSCC due to an unknown primary was 6 %. They had similar overall outcome (neurology post-operatively, complications and survival) to those patients with MSCC from a known primary. Our experience would suggest that we need to treat these patients expeditiously with thorough evaluation and urgent treatment.
Collapse
Affiliation(s)
- N A Quraishi
- Centre for Spine Studies and Surgery, West Block, D Floor, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK,
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Bilmon I, Nivison-Smith I, Hertzberg M, Ritchie D, Greenwood M, Spencer A, Kennedy G, Bryant A, Moore J. Outcomes following second allogeneic haematopoietic transplants using fludarabine-melphalan conditioning. Bone Marrow Transplant 2014; 49:852-3. [PMID: 24583626 DOI: 10.1038/bmt.2014.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- I Bilmon
- 1] Department of Haematology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia [2] Department of Haematology, Westmead Hospital, Westmead, New South Wales, Australia
| | - I Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, New South Wales, Australia
| | - M Hertzberg
- Department of Haematology, Westmead Hospital, Westmead, New South Wales, Australia
| | - D Ritchie
- Department of Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - M Greenwood
- Department of Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - A Spencer
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - G Kennedy
- Department of Haematology, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - A Bryant
- Department of Haematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - J Moore
- Department of Haematology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| |
Collapse
|
40
|
Underwood M, Lamb SE, Eldridge S, Sheehan B, Slowther A, Spencer A, Thorogood M, Atherton N, Bremner SA, Devine A, Diaz-Ordaz K, Ellard DR, Potter R, Spanjers K, Taylor SJC. Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA). Health Technol Assess 2014; 17:1-281. [PMID: 23632142 DOI: 10.3310/hta17180] [Citation(s) in RCA: 34] [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: 11/22/2022] Open
Abstract
BACKGROUND Many older people living in care homes (long term residential care or nursing homes) are depressed. Exercise is a promising non-drug intervention for preventing and treating depression in this population. OBJECTIVE To evaluate the impact of a 'whole-home' intervention, consisting of training for residential and nursing home staff backed up with a twice-weekly, physiotherapist-led exercise class on depressive symptoms in care home residents. DESIGN A cluster randomised controlled trial with a cost-effectiveness analysis to compare (1) the prevalence of depression in intervention homes with that in control homes in all residents contributing data 12 months after homes were randomised (cross-sectional analysis); (2) the number of depressive symptoms at 6 months between intervention and control homes in residents who were depressed at pre-randomisation baseline assessment (depressed cohort comparison); and (3) the number of depressive symptoms at 12 months between intervention and control homes in all residents who were present at pre-randomisation baseline assessment (cohort comparison). SETTING Seventy-eight care homes in Coventry and Warwickshire and north-east London. PARTICIPANTS Care home residents aged ≥ 65 years. INTERVENTIONS Control intervention: Depression awareness training programme for care home staff. Active intervention: A 'whole-home' exercise intervention, consisting of training for care home staff backed up with a twice-weekly, physiotherapist-led exercise group. MAIN OUTCOME MEASURES Geriatric Depression Scale-15, proxy European Quality of Life-5 Dimensions (EQ-5D), cost-effectiveness from an National Health Service perspective, peripheral fractures and death. RESULTS We recruited a total of 1054 participants. Cross-sectional analysis: We obtained 595 Geriatric Depression Scale-15 scores and 724 proxy EQ-5D scores. For the cohort analyses we obtained 765 baseline Geriatric Depression Scale-15 scores and 776 proxy EQ-5D scores. Of the 781 who we assessed prior to randomisation, 765 provided a Geriatric Depression Scale-15 score. Of these 374 (49%) were depressed and constitute our depressed cohort. Resource-use and quality-adjusted life-year data, based on proxy EQ-5D, were available for 798 residents recruited prior to randomisation. We delivered 3191 group exercise sessions with 31,705 person attendances and an average group size of 10 (5.3 study participants and 4.6 non-study participants). On average, our participants attended around half of the possible sessions. No serious adverse events occurred during the group exercise sessions. In the cross-sectional analysis the odds for being depressed were 0.76 [95% confidence interval (CI) 0.53 to 1.09] lower in the intervention group at 12 months. The point estimates for benefit for both the cohort analysis (0.13, 95% CI -0.33 to 0.60) and depressed cohort (0.22, 95% CI -0.52 to 0.95) favoured the control intervention. There was no evidence of differences in fracture rates or mortality (odds ratio 1.07, 95% CI 0.79 to 1.48) between the two groups. There was no evidence of differences in the other outcomes between the two groups. Economic analysis: The additional National Health Service cost of the OPERA intervention was £374 per participant (95% CI -£655 to £1404); the mean difference in quality-adjusted life-year was -0.0014 (95% CI -0.0728 to 0.0699). The active intervention was thus dominated by the control intervention, which was more effective and less costly. CONCLUSION The results do not support the use of a whole-home physical activity and moderate-intensity exercise programme to reduce depression in care home residents. TRIAL REGISTRATION Current Controlled Trials ISRCTN43769277. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 18. See the Health Technology Assessment programme website for further project information.
Collapse
Affiliation(s)
- M Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Bryant A, Nivison-Smith I, Pillai ES, Kennedy G, Kalff A, Ritchie D, George B, Hertzberg M, Patil S, Spencer A, Fay K, Cannell P, Berkahn L, Doocey R, Spearing R, Moore J. Fludarabine Melphalan reduced-intensity conditioning allotransplanation provides similar disease control in lymphoid and myeloid malignancies: analysis of 344 patients. Bone Marrow Transplant 2013; 49:17-23. [DOI: 10.1038/bmt.2013.142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 06/27/2013] [Accepted: 08/01/2013] [Indexed: 11/09/2022]
|
42
|
Devine AM, Taylor SJC, Spencer A, Diaz-Ordaz K, Eldridge S, Underwood M. OP77 Proxy Reporting of Health-Related Quality of Life using the Euroqol-5D in Care Home Residents; how Good is it and how should we Deal with Clustering Effects? Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Abstract
The Ras/Raf/MEK/extracellular signal regulated kinase (ERK) (Ras/mitogen-activated protein kinases (MAPK)) signal transduction pathway is a crucial mediator of many fundamental biological processes, including cellular proliferation, survival, angiogenesis and migration. Aberrant signalling through the Ras/MAPK cascade is common in a wide array of malignancies, including multiple myeloma (MM), making it an appealing candidate for the development of novel targeted therapies. In this review, we explore our current understanding of the Ras/MAPK pathway and its role in MM. Additionally, we summarise the current status of small molecule inhibitors of MEK under clinical evaluation, and discuss future approaches required to optimise their use.
Collapse
Affiliation(s)
- C Chang-Yew Leow
- Myeloma Research Group, Australian Centre for Blood Diseases and Division of Blood Cancers, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
44
|
Low M, Lee D, Coutsouvelis J, Patil S, Opat S, Walker P, Schwarer A, Salem H, Avery S, Spencer A, Wei A. High-dose cytarabine (24 g/m2) in combination with idarubicin (HiDAC-3) results in high first-cycle response with limited gastrointestinal toxicity in adult acute myeloid leukaemia. Intern Med J 2013; 43:294-7. [DOI: 10.1111/j.1445-5994.2012.02868.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
- M. Low
- Department of Clinical Haematology; The Alfred Hospital
| | - D. Lee
- Department of Clinical Haematology; The Alfred Hospital
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Allen VM, Dodds L, Spencer A, Cummings EA, MacDonald N, Kephart G. Application of a national administrative case definition for the identification of pre-existing diabetes mellitus in pregnancy. Chronic Dis Inj Can 2012; 32:113-120. [PMID: 22762897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease. METHOD To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD. RESULTS Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital. CONCLUSION Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.
Collapse
Affiliation(s)
- V M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | | | | | | | |
Collapse
|
46
|
Raux O, Spencer A, Fesseau R, Mercier G, Rochette A, Bringuier S, Lakhal K, Capdevila X, Dadure C. Intraoperative use of transoesophageal Doppler to predict response to volume expansion in infants and neonates. Br J Anaesth 2012; 108:100-7. [DOI: 10.1093/bja/aer336] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
|
47
|
Spencer A, Elsom T, Gury T, Jarecki A, Gautier JC. Evaluation of urinary biomarkers to assess degeneration and necrosis of ascending loop of Henle (ALH) in the rat. Toxicology 2011. [DOI: 10.1016/j.tox.2011.09.030] [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: 10/14/2022]
|
48
|
Taylor S, Bremner S, Choudhury A, Cook V, Devine A, Eldridge S, Feder G, Foster G, Islam K, Sohanpal R, Spencer A, Griffiths C, Barnes N. OEDIPUS: A cluster randomised trial of education for South Asians with asthma, and their primary and secondary care physicians, to reduce unscheduled care. J Epidemiol Community Health 2011. [DOI: 10.1136/jech.2011.143586.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Monaghan KA, Khong T, Burns CJ, Spencer A. The novel JAK inhibitor CYT387 suppresses multiple signalling pathways, prevents proliferation and induces apoptosis in phenotypically diverse myeloma cells. Leukemia 2011; 25:1891-9. [PMID: 21788946 DOI: 10.1038/leu.2011.175] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Janus kinases (JAKs) are involved in various signalling pathways exploited by malignant cells. In multiple myeloma (MM), the interleukin-6/JAK/signal transducers and activators of transcription (IL-6/JAK/STAT) pathway has been the focus of research for a number of years and IL-6 has an established role in MM drug resistance. JAKs therefore make a rational drug target for anti-MM therapy. CYT387 is a novel, orally bioavailable JAK1/2 inhibitor, which has recently been described. This preclinical evaluation of CYT387 for treatment of MM demonstrated that CYT387 was able to prevent IL-6-induced phosphorylation of STAT3 and greatly decrease IL-6- and insulin-like growth factor-1-induced phosphorylation of AKT and extracellular signal-regulated kinase in human myeloma cell lines (HMCL). CYT387 inhibited MM proliferation in a time- and dose-dependent manner in 6/8 HMCL, and this was not abrogated by the addition of exogenous IL-6 (3/3 HMCL). Cell cycling was inhibited with a G(2)/M accumulation of cells, and apoptosis was induced by CYT387 in all HMCL tested (3/3). CYT387 synergised in killing HMCL when used in combination with the conventional anti-MM therapies melphalan and bortezomib. Importantly, apoptosis was also induced in primary patient MM cells (n=6) with CYT387 as a single agent, and again synergy was seen when combined with conventional therapies.
Collapse
Affiliation(s)
- K A Monaghan
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
50
|
|