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Stewart A. Brachytherapy for rectal and anal cancer: Where are we and current perspectives? Brachytherapy 2024; 23:214-223. [PMID: 38278689 DOI: 10.1016/j.brachy.2023.12.001] [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] [Received: 10/03/2022] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/28/2024]
Abstract
Anal and rectal cancers were some of the first disease sites treated with brachytherapy due to the anatomic ease of implantation. As external beam radiotherapy grew in popularity the use of ano-rectal brachytherapy declined. However, the past few years have seen a steady resurgence in the use of brachytherapy in the ano-rectum supported by the use of large clinical series and randomized trials. The increasing acceptance by the surgical community of organ preservation as a valid treatment strategy for rectal cancer has encouraged the use of nonsurgical approaches and brachytherapy has shown itself to be a valuable tool for this. The current role of anal and rectal brachytherapy is presented with perspectives on its future use.
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Affiliation(s)
- Alexandra Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, England; University of Surrey, Guildford, England.
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2
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Keleher E, Iftikhar H, Schulz LF, McCanny P, Austin D, Stewart A, O'Regan W, Hallbäck M, Wallin M, Aneman A. Capnodynamic monitoring of lung volume and pulmonary blood flow during alveolar recruitment: a prospective observational study in postoperative cardiac patients. J Clin Monit Comput 2023; 37:1463-1472. [PMID: 37243954 DOI: 10.1007/s10877-023-01033-1] [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] [Received: 10/26/2022] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
Alveolar recruitment manoeuvres may mitigate ventilation and perfusion mismatch after cardiac surgery. Monitoring the efficacy of recruitment manoeuvres should provide concurrent information on pulmonary and cardiac changes. This study in postoperative cardiac patients applied capnodynamic monitoring of changes in end-expiratory lung volume and effective pulmonary blood flow. Alveolar recruitment was performed by incremental increases in positive end-expiratory pressure (PEEP) to a maximum of 15 cmH2O from a baseline of 5 cmH2O over 30 min. The change in systemic oxygen delivery index after the recruitment manoeuvre was used to identify responders (> 10% increase) with all other changes (≤ 10%) denoting non-responders. Mixed factor ANOVA using Bonferroni correction for multiple comparisons was used to denote significant changes (p < 0.05) reported as mean differences and 95% CI. Changes in end-expiratory lung volume and effective pulmonary blood flow were correlated using Pearson's regression. Twenty-seven (42%) of 64 patients were responders increasing oxygen delivery index by 172 (95% CI 61-2984) mL min-1 m-2 (p < 0.001). End-expiratory lung volume increased by 549 (95% CI 220-1116) mL (p = 0.042) in responders associated with an increase in effective pulmonary blood flow of 1140 (95% CI 435-2146) mL min-1 (p = 0.012) compared to non-responders. A positive correlation (r = 0.79, 95% CI 0.5-0.90, p < 0.001) between increased end-expiratory lung volume and effective pulmonary blood flow was only observed in responders. Changes in oxygen delivery index after lung recruitment were correlated to changes in end-expiratory lung volume (r = 0.39, 95% CI 0.16-0.59, p = 0.002) and effective pulmonary blood flow (r = 0.60, 95% CI 0.41-0.74, p < 0.001). Capnodynamic monitoring of end-expiratory lung volume and effective pulmonary blood flow early in postoperative cardiac patients identified a characteristic parallel increase in both lung volume and perfusion after the recruitment manoeuvre in patients with a significant increase in oxygen delivery.Trial registration This study was registered on ClinicalTrials.gov (NCT05082168, 18th of October 2021).
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Affiliation(s)
- E Keleher
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - H Iftikhar
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - L F Schulz
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - P McCanny
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - D Austin
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - A Stewart
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - W O'Regan
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | | | - M Wallin
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - A Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
- Southwestern Clinical School, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Intensive Care Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
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3
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Stewart A, Smith CH, Govender R, Eaton S, De Coppi P, Wray J. Qualitative research: A different option on the menu. J Pediatr Surg 2023; 58:782-783. [PMID: 36621343 DOI: 10.1016/j.jpedsurg.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandra Stewart
- Department of Language and Cognition, University College London, Chandler House, 2 Wakefield Street, London, WC1N 1PF, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Christina H Smith
- Department of Language and Cognition, University College London, Chandler House, 2 Wakefield Street, London, WC1N 1PF, UK
| | - Roganie Govender
- Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK; Head and Neck Academic Centre, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK; Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Hanks E, Stewart A, Au-Yeung CK, Johnson E, Smith CH. Consensus on level descriptors for a functional children's eating and drinking activity scale. Dev Med Child Neurol 2023. [PMID: 36798989 DOI: 10.1111/dmcn.15542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/13/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/18/2023]
Abstract
AIM To agree wording of level descriptors for a measure of functional outcome of children's eating and drinking. METHOD An online, modified Delphi method was used to gather feedback on current level descriptor wording and generate rewording suggestions. Thirty speech and language therapists, working in a variety of settings and geographical locations, were invited to be part of the Delphi expert panel. Content analysis was used to evaluate participants' comments and develop consensus level descriptors. Consensus for acceptable wording was set at 80% agreement. Face validity was assessed using 5-point Likert scales. RESULTS Nineteen expert speech and language therapists (median experience 18 years) completed round one; 15 out of 19 completed round two. Level descriptor rating reached 80% agreement in two rounds. Additionally, 93% of participants agreed the scale would accurately capture change in their setting, with 87% likely to use the scale in practice. INTERPRETATION This study has produced agreed wording for a functional measure of eating and drinking activity suitable for use with paediatrics feeding disorders, regardless of disease aetiology, presentation, age, or setting. Potential for widespread use is supported. Further evaluation of the tool's reliability and validity is required.
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Affiliation(s)
- Emily Hanks
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Alexandra Stewart
- Department of Psychology and Language Sciences, University College London, London, UK.,Department of Speech and Language Therapy, Great Ormond Street Hospital, London, UK
| | - Claudia Kate Au-Yeung
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Emily Johnson
- Department of Speech and Language Therapy, Great Ormond Street Hospital, London, UK
| | - Christina H Smith
- Department of Psychology and Language Sciences, University College London, London, UK
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Stewart A, Smith CH, Govender R, Eaton S, De Coppi P, Wray J. Parents' experiences of feeding children born with oesophageal atresia/tracheo-oesophageal fistula. J Pediatr Surg 2022; 57:792-799. [PMID: 36150934 PMCID: PMC9728016 DOI: 10.1016/j.jpedsurg.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Feeding difficulties are widely acknowledged following oesophageal atresia/tracheo-oesophageal fistula repair. However, little is understood about the nature and severity of these difficulties. This study explored feeding in children with oesophageal atresia/tracheo-oesophageal fistula from the parent perspective. METHODS In collaboration with a patient support group, data were collected using a research-specific online discussion forum. Thematic analysis was used to code the data and identify themes. RESULTS One hundred and twenty-seven parents registered for the online forum, of whom 83 (65%) provided demographic data. Seventy-four (89%) of responders were mothers, 75 (90%) were of white ethnicity, 65 (78%) were from the UK. Six key themes were identified: feeding is a traumatic experience, feeding my child is scary, feeding is isolating and filled with uncertainty, feeding outside of the home is difficult, feeding associated emotions, developing coping strategies. Parents described features of medical, nutritional, feeding skill and psychosocial dysfunction across all stages of eating/drinking development. They described how their child's feeding difficulties had an impacted their own well-being. An interactional model of feeding difficulties in OA/TOF is proposed. CONCLUSIONS Exploring parent experiences provides rich data from which to expand understanding of the complex nature of feeding difficulties in OA/TOF. Feeding should be viewed as a dyadic process, occurring within a family system. Intervention for feeding difficulties should be family-centred, addressing parental anxiety, trauma and uncertainty, as well as the child's underlying medical/surgical needs to optimise outcome. Further study of clinical correlates with parental experience is required. LEVEL OF EVIDENCE IV (non-experimental, qualitative).
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Affiliation(s)
- Alexandra Stewart
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Christina H. Smith
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK
| | - Roganie Govender
- Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK,Head and Neck Academic Centre, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK,Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Steinke J, Franklin A, Minnaar H, Patel N, Jordan C, Rossides S, Wang L, Ragnakumaran R, Brooker C, Rockall T, Stewart A. Contact X-ray brachytherapy (CXB) for early rectal cancer: A review of outcomes from a single UK centre. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.09.043] [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: 11/06/2022]
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Baird P, Drinkwater K, Forrest J, Stewart A. The Royal College of Radiologists (RCR) national vulvar cancer audit. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.09.007] [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: 11/06/2022]
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8
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Sun Myint A, Dhadda A, Stewart A, Mills J, Sripadam R, Rao C, Hunter A, Hershman M, Franklin A, Chadwick E, Banerjee A, Rockall T, Pritchard D, Gerard J. The Role of Contact X-Ray Brachytherapy in Early Rectal Cancer – Who, when and How? Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.10.003] [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: 11/28/2022]
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9
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Ingles Russo Garces A, Milite S, Oliveira E, Fernandez-Mateos J, Chen B, Pickard L, Stewart A, Lau R, De Haven Brandon A, Paranjape E, Sottoriva A, Banerjee S, Banerji U. 1697P Drug-induced evolutionary dynamics in BRCA-mutant/non-mutant ovarian cancer models. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1775] [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
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10
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Heeke S, Gay C, Estecio M, Stewart A, Tran H, Zhang B, Tang X, Raso M, Concannon K, De Sousa LG, Lewis W, Kondo K, Nilsson M, Xi Y, Diao L, Wang Q, Zhang J, Wang J, Wistuba I, Byers L, Heymach J. MA01.03 Exploiting DNA Methylation for Classification of SCLC Subtypes from Liquid Biopsies Using a Robust Machine Learning Approach. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.076] [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: 11/15/2022]
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11
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Weststrate H, Stimpson G, Thomas L, Scoto M, Johnson E, Stewart A, Muntoni F, Baranello G, Conway E. Evolution of bulbar function in spinal muscular atrophy type 1 treated with nusinersen. Dev Med Child Neurol 2022; 64:907-914. [PMID: 35103306 PMCID: PMC9306995 DOI: 10.1111/dmcn.15171] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
AIM To assess the evolution of bulbar function in nusinersen-treated spinal muscular atrophy type 1 (SMA1). METHOD This single-centre retrospective study identified 24 patients (14 females and 10 males) with SMA1, treated with nusinersen between 2017 and 2020. We adapted and validated the Paediatric Functional Oral Intake Scale (p-FOIS), which is an outcome measure to assess bulbar function. Analysis considered SMA1 subtype, nutritional support, and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and p-FOIS scores at initiation of nusinersen treatment (baseline) and at 6, 12, and 24 months after initiation. RESULTS The median age at baseline was 11 months (range 1 month-7 years 6 months). Median age at initiation of tube feeding was 8 months (range 0-2 years 2 months). Fourteen patients were tube fed at baseline. The median p-FOIS score was 3 at baseline and 2 at 12 and 24 months. Four patients, all with type 1c SMA, remained orally fed at 24 months. Median CHOP INTEND scores increased from 32 at baseline to 42 at 12 and 24 months. INTERPRETATION Impaired bulbar function persisted as a significant complication in most nusinersen-treated patients with SMA1, in contrast to the improvement in motor abilities demonstrated in the majority. p-FOIS allows for tracking of bulbar function progression and treatment response. Larger, prospective studies investigating the longer-term impacts of nusinersen on bulbar function are warranted.
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Affiliation(s)
- Harriet Weststrate
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Georgia Stimpson
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Lily Thomas
- Department of Language and CommunicationUniversity College LondonLondonUK
| | - Mariacristina Scoto
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Emily Johnson
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Alexandra Stewart
- Department of Language and CommunicationUniversity College LondonLondonUK,Department of Speech and Language TherapyGreat Ormond Street Hospital NHS Foundation TrustLondonUK
| | - Francesco Muntoni
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Giovanni Baranello
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Eleanor Conway
- The Dubowitz Neuromuscular CentreDevelopmental Neuroscience Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthNIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation TrustUCL Great Ormond Street Institute of Child HealthLondonUK
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Shelley C, Bolt M, Hollingdale R, Rashid M, Reinlo S, Fazel N, Adams E, Stewart A, South C. PO-1697 Assessment of the impact of CBCT-guided online adaptation on dose distribution in cervical cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03661-1] [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: 11/28/2022]
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13
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Salaveria K, Smith S, Liu YH, Bagshaw R, Ott M, Stewart A, Law M, Carter A, Hanson J. The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia. Am J Trop Med Hyg 2022; 106:257-267. [PMID: 34662860 PMCID: PMC8733535 DOI: 10.4269/ajtmh.21-0615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023] Open
Abstract
Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.
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Affiliation(s)
- Kris Salaveria
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Richard Bagshaw
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Markus Ott
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | | | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angus Carter
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia;,James Cook University, Cairns Campus, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;,Kirby Institute, University of New South Wales, Sydney, Australia;,Address correspondence to Josh Hanson, Kirby Institute, Level 6, Wallace Wurth Building, High Street, UNSW, Kensington NSW 2052, Australia. E-mail:
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Halfpenny R, Stewart A, Kelly P, Conway E, Smith C. Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol. Syst Rev 2021; 10:312. [PMID: 34903269 PMCID: PMC8667523 DOI: 10.1186/s13643-021-01861-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics. METHODS This study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed. DISCUSSION This review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia. SYSTEMATIC REVIEW REGISTRATION Open science framework osf.io/ja4dr.
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Affiliation(s)
- Rhiannon Halfpenny
- Great Ormond Street Hospital, Great Ormond Street, London, UK.
- University College London, London, UK.
| | - Alexandra Stewart
- Great Ormond Street Hospital, Great Ormond Street, London, UK
- University College London, London, UK
| | - Paula Kelly
- Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Eleanor Conway
- Great Ormond Street Hospital, Great Ormond Street, London, UK
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Butt N, Chaus A, Ratnani P, Stewart A. Smoky heart: cardiovascular manifestations of carbon monoxide poisoning. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1508] [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: 11/12/2022] Open
Abstract
Abstract
Background
Carbon monoxide (CO) poisoning is one of the most critical health concerns worldwide due to severe clinical effects with high morbidity and mortality. Tissue hypoxia and cellular damage from CO poisoning results in oxidative stress. Organs and tissues with high O2 demand including central nervous system (CNS) and cardiovascular (CV) system are the most susceptible to this oxidative stress. We investigate and describe the cardiovascular manifestations in 350 patients who were admitted for moderate to severe CO poisoning and treated with hyperbaric oxygen (HBO2) therapy.
Purpose
This study was conducted to identify the common cardiovascular manifestations of carbon monoxide poisoning.
Methods
We retrospectively collected data on 350 consecutive adult patients treated for CO poisoning between January 2011 to April 2018. Cardiac biomarkers, EKG and carboxyhemoglobin (COHb) levels were obtained from pre-hospital sources including EMS (emergency medical services) and from outside hospital records at the time of transfer. Glasgow Coma Scale (GCS) measurements were obtained at initial pre-hospital evaluation and upon arrival to the emergency room. Patient demographics, CV, CNS history and cardiac risk factors including hypertension, hyperlipidemia, diabetes, smoking history were obtained from electronic medical record. Myocardial injury was defined by cardiac troponin I level of ≥0.05 ng/mL.
Results
There were 350 patients admitted for CO poisoning from 2011 to 2018. 72% of the patients received HBO treatment due to severity of their symptoms. The mean age was 47.3 years with 60% men, 89% of the admissions were accidental exposure. Cardiac biomarkers were elevated in 40% of the patients and with 21% having sinus tachycardia. 6% had ischemic EKG changes with 23% having regional wall motion abnormalities on echocardiogram. In terms of intervention, 83% of the patients with elevated cardiac biomarkers received HBO treatment, 9% underwent coronary angiogram out of which 50% were candidate for either percutaneous intervention (PCI) or coronary artery bypass graft (CABG). In hospital mortality amongst this population was 2%.
Conclusion
Myocardial injury is common and widely seen with CO poisoning as seen by elevated cardiac biomarkers in 40% of the tested population. Initial work up for patients with CO poisoning should include evaluation with an EKG and serial biomarkers. If an abnormality is detected, patient should undergo an echocardiogram. Further evaluation with coronary angiography may be warranted in patients with new left ventricular dysfunction or wall motion abnormalities, especially in patients with risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Butt
- Advocate Lutheran General Hospital, Cardiology, Park Ridge, United States of America
| | - A Chaus
- Advocate Lutheran General Hospital, Cardiology, Park Ridge, United States of America
| | - P Ratnani
- Advocate Lutheran General Hospital, Internal Medicine, Park Ridge, United States of America
| | - A Stewart
- Advocate Lutheran General Hospital, Trauma Surgery, Park Ridge, United States of America
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Coma S, Chowdhury S, Musteanu M, Stewart A, Pickard L, Krebs M, Minchom A, Banerji U, Barbacid M, Pachter J. P52.05 Dual RAF/MEK Inhibitor VS-6766 for Treatment of KRAS Mutant NSCLC: Novel Combinations Targeting G12C or G12V Variants. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.549] [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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17
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Halfpenny R, Stewart A, Carter A, Wyatt M, Jephson C, O'Dwyer E, Cavalli L. Dysphonia and dysphagia consequences of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Int J Pediatr Otorhinolaryngol 2021; 148:110823. [PMID: 34237522 PMCID: PMC9754852 DOI: 10.1016/j.ijporl.2021.110823] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Paediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease first identified in 2020. Recent cohort studies have described the complex presentation and symptomatology. This paper provides detailed description of the dysphagia and dysphonia symptoms, management, and outcome. OBJECTIVE To describe dysphagia and dysphonia in PIMS-TS. DESIGN Retrospective cohort study. SETTING Single tertiary and quaternary children's hospital. PARTICIPANTS All 50 children treated for paediatric multisystem inflammatory disease between April and June 2020 were included in this study. MAIN OUTCOME(S) AND MEASURE(S) Dysphonia: GRBAS Perceptual Severity Scores, Vocal Handicap Index scores and the Vocal Tract Discomfort Scale. Dysphagia: Functional Oral Intake Scale. RESULTS Fifty children met the diagnostic criteria for PIMS-TS. 33 (66%) were male. Median age was 10 years (range: 1-17). 36 (72%) were of Black, Asian or minority ethnic background. Nine (18%) required specialist assessment and management of dysphagia and/or dysphonia. Five (55%) were male with a median age of 9 years 7 months (range: 1-15 years). Symptoms typically resolved within three months. Two children presented with persisting dysphonia three months post-presentation. Neurological, inflammatory, and iatrogenic causes of dysphagia and dysphonia were identified. CONCLUSIONS AND RELEVANCE Dysphonia and dysphagia are present in children with PIMS-TS. Further data is required to understand pathophysiology, estimate incidence, and determine prognostic factors. This preliminary data highlights the need for dysphagia and dysphonia screening and timely referral for specialist, multidisciplinary assessment and treatment to ensure short-term aspiration risk is managed and long-term, functional outcomes are optimised.
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Affiliation(s)
- Rhiannon Halfpenny
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK; University College London, Gower Street, London, WC1E 6BT, UK.
| | - Alexandra Stewart
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK,University College London, Gower Street, London, WC1E 6BT, UK
| | - Alison Carter
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Michelle Wyatt
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | | | - Emma O'Dwyer
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Lesley Cavalli
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK,University College London, Gower Street, London, WC1E 6BT, UK
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18
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Affiliation(s)
- S Otter
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
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Bolt M, Shelley C, Hollingdale R, Chadwick S, Barnard A, Leverton A, Stewart A, Adams E, South C. PO-1574 Evaluation of automated plan quality for cervical cancer using the Ethos TPS. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Shelley C, Bolt M, Hollingdale R, South C, Adams E, Stewart A. PO-1313 Evaluation of CBCT-based auto-segmentation for online adaptive radiotherapy in cervical cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Patterson BJ, Myers K, Stewart A, Mange B, Hillson EM, Poulos C. Preferences for herpes zoster vaccination among adults aged 50 years and older in the United States: results from a discrete choice experiment. Expert Rev Vaccines 2021; 20:729-741. [PMID: 33902368 DOI: 10.1080/14760584.2021.1910502] [Citation(s) in RCA: 3] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most adults, and disproportionately fewer African-Americans, have not received herpes zoster (HZ) vaccination despite current recommendations. This study (GSK study identifiers: 208677/HO-17-18066) assessed HZ vaccination preferences among adults aged ≥ 50 years. RESEARCH DESIGN AND METHODS In this discrete choice experiment, respondents chose among a 'no vaccine' option and two HZ vaccine profiles, characterized by seven attributes, in a series of choice questions. Random-parameters logit results were used to predict likely vaccine uptake. Subgroup and latent class analysis of African-American's preferences were performed. RESULTS The preference weight for choosing HZ vaccines over no vaccine was statistically significant among the 1,454 respondents (71.9% whites; 25.2% African-Americans). Out-of-pocket (OOP) cost and vaccine effectiveness (VE) were the most important attributes. The African-American and the non-African-American subgroups had statistically significant differences in preferences (χ2 = 59.91, p < 0.001), mainly driven by OOP cost and VE. Latent class analysis identified three groups of African-American respondents with systematically different preferences; two comprised likely-vaccinators, with one being more cost sensitive at lower price thresholds, and one likely non-vaccinators. CONCLUSIONS For all respondents, HZ vaccine choices were most sensitive to total OOP cost, followed by VE.
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Affiliation(s)
| | - Kelley Myers
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
| | | | - Brennan Mange
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
| | - Eric M Hillson
- US Health Outcomes & Epidemiology, GSK, Philadelphia, PA, United States
| | - Christine Poulos
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
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22
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Stewart A, Cloutier D. More than a roof; challenges for older women renters in British Columbia, Canada. J Women Aging 2021; 34:582-595. [PMID: 34255610 DOI: 10.1080/08952841.2021.1948791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The growing issue of housing affordability is an increasing challenge worldwide as the financialization of housing markets undermines housing as a basic human right. One of the most vulnerable segments of the population affected by rising housing costs are older, low-income, females. Drawing on qualitative interviews with older women, we explore lived experiences of housing insecurity using a feminist political ecology perspective. Our findings reveal substantial challenges as well as creative solutions being employed by these women to stay in place. We conclude that more targeted and age- and gender-inclusive housing policies, programs, supports and services are critically needed.
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Affiliation(s)
- Alexandra Stewart
- Department of Geography, University of Victoria, Victoria, British Columbia, Canada
| | - Denise Cloutier
- Department of Geography, Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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23
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Taggar AS, Mann P, Stewart A, Devlin P, Likhacheva A. Acute and late complications and toxicities of skin brachytherapy. Brachytherapy 2021; 20:1041-1052. [PMID: 34229964 DOI: 10.1016/j.brachy.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 01/31/2023]
Abstract
Skin cancer is the most prevalent malignancy, and its incidence is rising. Surgery is the primary treatment, however, morbidity of surgical resection in certain parts of the body warrant alternate treatment options such as radiation therapy. Complex topology of the skin can pose a challenge for treatment with photon and electron external beam radiotherapy techniques. Brachytherapy can be an attractive radiotherapy technique for these regions. Furthermore, brachytherapy results in lower dose to the underlying deep organs. The goal of this manuscript is to provide a brief overview of the role of brachytherapy for skin malignancies and to outline potential acute and long-term toxicities.
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Affiliation(s)
- Amandeep S Taggar
- Sunnybrook Odette Cancer Centre, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Paveen Mann
- Sunnybrook Odette Cancer Centre, Toronto, Canada
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Abstract
PURPOSE OF REVIEW Use of thickened fluids has long been a cornerstone of dysphagia management. However, clinicians and researchers are increasingly questioning their effectiveness and highlighting potential harms. This review aims to present the current state of the evidence for use of thickened fluids in children. RECENT FINDINGS The relationship between aspiration and respiratory infection is complex. The role of thickened fluids in improving respiratory health is limited and contradictory. A high level of variability exists in all aspects of thickened fluid use. Little is known about patient and family perspectives on meaningful endpoints for intervention. SUMMARY Clinicians should be open and transparent in their decision making with patients and families, acknowledging the limited evidence and the need for individualised care. Further research is needed to establish the efficacy of thickened fluid use in children with regard to improvements in respiratory health, fluid intake and child and family wellbeing.
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Affiliation(s)
- Alexandra Stewart
- Great Ormond Street Hospital for Children NHS Foundation Trust
- Department of Psychology and Language Sciences, University College London, London
| | - Samantha Burr
- Solent NHS Trust, Hampshire
- Faculty of Health and Applied Sciences, the University of the West of England, Bristol, UK
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25
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Whitehouse D, Piffer F, Becker T, Gravett K, Stewart A, Basi K, Inmand S, Bush A, Jarritt P, Stranks A, Newcombe V. Challenges, approaches and opportunities for Patient and Public Involvement (PPI) in Traumatic Brain Injury (TBI) research. Br J Neurosurg 2021; 35:651-652. [PMID: 33944645 DOI: 10.1080/02688697.2021.1922605] [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: 10/21/2022]
Affiliation(s)
- D Whitehouse
- Emergency Department, Addenbrooke's Hospital, Cambridge, UK
| | - F Piffer
- NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, UK
| | - T Becker
- NIHR Cambridge BRC Communications and PPI/E Department, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - K Gravett
- Panel Member, Cambridge TBI PPI Group, Cambridge, UK
| | - A Stewart
- Panel Member, Cambridge TBI PPI Group, Cambridge, UK
| | - K Basi
- Panel Member, Cambridge TBI PPI Group, Cambridge, UK
| | - S Inmand
- Panel Member, Cambridge TBI PPI Group, Cambridge, UK
| | - A Bush
- Panel Member, Cambridge TBI PPI Group, Cambridge, UK
| | - P Jarritt
- NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, UK
| | - A Stranks
- NIHR Cambridge BRC Communications and PPI/E Department, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - V Newcombe
- Emergency Department, Addenbrooke's Hospital, Cambridge, UK
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26
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Bourke S, Bertram I, Horne SJ, Wong AKH, Stewart A, Wallett L, Dufty NE. Mutually supporting: a near-peer mentoring system for military junior doctors. BMJ Mil Health 2021; 168:242. [PMID: 33685905 DOI: 10.1136/bmjmilitary-2020-001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Samuel Bourke
- 3 Medical Regiment, Royal Army Medical Corps, Preston, UK
| | - I Bertram
- AMS HQ, Roberston House, Camberley, England
| | - S-J Horne
- Royal Centre for Defence Medicine, Birmingham, UK
| | - A K H Wong
- Royal Centre for Defence Medicine, Birmingham, UK
| | - A Stewart
- Royal Centre for Defence Medicine, Birmingham, UK
| | - L Wallett
- Royal Centre for Defence Medicine, Birmingham, UK
| | - N E Dufty
- Royal Centre for Defence Medicine, Birmingham, UK.,Department of Sexual Health, Birmingham Heartlands Hospital, Birmingham, England, UK
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27
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Chuai Y, Rizzuto I, Zhang X, Li Y, Dai G, Otter SJ, Bharathan R, Stewart A, Wang A. Vascular endothelial growth factor (VEGF) targeting therapy for persistent, recurrent, or metastatic cervical cancer. Cochrane Database Syst Rev 2021; 3:CD013348. [PMID: 33661538 PMCID: PMC8428759 DOI: 10.1002/14651858.cd013348.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cervical cancer ranks as the fourth leading cause of death from cancer in women. Historically, women with metastatic or recurrent cervical cancer have had limited treatment options. New anti-angiogenesis therapies, such as vascular endothelial growth factor (VEGF) targeting agents, offer an alternative strategy to conventional chemotherapy; they act by inhibiting the growth of new blood vessels, thereby restricting tumour growth by blocking the blood supply. OBJECTIVES To assess the benefits and harms of VEGF targeting agents in the management of persistent, recurrent, or metastatic cervical cancer. SEARCH METHODS We performed searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, online registers of clinical trials, and abstracts of scientific meetings up until 27 May 2020. SELECTION CRITERIA We examined randomised controlled trials (RCTs) that evaluated the use of VEGF targeting agents alone or in combination with conventional chemotherapy or other VEGF targeting agents. DATA COLLECTION AND ANALYSIS Three review authors independently screened the results of search strategies, extracted data, assessed risk of bias, and analysed data according to the standard methods expected by Cochrane. The certainty of evidence was assessed via the GRADE approach. MAIN RESULTS A total of 1634 records were identified. From these, we identified four studies with a total of 808 participants for inclusion. We also identified two studies that were awaiting classification and nine ongoing studies. Bevacizumab plus chemotherapy versus chemotherapy Treatment with bevacizumab plus chemotherapy may result in lower risk of death compared to chemotherapy alone (hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.62 to 0.95; 1 study, 452 participants; low-certainty evidence). However, there are probably more specific adverse events when compared to chemotherapy alone, including gastrointestinal perforations or fistulae (risk ratio (RR) 18.00, 95% CI 2.42 to 133.67; 1 study, 440 participants; moderate-certainty evidence); serious thromboembolic events (RR 4.5, 95% CI 1.55 to 13.08; 1 study, 440 participants; moderate-certainty evidence); and hypertension (RR 13.75, 95% CI 5.07 to 37.29; 1 study, 440 participants; moderate-certainty evidence). There may also be a higher incidence of serious haemorrhage (RR 5.00, 95% CI 1.11 to 22.56; 1 study, 440 participants; low-certainty evidence). In addition, the incidence of serious adverse events is probably higher (RR 1.44, 95% CI 1.16 to 1.79; 1 study, 439 participants; moderate-certainty evidence). The incremental cost-effectiveness ratio was USD 295,164 per quality-adjusted life-year (1 study, 452 participants; low-certainty evidence). Cediranib plus chemotherapy versus chemotherapy Treatment with cediranib plus chemotherapy may or may not result in similar risk of death when compared to chemotherapy alone (HR 0.94, 95% CI 0.53 to 1.65; 1 study, 69 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 3.27, 95% CI 0.14 to 77.57; 1 study, 67 participants; very low-certainty evidence); serious haemorrhage (RR 5.45, 95% CI 0.27 to 109.49; 1 study, 67 participants; very low-certainty evidence); serious thromboembolic events (RR 3.41, 95% CI 0.14 to 80.59; 1 study, 60 participants; very low-certainty evidence); and serious hypertension (RR 0.36, 95% CI 0.02 to 8.62; 1 study, 67 participants; very low-certainty evidence). In addition, there may or may not be a similar incidence of serious adverse events compared to chemotherapy alone (RR 1.15, 95% CI 0.75 to 1.78; 1 study, 67 participants; low-certainty evidence). Apatinib plus chemotherapy or chemotherapy/brachytherapy versus chemotherapy or chemotherapy/brachytherapy Treatment with apatinib plus chemotherapy or chemotherapy/brachytherapy may or may not result in similar risk of death compared to chemotherapy alone or chemotherapy/brachytherapy alone (HR 0.90, 95% CI 0.51 to 1.60; 1 study, 52 participants; low-certainty evidence). However, hypertension events may occur at a higher incidence as compared to chemotherapy alone or chemotherapy/brachytherapy alone (RR 5.14, 95% CI 1.28 to 20.73; 1 study, 52 participants; low-certainty evidence). Pazopanib plus lapatinib versus lapatinib Treatment with pazopanib plus lapatinib may result in higher risk of death compared to lapatinib alone (HR 2.71, 95% CI 1.16 to 6.31; 1 study, 117 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 2.00, 95% CI 0.19 to 21.59; 1 study, 152 participants; very low-certainty evidence); haemorrhage (RR 2.00, 95% CI 0.72 to 5.58; 1 study, 152 participants; very low-certainty evidence); and thromboembolic events (RR 3.00, 95% CI 0.12 to 72.50; 1 study, 152 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 12.00, 95% CI 2.94 to 49.01; 1 study, 152 participants; moderate-certainty evidence). There may or may not be a similar incidence of serious adverse events as compared to lapatinib alone (RR 1.45, 95% CI 0.94 to 2.26; 1 study, 152 participants; low-certainty evidence). Pazopanib versus lapatinib Treatment with pazopanib may or may not result in similar risk of death as compared to lapatinib (HR 0.96, 95% CI 0.67 to 1.38; 1 study, 152 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 1.03, 95% CI 0.07 to 16.12; 1 study, 150 participants; very low-certainty evidence); haemorrhage (RR 1.03, 95% CI 0.31 to 3.40; 1 study, 150 participants; very low-certainty evidence); and thromboembolic events (RR 3.08, 95% CI 0.13 to 74.42; 1 study, 150 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 11.81, 95% CI 2.89 to 48.33; 1 study, 150 participants; moderate-certainty evidence). The risk of serious adverse events may or may not be similar as compared to lapatinib (RR 1.31, 95% CI 0.83 to 2.07; 1 study, 150 participants; low-certainty evidence). AUTHORS' CONCLUSIONS We found low-certainty evidence in favour of the use of bevacizumab plus chemotherapy. However, bevacizumab probably increases specific adverse events (gastrointestinal perforations or fistulae, thromboembolic events, hypertension) and serious adverse events. We found low-certainty evidence that does not support the use of cediranib plus chemotherapy, apatinib plus chemotherapy, apatinib plus chemotherapy/brachytherapy, or pazopanib monotherapy. We found low-certainty evidence suggesting that pazopanib plus lapatinib worsens outcomes. The VEGF inhibitors apatinib and pazopanib may increase the probability of hypertension events.
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Affiliation(s)
- Yunhai Chuai
- Department of Obstetrics and Gynaecology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Ivana Rizzuto
- Department of Gynaecological Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Xia Zhang
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ying Li
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Guanghai Dai
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Rasiah Bharathan
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | | | - Aiming Wang
- Department of Obstetrics and Gynaecology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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Stewart A, Smith CH, Eaton S, De Coppi P, Wray J. COVID-19 pandemic experiences of parents caring for children with oesophageal atresia/tracheo-oesophageal fistula. BMJ Paediatr Open 2021; 5:e001077. [PMID: 34192203 PMCID: PMC8136802 DOI: 10.1136/bmjpo-2021-001077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has resulted in a global health crisis of unparalleled magnitude. The direct risk to the health of children is low. However, disease-containment measures have society-wide impacts. This study explored the pandemic experiences of parents of children with oesophageal atresia/tracheo-oesophageal fistula (OA/TOF) in the UK. DESIGN A phenomenological approach underpinned use of an asynchronous online forum method, in collaboration with a patient support group. Data were evaluated using thematic analysis. RESULTS The online forum ran between 7 November and 18 December 2020 with 109 participants.Pandemic experiences were divided into themes relating to healthcare and disease containment. Participants described positive experiences with remote healthcare but identified limitations. Delays and cancellations led to escalation of care to an emergency level, slower developmental progress and feelings of being abandoned by services. Inpatient care was perceived as safe but caring alone was emotionally and practically challenging. Disease containment themes revealed anxiety regarding health risks, 'collateral' damage to well-being because of isolation, and an impact on finances and employment. Parents described a transition from worry about direct health risks to concern about the impact of isolation on socialisation and development. A process of risk-benefit analysis led some to transition to a more 'normal life', while others continued to isolate. Benefits to their child's health from isolation were reported. CONCLUSIONS Parents' experiences of caring for a child with OA/TOF during the pandemic were varied. Rapid adoption of telehealth has demonstrated the enormous potential of remote healthcare delivery but requires refinement to meet the needs of the individual. Future pandemic planning should aim to retain community healthcare services to avoid escalation of care to an emergency, manage chronic and developmental concerns, and support parental well-being. Accurate and consistent disease-specific information is highly valued by parents. Third sector organisations are ideally positioned to support this.
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Affiliation(s)
- Alexandra Stewart
- Department of Speech and Language Therapy, Great Ormond Street Hospital For Children NHS Trust, London, UK.,Department of Language and Cognition, University College London, London, UK
| | - Christina H Smith
- Department of Language and Cognition, University College London, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, London, UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, London, UK.,Specialist Paediatric and Neonatal Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Trust, London, UK
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29
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Newman L, Brown J, Kerawala C, Patel M, Woodwards B, Lavery K, Courtney D, Stewart A, Herold J, Hyde N. Our specialty. The future. Is the writing on the wall? Br J Oral Maxillofac Surg 2020; 58:1219-1221. [DOI: 10.1016/j.bjoms.2019.10.322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 10/24/2022]
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30
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Wang L, Madhuri T, Ashworth M, Curtis P, Butler-Manuel S, Stewart A, Tailor A. Ovarian transposition prior to irradiation in young women with cervical cancer. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.11.018] [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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31
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Fog L, Wirth A, MacManus M, Downes S, Grace M, Moggre A, Mugabe K, Neveri G, Nourbehesht L, Panetieri V, Pope D, Sim L, Stanton C, Steer B, Stewart A, Ungureanu E, Kron T. PO-1464: Total body irradiation practice in Australia and New Zealand: Results of a Survey. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01482-1] [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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Uwins C, Bhandoria GP, Shylasree TS, Butler-Manuel S, Ellis P, Chatterjee J, Tailor A, Stewart A, Michael A. COVID-19 and gynecological cancer: a review of the published guidelines. Int J Gynecol Cancer 2020; 30:1424-1433. [PMID: 32576608 DOI: 10.1136/ijgc-2020-001634] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/18/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023] Open
Abstract
On March 11, 2020 the COVID-19 outbreak was declared a 'pandemic' by the World Health Organization. COVID-19 is associated with higher surgical morbidity and mortality. An array of guidelines on the management of cancer during this pandemic have been published since the first reports of the outbreak. This narrative review brings all the relevant information from the guidelines together into one document, to support patient care. We present a detailed review of published guidelines, statements, comments from peer-reviewed journals, and nationally/internationally recognized professional bodies and societies' web pages (in English or with English translation available) between December 1, 2019 and May 27, 2020. Search terms included combinations of COVID, SARS-COV-2, guideline, gynecology, oncology, gynecological, cancer. Recommendations for surgical and oncological prioritization of gynecological cancers are discussed and summarized. The role of minimally invasive surgery, patient perspectives, medico-legal aspects, and clinical trials during the pandemic are also discussed. The consensus is that elective benign surgery should cease and cancer surgery, chemotherapy, and radiotherapy should continue based on prioritization. Patient and staff face-to-face interactions should be limited, and health resources used efficiently using prioritization strategies. This review and the guidelines on which it is based support the difficult decisions currently facing us in gynecological cancer. It is a balancing act: limited resources and a hostile environment pitted against the time-sensitive nature of cancer treatment. We can only hope to do our best for our patients with the resources available to us.
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Affiliation(s)
- Christina Uwins
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | | | - T S Shylasree
- Department of Gynaecologic Oncology, Tata Memorial Hospital, Homi Baba National Institute, Mumbai, India
| | - Simon Butler-Manuel
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Patricia Ellis
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Jayanta Chatterjee
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Anil Tailor
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke's Cancer Centre, Department of Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Agnieszka Michael
- Department of Oncology, University of Surrey, Guildford, United Kingdom
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Antwi AN, Stewart A, Crosbie M. Fighting antibiotic resistance: a narrative review of public knowledge, attitudes, and perceptions of antibiotics use. Perspect Public Health 2020; 140:338-350. [PMID: 32515278 DOI: 10.1177/1757913920921209] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS The aims of this study were to ascertain the comprehensive knowledge, perceptions, and attitudes of people from varying socioeconomic regions towards antibiotic use; identify the misperceptions and malpractices; and inform health policy and practice. METHOD EBSCO host databases, PubMed, and Google Scholar were searched to obtain relevant primary research papers within the years 2010-2018. Search phrases included the following: 'antibiotics use', 'community perceptions', 'public opinion, knowledge, behaviour, practices, perceptions'. Initially, selected papers were screened using the Preview, Question, Read, Summarize (PQRS) model. RESULTS Review of the 20 articles selected was based on six identified themes. It was found that insufficient knowledge and awareness of antibiotics use; self-medication and the use of leftover antibiotics; treating viral diseases with antibiotics or used as painkillers; expecting antibiotic prescription as a culmination of consultation; and the credibility of information obtained are issues that cut across different countries. CONCLUSION Evidence from this review suggests that misconceptions of antibiotic use are similar in different countries. Therefore, the need for the development and implementation of transferable policies as well as educating the public is necessary for the fight against ABR.
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Affiliation(s)
- A N Antwi
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.,Parasitology Department, Noguchi Memorial Institute for Medical Research, P.O. Box LG 581, Legon, Accra, Ghana
| | - A Stewart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Michelle Crosbie
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
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Reed AD, Nethery MA, Stewart A, Barrangou R, Theriot CM. Strain-Dependent Inhibition of Clostridioides difficile by Commensal Clostridia Carrying the Bile Acid-Inducible ( bai) Operon. J Bacteriol 2020; 202:e00039-20. [PMID: 32179626 PMCID: PMC7221253 DOI: 10.1128/jb.00039-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
Clostridioides difficile is one of the leading causes of antibiotic-associated diarrhea. Gut microbiota-derived secondary bile acids and commensal Clostridia that carry the bile acid-inducible (bai) operon are associated with protection from C. difficile infection (CDI), although the mechanism is not known. In this study, we hypothesized that commensal Clostridia are important for providing colonization resistance against C. difficile due to their ability to produce secondary bile acids, as well as potentially competing against C. difficile for similar nutrients. To test this hypothesis, we examined the abilities of four commensal Clostridia carrying the bai operon (Clostridium scindens VPI 12708, C. scindens ATCC 35704, Clostridium hiranonis, and Clostridium hylemonae) to convert cholate (CA) to deoxycholate (DCA) in vitro, and we determined whether the amount of DCA produced was sufficient to inhibit the growth of a clinically relevant C. difficile strain. We also investigated the competitive relationships between these commensals and C. difficile using an in vitro coculture system. We found that inhibition of C. difficile growth by commensal Clostridia supplemented with CA was strain dependent, correlated with the production of ∼2 mM DCA, and increased the expression of bai operon genes. We also found that C. difficile was able to outcompete all four commensal Clostridia in an in vitro coculture system. These studies are instrumental in understanding the relationship between commensal Clostridia and C. difficile in the gut, which is vital for designing targeted bacterial therapeutics. Future studies dissecting the regulation of the bai operon in vitro and in vivo and how this affects CDI will be important.IMPORTANCE Commensal Clostridia carrying the bai operon, such as C. scindens, have been associated with protection against CDI; however, the mechanism for this protection is unknown. Herein, we show four commensal Clostridia that carry the bai operon and affect C. difficile growth in a strain-dependent manner, with and without the addition of cholate. Inhibition of C. difficile by commensals correlated with the efficient conversion of cholate to deoxycholate, a secondary bile acid that inhibits C. difficile germination, growth, and toxin production. Competition studies also revealed that C. difficile was able to outcompete the commensals in an in vitro coculture system. These studies are instrumental in understanding the relationship between commensal Clostridia and C. difficile in the gut, which is vital for designing targeted bacterial therapeutics.
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Affiliation(s)
- A D Reed
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - M A Nethery
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - A Stewart
- Molecular Education, Technology and Research Innovation Center, North Carolina State University, Raleigh, North Carolina, USA
| | - R Barrangou
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - C M Theriot
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Rizzuto I, Otter SJ, Bharathan R, Stewart A. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of metastatic and recurrent cervical cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013605] [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)
- Ivana Rizzuto
- Department of Gynaecological Oncology; Royal Brisbane and Women’s Hospital; Brisbane Australia
| | | | - Rasiah Bharathan
- Department of Gynaecological Oncology; University Hospitals of Leicester NHS Trust, Leicester General Hospital; Leicester UK
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Court R, Wiesner L, Stewart A, de Vries N, Harding J, Maartens G, Gumbo T, McIlleron H. Steady state pharmacokinetics of cycloserine in patients on terizidone for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 22:30-33. [PMID: 29297422 DOI: 10.5588/ijtld.17.0475] [Citation(s) in RCA: 17] [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: 11/10/2022] Open
Abstract
SETTING Terizidone/cycloserine (TRD/CS) is included in standard treatment regimens for multidrug-resistant tuberculosis (MDR-TB) in many countries. The steady state pharmacokinetics (PKs) of CS after TRD administration are not known. OBJECTIVES AND DESIGN We recruited in-patients treated with 250-750 mg oral TRD daily as part of standard treatment regimens for pulmonary MDR-TB in Cape Town, South Africa. Plasma CS assays were performed in samples taken pre-dose and at 2, 4, 6, 8 and 10 h post-dose. CS concentrations were measured using a validated liquid chromatography-tandem mass spectrometry method. Non-compartmental PK analyses were performed. RESULTS Of 35 participants enrolled, 22 were males, and 20 (57%) were infected with the human immunodeficiency virus; the median age was 37 years. The median duration on TRD at the time of sampling was 33 days (interquartile range [IQR] 28-39). The area under the concentration-time curve at 0-10 h (AUC0-10) was 319 μg.h/ml (IQR 267.5-378.7), and peak concentration was 38.1 μg/ml (IQR 32.6-47.2). On multiple regression, dose (mg/kg) was the only factor independently associated with AUC0-10. CONCLUSION Steady state concentrations of CS in patients treated with TRD for MDR-TB were higher than those reported with CS formulations. Our findings support once-daily dosing.
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Affiliation(s)
- R Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town
| | - L Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town
| | - A Stewart
- Clinical Research Centre, Health Sciences Faculty, University of Cape Town, Cape Town
| | | | - J Harding
- D P Marais Hospital, Cape Town, South Africa
| | - G Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town
| | - T Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town
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Park J, Stewart A, Irvine M, Pedersen B, Kefford R, Diefenbach R, Carlino M, Rizos H. Uveal melanoma cell lines depend on multiple signaling pathways for survival. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.020] [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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Reid IR, Horne AM, Mihov B, Stewart A, Garratt E, Wiessing KR, Bolland MJ, Bastin S, Gamble GD. Anti-fracture efficacy of zoledronate in subgroups of osteopenic postmenopausal women: secondary analysis of a randomized controlled trial. J Intern Med 2019; 286:221-229. [PMID: 30887607 DOI: 10.1111/joim.12901] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND We recently reported that the administration of zoledronate every 18 months to osteopenic older women reduces the incidence of fractures. OBJECTIVE Here, we present a more detailed analysis of that trial to determine whether baseline clinical characteristics impact on the anti-fracture efficacy of this intervention. METHODS This is a prospective, randomized, placebo-controlled, double-blind trial in osteopenic postmenopausal women aged ≥ 65 years, to determine the anti-fracture efficacy of zoledronate. 2000 women were recruited using electoral rolls and randomized to receive 4 infusions of either zoledronate 5 mg or normal saline, at 18-month intervals. Each participant was followed for 6 years. Calcium supplements were not supplied. RESULTS Fragility fractures (either vertebral or nonvertebral) occurred in 190 women in the placebo group (227 fractures) and in 122 women in the zoledronate group (131 fractures), odds ratio (OR) 0.59 (95%CI 0.46, 0.76; P < 0.0001). There were no significant interactions between baseline variables (age, anthropometry, BMI, dietary calcium intake, baseline fracture status, recent falls history, bone mineral density, calculated fracture risk) and the treatment effect. In particular, the reduction in fractures appeared to be independent of baseline fracture risk, and numbers needed to treat (NNT) to prevent one woman fracturing were not significantly different across baseline fracture risk tertiles. CONCLUSIONS The present analyses indicate that the decrease in fracture numbers is broadly consistent across this cohort. The lack of relationship between NNTs and baseline fracture risk calls into question the need for BMD measurement and precise fracture risk assessment before initiating treatment in older postmenopausal women.
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Affiliation(s)
- I R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - A M Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B Mihov
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A Stewart
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - E Garratt
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - K R Wiessing
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - M J Bolland
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Bastin
- Auckland District Health Board, Auckland, New Zealand
| | - G D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Bialasiewicz S, Duarte TPS, Nguyen SH, Sukumaran V, Stewart A, Appleton S, Pitt ME, Bainomugisa A, Jennison AV, Graham R, Coin LJM, Hajkowicz K. Rapid diagnosis of Capnocytophaga canimorsus septic shock in an immunocompetent individual using real-time Nanopore sequencing: a case report. BMC Infect Dis 2019; 19:660. [PMID: 31340776 PMCID: PMC6657077 DOI: 10.1186/s12879-019-4173-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid diagnosis and appropriate treatment is imperative in bacterial sepsis due increasing risk of mortality with every hour without appropriate antibiotic therapy. Atypical infections with fastidious organisms may take more than 4 days to diagnose leading to calls for improved methods for rapidly diagnosing sepsis. Capnocytophaga canimorsus is a slow-growing, fastidious gram-negative bacillus which is a common commensal within the mouths of dogs, but rarely cause infections in humans. C. canimorsus sepsis risk factors include immunosuppression, alcoholism and elderly age. Here we report on the application of emerging nanopore sequencing methods to rapidly diagnose an atypical case of C. canimorsus septic shock. CASE PRESENTATION A 62 year-old female patient was admitted to an intensive care unit with septic shock and multi-organ failure six days after a reported dog bite. Blood cultures were unable to detect a pathogen after 3 days despite observed intracellular bacilli on blood smears. Real-time nanopore sequencing was subsequently employed on whole blood to detect Capnocytophaga canimorsus in 19 h. The patient was not immunocompromised and did not have any other known risk factors. Whole-genome sequencing of clinical sample and of the offending dog's oral swabs showed near-identical C. canimorsus genomes. The patient responded to antibiotic treatment and was discharged from hospital 31 days after admission. CONCLUSIONS Use of real-time nanopore sequencing reduced the time-to-diagnosis of Capnocytophaga canimorsus in this case from 6.25 days to 19 h. Capnocytophaga canimorsus should be considered in cases of suspected sepsis involving cat or dog contact, irrespective of the patient's known risk factors.
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Affiliation(s)
- Seweryn Bialasiewicz
- Centre for Children's Health Research, Children's Health Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia. .,Child Health Research Centre, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia.
| | - Tania P S Duarte
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4072, Australia
| | - Son H Nguyen
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4072, Australia
| | - Vichitra Sukumaran
- Infectious Diseases Unit Royal Brisbane and Women's Hospital, Level 6, Joyce Tweddell Building, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
| | - Alexandra Stewart
- Infectious Diseases Unit Royal Brisbane and Women's Hospital, Level 6, Joyce Tweddell Building, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
| | - Sally Appleton
- QML Pathology, PO Box 2280, Mansfield, QLD, 4122, Australia
| | - Miranda E Pitt
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4072, Australia
| | - Arnold Bainomugisa
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4072, Australia
| | - Amy V Jennison
- Forensic and Scientific Services, Queensland Department of Health, 39 Kessels Rd, Coopers Plains, QLD, 4108, Australia
| | - Rikki Graham
- Forensic and Scientific Services, Queensland Department of Health, 39 Kessels Rd, Coopers Plains, QLD, 4108, Australia
| | - Lachlan J M Coin
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4072, Australia
| | - Krispin Hajkowicz
- Infectious Diseases Unit Royal Brisbane and Women's Hospital, Level 6, Joyce Tweddell Building, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia.,School of Clinical Medicine, University of Queensland Level 6, Oral Health Centre, (883) 288 Herston Road, Herston, QLD, 4006, Australia
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Brinkler R, Edwards Z, Abid S, Oliver CM, Lo Q, Stewart A, Abayalingam M, Abid S, Afzal S, Aly H, Kasi Anandan T, Ariyanayagam R, Armstrong S, Ashiru G, Barrett S, Baytug B, Black R, Bowman S, Brayshaw S, Brinkler R, Brocklesby S, Cain J, Casey P, Chambers K, Chan C, Chapman R, Cheah C, Cheesman K, Cohen J, Cole A, Combeer A, Cowie V, Dabrowicz A, Desai N, Donovan C, Doraiswami M, El Amin O, Edwards Z, Ellimah T, Evans M, Fawcett E, Fletcher L, Forman E, Fulton L, Gardener K, George R, Gorur P, Gowripalann T, Greenslade T, Hamlyn L, Hawkins R, Herrmann R, Hilton J, Hutchinson J, Kelliher L, Kelly J, King K, Lim S, Mahinthan V, Mahmood N, Major J, Masood N, Matthews L, McHugh B, Milne S, Miltsios K, Monks D, Moores R, Nicklin A, Panesar N, Papageorgiou C, Patel R, Pathmabaskaran S, Perinpanayagam J, Peake M, Pritchard N, Powell K, Qureshi J, Redington K, Richards N, Rintoul E, Robson M, Routley C, Salota V, Samuel M, Sapsford M, Schwartz N, Sellers C, Shareiff I, Sharifi L, Shonfeld A, Stewart A, Story H, Sudunagunta S, Suppiah P, Tamilselvan P, Thompson H, Turner W, Uzkalniene V, Veglio E, Webb A, Waiting J, Wedgewood T, Westcott L, Wickham A, Wilson L, Wimble K, Wong R, Wong S, Wray S, Zafar S. A survey of antenatal and peripartum provision of information on analgesia and anaesthesia. Anaesthesia 2019; 74:1101-1111. [DOI: 10.1111/anae.14745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- R. Brinkler
- Department of Anaesthesia University College Hospital LondonUK
| | - Z. Edwards
- Department of Anaesthesia Queen Charlotte's and Chelsea Hospital London UK
| | - S. Abid
- Department of Anaesthesia Queen Charlotte's and Chelsea Hospital London UK
| | - C. M. Oliver
- Division of Surgery and Interventional Science University College London UK
| | - Q. Lo
- Department of Anaesthesia Queen Charlotte's and Chelsea Hospital London UK
| | - A. Stewart
- Department of Anaesthesia University College Hospital LondonUK
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Ghebrehewet S, Harries AD, Kliner M, Smith K, Cleary P, Wilkinson E, Stewart A. Adapting the Structured Operational Research Training Initiative (SORT IT) for high-income countries. Public Health Action 2019; 9:69-71. [PMID: 31417856 DOI: 10.5588/pha.18.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/20/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
SORT IT (Structured Operational Research Training InitiaTive) is a successful capacity building programme started 10 years ago to develop operational research skills in low- and middle-income countries. Public Health England (PHE) aims to embed a culture of research in front-line staff, and SORT IT has been adapted to train frontline health protection professionals at PHE North West (PHE NW) to collate, analyse and interpret routinely collected data for evidence-informed decision-making. Six participants from the PHE NW Health Protection team were selected to attend a two-module course in Liverpool, UK, in May and in November 2018. Five participants finished the course with completed papers on characteristics and burden of influenza-like illness in elderly care homes (two papers), use of dried blood spots for blood-borne virus screening in prisons, uptake of meningococcal ACWY (groups A, C, W-135 and Y) vaccine in schoolchildren and fires in waste management sites. The SORT IT course led to 1) new evidence being produced to inform health protection practice, and 2) agreement within PHE NW to continue SORT IT with two courses per year, and 3) showed how a research capacity building initiative for low- and middle-income countries that combines 'learning with doing' can be adapted and used in a high-income country.
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Affiliation(s)
- S Ghebrehewet
- Cheshire & Merseyside Health Protection Team, Public Health England, North West Centre, Liverpool, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Kliner
- Greater Manchester Health Protection Team, Public Health England, North West Centre, Manchester, UK
| | - K Smith
- Cheshire & Merseyside Health Protection Team, Public Health England, North West Centre, Liverpool, UK
| | - P Cleary
- Field Service, Public Health England, Liverpool, UK
| | - E Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - A Stewart
- College of Life and Environmental Science, University of Exeter, Exeter, UK
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Webb K, Prakash V, Kirresh O, Stewart A. A case of aortitis during cisplatin-based chemotherapy for cervical cancer. BJR Case Rep 2019; 5:20180054. [PMID: 31131127 PMCID: PMC6519499 DOI: 10.1259/bjrcr.20180054] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
A case of aortitis in a patient undergoing adjuvant cisplatin and topotecan
chemotherapy for cervical cancer following presentation with pyrexia of unknown
origin and raised inflammatory markers is presented. Although many chemotherapy
agents are known to cause small vessel vasculitis and there are several reported
cases of large vessel vasculitis following gemcitabine chemotherapy, there is
only one previously described case of aortitis following cisplatin
administration. This case is presented with corresponding CT and
18F-FDG PET-CT imaging with discussion of the literature regarding
vasculitis and chemotherapy.
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Affiliation(s)
- Katharine Webb
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Vineet Prakash
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Othman Kirresh
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
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Papachristodoulou G, Otter S, Franklin A, Stewart A, Evans P, Nisbet A, Cunningham M, Jones M. Clinical Evaluation of a Magnetic Tracking System for Cervical Brachytherapy Applicator Tracking. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Otter S, Franklin A, Evans P, Stewart A. EP-1479 The use of CT texture analysis in cervical cancer to predict response to chemoradiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sun Myint A, Stewart A, Mills J, Sripadam R, Whitmarsh K, Roy R, Franklin A, Dhadda A. Treatment: the role of contact X-ray brachytherapy (Papillon) in the management of early rectal cancer. Colorectal Dis 2019; 21 Suppl 1:45-52. [PMID: 30809905 DOI: 10.1111/codi.14507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- A Sun Myint
- Papillon Suite, Clatterbridge Cancer Centre, Bebington, Wirral, UK.,Translational Medicine Department, University of Liverpool, Liverpool, UK
| | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.,University of Surrey, Guildford, UK
| | - J Mills
- Nottingham University Hospital, Nottingham, UK
| | - R Sripadam
- Papillon Suite, Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - K Whitmarsh
- Papillon Suite, Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - R Roy
- Queen's Centre for Oncology and Haematology, Hull, UK
| | - A Franklin
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - A Dhadda
- Queen's Centre for Oncology and Haematology, Hull, UK
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van den Elsen LWJ, Tims S, Jones AM, Stewart A, Stahl B, Garssen J, Knol J, Forbes-Blom EE, Van't Land B. Prebiotic oligosaccharides in early life alter gut microbiome development in male mice while supporting influenza vaccination responses. Benef Microbes 2019; 10:279-291. [PMID: 30773928 DOI: 10.3920/bm2018.0098] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/17/2023]
Abstract
Beneficial modulation of the gut microbiota is an attractive therapeutic approach to improve the efficacy of vaccine-induced immunity. In this study, mice were supplemented with the prebiotic milk oligosaccharide 2'-fucosyllactose (2'FL) as well as a complex mixture of immune modulatory prebiotic short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS) from different stages in early life. Adult mice were vaccinated with trivalent influenza vaccine (TIV) and both development of the gut microbiota and antibody-mediated vaccine responses were followed over time. Within the control group, female mice demonstrated a larger antibody response to TIV vaccination than male mice, which was accompanied by enhanced cytokine production by splenocytes and a higher percentage of plasma cells in skin draining lymph nodes. In addition, the prebiotic diet improved vaccine-specific antibody responses in male mice. Introduction of prebiotics into the diet modulated the gut microbiota composition and at the genus level several bacterial groups showed a significant interaction effect which potentially contributed to the immunological effects observed. This study provides insight in the effect of scGOS/lcFOS/2'FL in influenza vaccination antibody production.
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Affiliation(s)
- L W J van den Elsen
- 1 Malaghan Institute of Medical Research, Gate 7 Victoria University, Kelburn Parade, Wellington 6012, New Zealand
| | - S Tims
- 1 Malaghan Institute of Medical Research, Gate 7 Victoria University, Kelburn Parade, Wellington 6012, New Zealand
| | - A M Jones
- 1 Malaghan Institute of Medical Research, Gate 7 Victoria University, Kelburn Parade, Wellington 6012, New Zealand
| | - A Stewart
- 1 Malaghan Institute of Medical Research, Gate 7 Victoria University, Kelburn Parade, Wellington 6012, New Zealand
| | - B Stahl
- 2 Danone Nutricia Research, Departments of Immunology/Microbiology/Human Milk Research, Uppsalalaan 12, 3584 CT Utrecht, the Netherlands
| | - J Garssen
- 2 Danone Nutricia Research, Departments of Immunology/Microbiology/Human Milk Research, Uppsalalaan 12, 3584 CT Utrecht, the Netherlands.,3 Utrecht University, Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmacology, Universiteitsweg 99, 3584 CG Utrecht, the Netherlands
| | - J Knol
- 2 Danone Nutricia Research, Departments of Immunology/Microbiology/Human Milk Research, Uppsalalaan 12, 3584 CT Utrecht, the Netherlands.,4 Wageningen University & Research, 6708 PB Wageningen, the Netherlands
| | - E E Forbes-Blom
- 1 Malaghan Institute of Medical Research, Gate 7 Victoria University, Kelburn Parade, Wellington 6012, New Zealand
| | - B Van't Land
- 2 Danone Nutricia Research, Departments of Immunology/Microbiology/Human Milk Research, Uppsalalaan 12, 3584 CT Utrecht, the Netherlands.,5 University Medical Center Utrecht, The Wilhelmina Children's Hospital, Laboratory of Translational Immunology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Otter S, Whitaker S, Chatterjee J, Stewart A. The Human Papillomavirus as a Common Pathogen in Oropharyngeal, Anal and Cervical Cancers. Clin Oncol (R Coll Radiol) 2019; 31:81-90. [DOI: 10.1016/j.clon.2018.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
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del Arroyo A, Sanchez J, Patel S, Phillips S, Reyes A, Cubillos C, Fernando R, David A, Sultan P, Ackland G, Reeve A, Sodha S, Ciechanowicz S, Olearo E, Dick J, Stewart A. Role of leucocyte caspase-1 activity in epidural-related maternal fever: a single-centre, observational, mechanistic cohort study. Br J Anaesth 2019; 122:92-102. [DOI: 10.1016/j.bja.2018.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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Johnson J, Stewart A, Anna N, Acree M, Flatt J, Max W, Gregorich S. A CHOIR INTERVENTION TO PROMOTE WELL-BEING AMONG DIVERSE OLDER ADULTS: THE COMMUNITY OF VOICES TRIAL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] Open
Affiliation(s)
- J Johnson
- University of California San Francisco
| | - A Stewart
- University of California San Francisco
| | - N Anna
- National Institute on Minority Health and Health Disparities
| | - M Acree
- University of California San Francisco
| | - J Flatt
- University of California-San Francisco
| | - W Max
- University of California San Francisco
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van Genderen E, Clabbers MTB, Das PP, Stewart A, Nederlof I, Barentsen KC, Portillo Q, Pannu NS, Nicolopoulos S, Gruene T, Abrahams JP. Ab initio structure determination of nanocrystals of organic pharmaceutical compounds by electron diffraction at room temperature using a Timepix quantum area direct electron detector. Corrigendum. Acta Crystallogr A Found Adv 2018; 74:709. [PMID: 30378582 PMCID: PMC6207913 DOI: 10.1107/s2053273318014079] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/10/2022]
Abstract
Corrections are made to Table 1 in the article by van Genderen et al. [Acta Cryst. (2016), A72, 236-242].
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Affiliation(s)
- E van Genderen
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - M T B Clabbers
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - P P Das
- Nanomegas SPRL, Boulevard Edmond Machtens 79, B 1080, Brussels, Belgium
| | - A Stewart
- Department of Physics and Energy, Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland
| | - I Nederlof
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - K C Barentsen
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Q Portillo
- Nanomegas SPRL, Boulevard Edmond Machtens 79, B 1080, Brussels, Belgium
| | - N S Pannu
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - S Nicolopoulos
- Nanomegas SPRL, Boulevard Edmond Machtens 79, B 1080, Brussels, Belgium
| | - T Gruene
- Biology and Chemistry, Laboratory of Biomolecular Research, Paul Scherrer Institute (PSI), 5232 Villigen, Switzerland
| | - J P Abrahams
- Biophysical Structural Chemistry, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
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