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Blackmur JP, Chew E, Trail M, Brodie K, Santoni N, Rodger F, Hamilton D, Gaba F, Randall S, Nalagatla S, Little B, Janjua K, Sweeney C, Martindale A, Qureshi K, Riddick A, O'Connor K, McNeill SA, Phipps S, Cutress ML, Mains EAA, Dunn I, Reid S, Stewart GD, Lamb G, Aslam MZ, Leung S, Clark R, Wilson I, Oades G, Chapman A, Laird A. Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium. World J Urol 2023; 41:757-765. [PMID: 36692533 PMCID: PMC10082697 DOI: 10.1007/s00345-023-04283-5] [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: 05/18/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Nephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC). METHODS Patients who underwent NU for UTUC across the SRCC 2012-2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan-Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS). RESULTS In 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan-Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS. CONCLUSION These data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.
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Affiliation(s)
- James Peter Blackmur
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
- Department of Urology, NHS Lothian, Edinburgh, UK.
| | - Etienne Chew
- Department of Urology, NHS Lothian, Edinburgh, UK
- College of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Flora Rodger
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | | | - Fortis Gaba
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sophie Randall
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
- College of Medicine, University of Glasgow, Glasgow, UK
| | | | - Brian Little
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | | | | | | | - Khaver Qureshi
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Antony Riddick
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin O'Connor
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Cork University Hospital, Cork, Republic of Ireland
| | | | - Simon Phipps
- Department of Urology, NHS Lothian, Edinburgh, UK
| | | | | | - Ian Dunn
- Department of Urology, NHS Lanarkshire, Airdrie, UK
| | - Sarah Reid
- Department of Urology, NHS Lanarkshire, Airdrie, UK
| | - Grant D Stewart
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Gavin Lamb
- Department of Urology, NHS Forth Valley, Larbert, UK
| | | | - Steve Leung
- Department of Urology, NHS Lothian, Edinburgh, UK
| | - Ross Clark
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | - Ian Wilson
- Department of Urology, NHS Highland, Inverness, UK
| | - Grenville Oades
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Alexander Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Urology, NHS Lothian, Edinburgh, UK
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Al-Hourani K, Pearce O, Bott A, Riddick A, Trompeter A, Kelly MB. Three-vessel view debridement of the open tibial fracture: a surgical technique. Eur J Orthop Surg Traumatol 2021; 32:1435-1441. [PMID: 34505912 DOI: 10.1007/s00590-021-03110-0] [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] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Adequate debridement of an open fracture is a key component of successful management. Despite having set debridement principles, there is no structured technique available in the literature to guide the surgeon in achieving this. We therefore present a technical note detailing the structured approach to the debridement of any open tibial fracture. Our unit has developed a novel stepwise technique termed locally as the "three-vessel view". Identifying all three primary vessels of the leg facilitates confirmation of inspection of all lower limb compartments thus minimising the risk of missed devitalised tissue or neglected areas of contamination and the potential for consequent disastrous outcomes as a result of inadequate exposure.
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Affiliation(s)
- K Al-Hourani
- Department of Trauma & Orthopaedic Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - O Pearce
- Department of Trauma & Orthopaedic Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
| | - A Bott
- Department of Trauma & Orthopaedic Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - A Riddick
- Department of Trauma & Orthopaedic Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - A Trompeter
- Department of Trauma & Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - M B Kelly
- Department of Trauma & Orthopaedic Surgery, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
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Stewart GD, Welsh SJ, Ursprung S, Gallagher F, Mendichovszky I, Riddick A, Eisen T, Leung S, Laird A, Malik J, Oades G, Venugopal B, Mumtaz F, Bex A, Boleti E, Hamid A, Riddle K, Welsh M, Hopcroft L, Jones RJ. NAXIVA: A phase II neoadjuvant study of axitinib for reducing extent of venous tumor thrombus in clear cell renal cell cancer (RCC) with venous invasion. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
275 Background: Venous tumor thrombus (VTT) extension occurs in 4-15% cases of renal cell cancer (RCC). The Mayo classification distinguishes 4 levels of VTT extension between the renal vein and supradiaphragmatic inferior vena cava (IVC). Although surgery is performed with curative intent, mortality is high (5-15%) with complications increasing with the level of the VTT. 5-year survival rates are poor; ~40-65% in non-metastatic RCC. It is hypothesised that neoadjuvant targeted therapy could downstage the VTT reducing the extent of surgery, leading to reduced surgical morbidity and mortality, and increased survival. However, level I or II evidence is lacking. NAXIVA provides the first level II evidence in this patient group, assessing the response of VTT to axitinib. Extensive translational sampling will provide in depth interrogation of VTT (using genomics, proteomics, immunophenotyping and metabolomics) to examine the role of the tumor microenvironment of VTT and response to axitinib. Methods: NAXIVA was a single arm, single agent, multi-center phase 2 feasibility study of axitinib in patients with both metastatic and non-metastatic clear cell RCC prior to nephrectomy and thrombectomy. A Simon two stage minimax design was adopted and the trial designed for adequate power to distinguish a <5% from a >25% improvement in the Mayo VTT level. 21 patients were recruited over a 24 month period between 15/Dec/2017 and 06/Jan/2020 at 5 sites across the UK. Patients were treated with 8 weeks of axitinib (starting dose 5mg bd, increasing to 10mg bd as tolerated) prior to planned surgery. The primary endpoint was the percentage of evaluable patients with an improvement in VTT according to the Mayo classification (assessed using MRI abdomen scans at screening and week 9, prior to surgery. Secondary endpoints were percentage change in surgical approach, percentage change in VTT height, response rate (by RECIST) and evaluation of surgical morbidity assessed by Clavien-Dindo classification. Results: The percentage of evaluable patients with an improvement in VTT according to the Mayo classification was 26.58% [80% CI: 15.76%, 39.74%] (6 of 21 evaluable patients). 35.29% (6 of 17 patients who progressed to surgery) had a change in surgical approach to a less invasive option. There was a median percentage reduction in VTT height of 21.49% (SD=27.60%). The response rate (by RECIST) in the evaluable population was 61.90% SD, 14.29% PR, 9.52% PD. In terms of surgical morbidity 11.76% (2 of 17 patients who progressed to surgery) experienced a Clavien-Dindo 3 or greater complication (0 CD3, 1 CD4, 1 CD5). Conclusions: NAXIVA provides unique prospective data on the feasibility of neoadjuvant axitinib administration to down stage IVC VTT and reduce the extent of surgery. Work is ongoing to establish predictors of response. Clinical trial information: NCT03494816 .
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Affiliation(s)
| | - Sarah J. Welsh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Iosif Mendichovszky
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antony Riddick
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Tim Eisen
- University of Cambridge, Cambridge, United Kingdom
| | - Steve Leung
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | | | | | - Faiz Mumtaz
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Axel Bex
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Abdel Hamid
- Broomfield Hospital, Chelmsford, United Kingdom
| | | | | | | | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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Al-Hourani K, Stoddart M, Khan U, Riddick A, Kelly M. Orthoplastic reconstruction of type IIIB open tibial fractures retaining debrided devitalized cortical segments: the Bristol experience 2014 to 2018. Bone Joint J 2019; 101-B:1002-1008. [PMID: 31362546 DOI: 10.1302/0301-620x.101b8.bjj-2018-1526.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/05/2022]
Abstract
AIMS Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures. PATIENT AND METHODS This was a consecutive cohort study of 113 patients, who had sustained type IIIB fractures of the tibia following blunt trauma, over a four-year period in a level 1 trauma centre. The median age was 44.3 years (interquartile range (IQR) 28.1 to 65.9) with a median follow-up of 1.7 years (IQR 1.2 to 2.1). There were 73 male patients and 40 female patients. The primary outcome measures were deep infection rate and number of operations. The secondary outcomes were nonunion and flap failure. RESULTS In all, 44 patients had ORDB as part of their reconstruction, with the remaining 69 not requiring it. Eight out of 113 patients (7.1%) developed a deep infection (ORDB 1/44, non-ORDB 7/69). The median number of operations was two. A total of 16/242 complication-related reoperations were undertaken (6.6%), with 2/16 (12.5%) occurring in the ORDB group. CONCLUSION In the setting of an effective orthoplastic approach to type IIIB open diaphyseal tibial fractures, using mechanically relevant debrided devitalized bone fragments in the definitive reconstruction appears to be safe. Cite this article: Bone Joint J 2019;101-B:1002-1008.
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Affiliation(s)
- K Al-Hourani
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, UK
| | - M Stoddart
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, UK
| | - U Khan
- Department of Plastic Surgery, Southmead Hospital, Bristol, UK
| | - A Riddick
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, UK
| | - M Kelly
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, UK
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Welsh S, Fife K, Matakidou A, Mullin J, Machin A, Qian W, Ingleson V, Dalchau KM, Whittaker P, Warren A, Priest AN, Zaccagna F, Barrett T, Gallagher FA, Riddick A, Armitage JN, Eisen TGQ. A phase II clinical study evaluating the efficacy and safety of neoadjuvant and adjuvant sunitinib in previously untreated patients with metastatic renal cell carcinoma (mRCC)(NeoSun). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e16087] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16087 Background: Sunitinib improves clinical outcomes in patients (pts) with mRCC. The single arm phase II NeoSun trial was designed to investigate its added value to nephrectomy, and to explore translational biological and imaging biomarkers. Methods: Pts with mRCC, scheduled for nephrectomy, no prior systemic therapy were recruited to receive 50mg OD sunitinib for 12 days, then post-surgery on a 4 week-on, 2 week-off, repeating 6 week cycle until disease progression. Diffusion-weighted, BOLD and dynamic contrast enhanced MR imaging (DW-MRI, DCE-MRI) and research blood sample collection were performed at baseline and end of 12 days. CT Imaging was performed at baseline, pre- and post-surgery, and then every 2 cycles. The primary endpoint was objective response rate (RECIST). Secondary endpoints included changes in diffusion DW-MRI, DCE- MRI of the tumour following 12 days suntinib, overall survival (OS), progression-free survival (PFS), response duration, surgical morbidity/mortality, and toxicity. Results: 14 pts received pre-surgery sunitinib, 71% (10/14) took the planned 12 doses. All 14 underwent total nephrectomy, and 13 recommenced sunitinib post-operatively. The mean number of post-surgery cycles was 11 (range 2 – 22). 58.3% (7/12) of pts achieved confirmed response (95% CI: 27.7 - 84.8%).91.7% (11/12) achieved objective clinical benefit (95% CI: 61.5 - 99.8%). Median OS is 33.7m and median PFS is 15.7m. Amongst those achieving PR/CR, median response duration is 8.7m. No unexpected surgical or sunitinib-related toxicities or complications were observed and the mean number of days from surgery to hospital discharge was 5.9 (range 3.0 – 17.0).There was a trend forOS to be better in pts with high baseline plasma VEGF-A (p = 0.06) or VEGF-C (p = 0.02) expression. A larger % tumour volume reduction after 12 days treatment is correlated with a smaller baseline % necrosis (coefficient = -0.51, p = 0.03). Conclusions: Sunitinib is effective and safe when given before and after nephrectomy to previously untreated pts with mRCC. Neoadjuvant studies such as NeoSun can safely explore translational biological and imaging endpoints. Clinical trial information: 2005-004502-82.
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Affiliation(s)
- Sarah Welsh
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Kate Fife
- NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | | | - Jean Mullin
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Andrea Machin
- Cambridge Cancer Trials Centre, Cambridge, United Kingdom
| | - Wendi Qian
- Cambridge Cancer Trials Centre, Cambridge, United Kingdom
| | | | | | | | - Anne Warren
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Andrew N Priest
- NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Fulvio Zaccagna
- University of Cambridge, Department of Radiology, Cambridge, United Kingdom
| | - Tristan Barrett
- University of Cambridge, Department of Radiology, Cambridge, United Kingdom
| | | | - Antony Riddick
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
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Rossi SH, Koo B, Riddick A, Shah N, Stewart GD. Different Successful Management Strategies for Obstructing Renal Parapelvic Cysts. Urol Int 2017; 101:366-368. [DOI: 10.1159/000475886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022]
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Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A. A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study. Eur Urol 2016; 69:94-102. [DOI: 10.1016/j.eururo.2015.07.054] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
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Laird A, Sproul D, Stewart G, O'Mahony F, Riddick A, Meehan R, Harrison D. PD33-06 A RETROSPECTIVE COHORT STUDY OF RENAL CANCER MOLECULAR HETEROGENEITY AND DNA METHYLATION PROGNOSTIC MARKERS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2104] [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: 11/17/2022]
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Thomas JA, Tubaro A, Barber N, d' Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink J, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi N, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Bachmann A. PD5-10 TRANSURETHRAL RESECTION OF THE PROSTATE (GL-XPS OR TURP) DOES NOT RESULT IN SIGNIFICANT IMPAIRMENT OF ERECTILE FUNCTION. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.309] [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: 10/23/2022]
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Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA. A European Multicenter Randomized Noninferiority Trial Comparing 180 W GreenLight XPS Laser Vaporization and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 12-Month Results of the GOLIATH Study. J Urol 2015; 193:570-8. [DOI: 10.1016/j.juro.2014.09.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Alexander Bachmann
- Department of Urology Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Frimley, Camberley
| | - Frank d’Ancona
- Department of Urology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gordon Muir
- Department of Urology, King’s College Hospital and King’s Health Partners, London
| | - Ulrich Witzsch
- Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Joan Benejam
- Department of Urology, Hospital de Manacor, Manacor, Spain
| | | | - Antony Riddick
- Department of Urology, Lothian University Hospitals Division, Western General Hospital, Edinburgh
| | - Sascha Pahernik
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Herman Roelink
- Department of Urology, Ziekenhuis Groep Twente, Almelo/Hengelo, The Netherlands
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares Gent, Gent, Belgium
| | - Christian Saussine
- Department of Urology, Nouvel Hopital Civil de Strasbourg, Strasbourg University, Strasbourg, France
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, Loire Valley and Université François Rabelais de Tours, PRES Centre- Val de Loire Université, Val de Loire, France
| | - Wolfgang Loidl
- Department of Urology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | - Tim Larner
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - Nirjan-Kumar Gogoi
- Department of Urology, Mid Yorkshire NHS Trust, Dewsbury & District Hospital, Dewsbury
| | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Hampshire
| | - Rolf Muschter
- Department of Urology, Diakoniekrankenhaus Rotenburg, Rotenburg, Germany
| | - Andrew Thorpe
- Department of Urology, Freeman Hospital Newcastle, Newcastle upon Tyne
| | - Nitin Shrotri
- Department of Urology, Kent and Canterbury Hospital, Kent
| | - Stuart Graham
- Department of Urology, Whipps Cross University Hospital, London
| | - Moritz Hamann
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Martin Schostak
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - Carlos Capitán
- Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - Helmut Knispel
- Department of Urology, Uro-Forschungs GmbH im St. Hedwig Krankenhaus, Berlin, Germany
| | - J. Andrew Thomas
- Department of Urology, ABMU LHB, Princess of Wales Hospital, Bridgend, Wales
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Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Pahernik S, Riddick A, Roelink J, Ameye F, Thomas A. MP71-16 PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING GREENLIGHT (GL) 180-W XPS PVP AND TRANSURETHRAL RESECTION OF THE PROSTATE (THE GOLIATH STUDY): ONE YEAR FOLLOW-UP BY PROSTATE SIZE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stewart G, Laird A, O'Mahony F, Eory L, Lubbock A, Nanda J, O'Donnell M, Mackay A, Mullen P, McNeill A, Riddick A, Aitchison M, Berney D, Bex A, Overton I, Harrison DJ, Powles T. The effect of sunitinib on biomarkers and tumor heterogeneity in metastatic clear cell renal cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
408 Background: The purpose of this work was to investigate the effect of sunitinib on tumour biomarkers and assess intratumoural heterogeneity in metastatic clear cell renal cancer (mRCC). Primary tumours and metastatic sites were examined. Methods: Multiple fresh frozen tissue samples (median=4) were taken from sunitinib naive (n=23) and sunitinib treated (18 weeks at sunitinib 50mg) patients (n=27) with mRCC. Tissue was taken from the primary renal tumours. Multiple analysis of DNA (aCGH), mRNA (Illumina Beadarray) and protein lysates (reverse phase protein array) were performed on each tumour sample. Analysis of metastatic tissue occurred where possible (n=4). A cohort of matched untreated and sunitinib/pazopanib treated paraffin embedded mRCC samples from 3 clinical trials was used for validation with automated quantitative analysis. Results: Treated and untreated patient had similar patient characteristics. Significant intratumoural heterogeneity in DNA, RNA and protein occurred. Sunitinib was associated with increased intratumoural heterogeneity in protein expression (p<0.05), but not DNA or RNA. Despite this heterogeneity, significant changes to protein expression with sunitinib occurred. Four proteins changed significantly in terms of both expression and variance with sunitinib (BCL2, MLH1, CAIX and mTOR; p<0.05 for each). Elevation of CAIX expression in sunitinib treated patients was confirmed in the validation cohort (p=0.01). Low levels of CAIX correlated with poor outcome in treated samples (HR=0.26, 95% CI: 0.11-0.61, p=0.001). A positive correlation between protein expression in the primary tumour and metastatic sites occurred. Individual metastasis within patients exhibited a variable radiological response to therapy, which was equally marked in the genetically more homogeneous primary tumours. Conclusions: Intratumoural heterogeneity occurs on many levels in mRCC. Sunitinib is associated with increase in protein heterogeneity. Despite this, upregulation of CAIX is a potential prognostic biomarker.
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Affiliation(s)
| | | | | | - Lel Eory
- Roslin Institute, Edinburgh, United Kingdom
| | | | - Jyoti Nanda
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - Alan Mackay
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Peter Mullen
- University of St. Andrews, St. Andrews, United Kingdom
| | - Alan McNeill
- University of Edinburgh, Edinburgh, United Kingdom
| | - Antony Riddick
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | | | - Axel Bex
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ian Overton
- MRC Human Genetics Unit, Edinburgh, United Kingdom
| | | | - Tom Powles
- Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Stewart GD, O'Mahony F, Eory L, Nanda J, Laird A, O'Donnell M, Mullen P, Riddick A, McNeill A, Aitchison M, Berney D, Peters J, Rockall A, Sahdev A, Bex A, Faratian D, Chowdhury S, Harrison D, Overton I, Powles T. Proteomic analysis of pre- and post-sunitinib treated renal cancer tissue to assess tumor heterogeneity and differential protein expression. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
388 Background: To investigate acquired resistance of clear cell renal cell cancer (ccRCC) patients to sunitinib and develop personalised treatment strategies, sequential tissue after a specific period of targeted therapy is required. This approach has proven successful with targeted therapy in chronic myeloid leukaemia; however, we are concerned that extensive tumour heterogeneity occurs in ccRCC. In this study we evaluated heterogeneity and differential protein expression in sunitinib treated and untreated ccRCC samples using high-throughput proteomics. Methods: Fresh frozen tissue was obtained from 27 sunitinib naïve ccRCC specimens and 27 nephrectomy samples from patients treated with neoadjuvant sunitinib (18 weeks) as part of the SuMR trial. From each tumour frozen sections were performed and up to 5 protein lysates obtained from each morphologically differing region of each tumour as well as matched normal kidney. Reverse phase protein arrays (RPPA) were performed to assess the levels of multiple proteins relevant to ccRCC pathogenesis and sunitinib activity. Appropriate statistical tests were used to examine protein heterogeneity and differential expression, including false discovery rate (FDR) correction. Kaplan-Meier method was used to correlate changes in protein expression with outcome. Results: Expression of 20 proteins has been examined to date. The range of expression in tumours normalised by matched normal renal tissue had >2-fold differences in untreated (n=8 proteins) and treated samples (n=4 proteins). Four markers displayed significantly increased inter-tumoural variance in sunitinib treated tumours compared with untreated tissue (e.g. VEGFR1, FDR P<0.05). Despite this heterogeneity, sunitinib was associated with significant expression changes for several key proteins (e.g. VEGFR2, CyclinD2; FDR P<0.05). Conclusions: Protein expression in ccRCC is heterogenous and key proteins showed significantly increased variance of expression with sunitinib therapy. Despite heterogeneity, significant changes in protein expression can be identified with sunitinib treatment and have been correlated with outcome.
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Affiliation(s)
- Grant Duncan Stewart
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fiach O'Mahony
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lel Eory
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jyoti Nanda
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alexander Laird
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Marie O'Donnell
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Mullen
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antony Riddick
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alan McNeill
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Aitchison
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dan Berney
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Peters
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrea Rockall
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anju Sahdev
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Axel Bex
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dana Faratian
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Chowdhury
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Harrison
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ian Overton
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas Powles
- University of Edinburgh, Edinburgh, United Kingdom; MRC Human Genetics Unit, Edinburgh, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Department of Histopathology, St. Bartholomew's Hospital, London, United Kingdom; Whipps Cross Hospital, London, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; The Netherlands Cancer Institute, Amsterdam, Netherlands; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Stewart G, Humphries K, Cutress M, Riddick A, McNeill A, Tolley D. 665 LONG TERM COMPARATIVE OUTCOMES OF OPEN VERSUS LAPAROSCOPIC NEPHROURETERECTOMY FOR UPPER TRACT TRANSITIONAL CELL CARCINOMA AFTER A MEDIAN FOLLOW-UP OF 12 YEARS. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1595] [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: 11/17/2022]
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Henke A, Brigid O, Katz E, Stewart G, Riddick A, Thomson A. 501 Analysis of the contractility of prostatic cancer-associated fibroblasts in a 3D collagen gel contraction assay. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71302-1] [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: 10/19/2022] Open
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Ong E, Gregor N, Hanley J, Graham C, McNeill A, Riddick A. UP-3.079: An Efficient Way of Trial without Catheter Following an Episode of Acute Urinary Retention. Urology 2009. [DOI: 10.1016/j.urology.2009.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Riddick A. Testicular lumps in general practice. Practitioner 1998; 242:627-30. [PMID: 10534878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- A Riddick
- Department of Urology, Edith Cavell Hospital, Peterborough Hospitals NHS Trust, Cambs
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Abstract
The effectiveness of volunteers was examined in a sample of 98 volunteer workers at a community hospital in central North Carolina. The volunteers were asked to provide demographic information about themselves and to respond to a 20-item questionnaire designed to assess their motives for volunteering. Their effectiveness was also evaluated by a hospital administrator who was familiar with the quality of their work. The older volunteers were rated as more effective than the younger volunteers, and the women were rated as more effective than the men.
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Affiliation(s)
- R L Zweigenhaft
- Department of Psychology, Guilford College, Greensboro, NC 27410, USA
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