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So S, Lau A. Healing and humanitarianism: an interview with Dr Wing-yan Kwong. Hong Kong Med J 2024; 30:188-190. [PMID: 38651207 DOI: 10.12809/hkmj-hc202404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- S So
- Year 4 MB, ChB, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A Lau
- Year 1 MB, ChB, The Chinese University of Hong Kong, Hong Kong SAR, China
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Long R, Heffernan C, Lau A. Emphasis on post-TB lung disease and other sequelae of TB is good but a public health approach to TB is morally ambitious??? Int J Tuberc Lung Dis 2024; 28:70-72. [PMID: 38303042 DOI: 10.5588/ijtld.23.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
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Weiss Y, Mutsaers A, Chin L, Pang G, Bayley A, Poon I, Lau A, Karam I. Heatmaps to Assess Tumor Motion Probability with MRcine in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S48. [PMID: 37784510 DOI: 10.1016/j.ijrobp.2023.06.328] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intrafraction motion affects tumor position during radiation for head and neck cancers (HNC) and can be assessed using magnetic resonance cine (MR-cine). Heatmaps - visual representation of patient specific temporal tumor location akin to internal target volume (ITV) - were analyzed to demonstrate the variation of population-based motion margins in primary oropharyngeal (OP) and laryngeal/hypopharyngeal (LH) sites with the goal to provide insights towards personalized margins. MATERIALS/METHODS MR-cine were performed for LH and OP HNC patients as part of simulation protocol. Images (900-1500 slices) were acquired across 3-5 minutes per patient. Gross target volumes were propagated on T1 contrast sagittal sequence using deformable image registration then adjusted manually. Tumor locations were integrated across all frames and displayed as heatmaps representing location probability. To determine individualized motion, a baseline contour representing average tumor rest position was expanded both isotropically and directionally in 1 mm increments in a novel analysis to define the contribution of each increment on target coverage. To assess directional dependence, displacements from rest position were evaluated in 4 planes from centroid: (A) 12 o'clock (OC) to 6OC (capturing volumetric shift in a portion of superior, posterior and inferior directions), B) 3OC-9OC, C) 6OC-12OC, D) 9OC-3OC. Histograms demonstrating the proportion of scan time the tumor was within expansions were generated, with expansion margins for 25%-95% coverage analyzed by patient. Wilcoxon-rank-sum test was performed to compare motion by site. RESULTS Motion was evaluated in 66 patients (LH n = 27, OP n = 39). In LH, a median (med) isometric expansion of 8.5mm to achieve 95% target was required, with large variations observed for minimum (min): 2.8mm and maximum (max):23.5mm. Smaller differences were observed for OP with med of 5.3mm, (min:1.9mm, max:14.6mm). At 75%, 50% and 25% coverage, expansions for LH (med: 4.8 min: 1.9 max: 17.3; med: 3.8 min: 1.2 max: 12.9; med: 3.3, min: 0.6, max: 9.3) were not significantly different than OP (med: 3.8, min: 1.7, max: 10.9; med: 3.1 min: 1.3, max: 9.4; med: 2.1, min: 0.7, max: 8.4), suggesting larger but infrequent shifts in LH. Directional tumor displacement varied widely (Table 1), and by site and points describing the need for personalized margins. CONCLUSION Current literature as well as the analysis in this study indicate a wide range of motion - both in magnitude and duty cycle - between and within HN sub-sites not captured on CT simulation. Moving forward, motion based heatmaps based on MR-cine may serve as visualization tool for ITV contouring or to generate personalized motion margins.
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Affiliation(s)
- Y Weiss
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Pang
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Bayley
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Lau
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - I Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ong WL, Stewart J, Sahgal A, Soliman H, Tseng CL, Detsky J, Ho L, Das S, Maralani P, Lipsman N, Stanisz G, Perry J, Chen H, Atenafu E, Lau A, Ruschin ME, Myrehaug SD. Predictors of Tumor Dynamics during a 6-Week Course of Chemoradiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e142. [PMID: 37784716 DOI: 10.1016/j.ijrobp.2023.06.953] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Our prior imaging studies have shown geometrically meaningful inter-fraction tumor dynamics specific to glioblastoma (GBM). We aim to identify predictors associated with tumor dynamics during a 6-week course of concurrent chemoradiotherapy (CRT) for GBM. MATERIALS/METHODS Patients enrolled in a prospective serial magnetic resonance imaging (MRI) study were reviewed. All patients were treated with 54-60 Gy in 30 fractions. The gross tumor volume (GTV) included the surgical cavity and T1c enhanced residual tumor; clinical tumor volume (CTV) included GTV with a 15mm isotropic expansion, respecting anatomical boundaries; planning target volume (PTV) was 4mm expansion. MRIs were obtained at RT planning (F0), fraction 10 (F10), and fraction 20 (F20). Tumor dynamic metrics (relative to F0) assessed included the GTV volume (Vrel), Hausdorff distance (dH) and migration distance (dM). dH is the average distance between two datasets in metric space. dM is the maximum linear displacement of the GTV in any direction. Factors to be determined associated with tumor dynamics included: age, sex, corpus callosum (CC) involvement, extent of surgery (gross total resection (GTR), subtotal resection (STR) or biopsy alone (Bx)), MGMT methylation and IDH mutation status. RESULTS A total of 129 patients were reviewed. Median GTV was 20.9cc at F0, 17.6cc at F10 (Vrel 0.85), and 16.1cc at F20 (Vrel 0.78). Patients without CC involvement had more marked GTV volume reduction: Vrel 0.82 vs 1.02 with CC involvement at F10 (P = 0.05), and Vrel 0.77 vs 0.88 with CC involvement at F20 (P = 0.03). Patients with GTR (vs STR vs Bx) had more marked GTV volume reduction across all time points: Vrel 0.78, 0.85 and 1.07 respectively at F10 (P = 0.001), and Vrel 0.69, 0.80, 1.04 respectively at F20 (P = 0.001). The median dH was 8.1mm at F10 and 9.2mm at F20. Patients with CC involvement (vs without CC involvement) had a larger dH: 54% vs 25% had dH>10mm respectively at F10 (P = 0.03), and 73% vs 28% had dH>10mm respectively at F20 (P<0.005). Patients with a GTR had smaller dH at both F10 (P = 0.02) and F20 (P = 0.006). At F20, 20%, 47% and 37% of patients with GTR, STR and Bx had dH>10mm (P = 0.04). The median dM were 4.7mm at F10 and 4.7mm at F20. Patients with CC involvement (vs without CC involvement) had larger dM: 41% vs 12% had dM >10mm respectively at F10 (P = 0.01), and 45% vs 9% had dM >10mm respectively at F20 (P<0.001). Patients with GTR had smaller dM at F10 (P = 0.03) and F20 (P0.002). At F20, 0%, 25% and 19% of patients with GTR, STR and Bx had dM>10mm (P = 0.002). Age, sex, MGMT methylation and IDH mutation status were not associated with Vrel, dH and dM at F10 and F20. CONCLUSION We identified CC involvement and extent of surgery to be associated with tumor dynamics at F10 and F20 over the course of CRT for GBM. This offers opportunities to better select patients who may benefit from earlier/ more frequent RT replan/ adaptation to ensure adequate tumor coverage, or to reduce RT toxicities.
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Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - J Stewart
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Ho
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - G Stanisz
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - J Perry
- Department of Neurooncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - A Lau
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Lebbe C, Long G, Robert C, Hamid O, Atkinson V, Shoushtari A, Daud A, Bechter O, Schadendorf D, Sullivan R, Dummer R, Grob J, Lewis N, Fan L, Basu S, Caponigro G, Cooke V, Lau A, Amaria R. LBA40 Phase II study of multiple LXH254 drug combinations in patients (pts) with unresectable/metastatic, BRAF V600- or NRAS-mutant melanoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.038] [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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Lau A, Aseem R, Shrestha A. 175 Rare Complications and Management of Port Site Hernias (PSH) Following Robotic-Assisted Radical Prostatectomy (RARP). Br J Surg 2022. [DOI: 10.1093/bjs/znac269.373] [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: 11/05/2022]
Abstract
Abstract
Robot-assisted surgery has become increasingly prevalent in surgical practice and is very commonly performed in urological cancers especially of the prostate gland. Robotic surgical techniques are safe and reproducible; however, they have their associated complications. Risk factors such as the nature of cancer, learning curve of the surgery, experience of the surgeon and patient characteristics have been implicated for potential complications. Complications can range from bleeding, infection, bowel injury, ureteric and nerve damage. Port site hernias (PSH) are an infrequent complication with a reported incidence varying from 0.2–4.8%. Although uncommon, they can result in high morbidity due to bowel incarceration and strangulation.
We report two cases of PSH from our large district general hospital, both at the supraumbilical port site after robotic assisted radical prostatectomy (RARP). The first case presented with complete evisceration and strangulation of a segment of small bowel and the second with bowel incarceration and small bowel obstruction. Our cases highlight potentially rare but severe complications of RARP that should be promptly recognised and urgently treated to prevent significant patient morbidity and mortality.
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Affiliation(s)
- A Lau
- William Harvey Hospital , Ashford , United Kingdom
| | - R Aseem
- William Harvey Hospital , Ashford , United Kingdom
- East Kent Hospitals University NHS Foundation Trust , Kent , United Kingdom
| | - A Shrestha
- William Harvey Hospital , Ashford , United Kingdom
- East Kent Hospitals University NHS Foundation Trust , Ashford , United Kingdom
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Lau A, Figueredo C, Vu C, Goldman R. Abstract No. 279 Serial transthoracic echocardiography for clinical assessment of submassive pulmonary embolism. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lewis J, Lau B, Pitney M, Borrie A, Lee L, Lau A. Blunt Chest Trauma (BCT): An Uncommon Association With Anterior STEMI in Patients With Pre-Existing Bulky LAD Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.565] [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: 11/17/2022]
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Cher BAY, Wilson EA, Pinsky AM, Townshend RF, Wolski AV, Broderick M, Milen AM, Lau A, Singh A, Cinti SK, Engelke CG, Saha AK. Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study. J Med Internet Res 2021; 23:e28105. [PMID: 34559669 PMCID: PMC8562418 DOI: 10.2196/28105] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022] Open
Abstract
Background During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases.
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Affiliation(s)
- Benjamin A Y Cher
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Eric A Wilson
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Alexa M Pinsky
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ryan F Townshend
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ann V Wolski
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael Broderick
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Allison M Milen
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Audrey Lau
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amrit Singh
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sandro K Cinti
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Carl G Engelke
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Anjan K Saha
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, United States
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Tseng C, Chen H, Stewart J, Lau A, Chan R, Lawrence L, Campbell M, Myrehaug S, Soliman H, Husain Z, Detsky J, Maralani P, Keller B, Ruschin M, Sahgal A. Glioma Radiation Therapy on a High Field 1.5 MR-Linac: Workflow and Initial Experience. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1608] [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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Lau A, Ferrara G. Disseminated TB: still being missed and misunderstood. Int J Tuberc Lung Dis 2021; 25:255-257. [PMID: 33762067 DOI: 10.5588/ijtld.21.0037] [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: 11/10/2022] Open
Affiliation(s)
- A Lau
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - G Ferrara
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Geraghty B, Dasgupta A, Sandhu M, Malik N, Maralani P, Detsky J, Lau A, Czarnota G, Sahgal A. Quantitative Mapping of the Peritumoral Region to Demarcate Areas of Tumor Infiltration from Vasogenic Edema in Radiation Planning MRI of Glioblastoma Multiform (GBM). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bao K, Cheung K, Chow JH, Leung C, Tsui W, Lau A, Tse T, Wan S, Kwok M, Wong K. 1709P Cancer patients' perspectives on the real-world impact of COVID-19 pandemic: A multidisciplinary survey. Ann Oncol 2020. [PMCID: PMC7506366 DOI: 10.1016/j.annonc.2020.08.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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McKee H, Ioannidis G, Lau A, Treleaven D, Gangji A, Ribic C, Wong-Pack M, Papaioannou A, Adachi JD. Correction to: Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients. Osteoporos Int 2020; 31:981. [PMID: 32189031 DOI: 10.1007/s00198-020-05381-5] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The original version of this article, published on 03 January 2020 contained a mistake. An author's name was misspelled.
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Affiliation(s)
- H McKee
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
| | - G Ioannidis
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Lau
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - D Treleaven
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Gangji
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - C Ribic
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - M Wong-Pack
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Papaioannou
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - J D Adachi
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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McKee H, Ioannidis G, Lau A, Treleaven D, Gangji A, Ribic C, Wong-Pack M, Papaioannou A, Adachi JD. Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients. Osteoporos Int 2020; 31:973-980. [PMID: 31900542 DOI: 10.1007/s00198-019-05267-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/15/2019] [Indexed: 12/29/2022]
Abstract
UNLABELLED A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; at years 1, 2, and 3; and at final follow-up (average of 3.4 years). Both bisphosphonate and denosumab treatments increased lumbar spine bone density; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Denosumab treatment increased femoral neck BMD, whereas bisphosphonate treatment had a mean decrease in femoral neck BMD at final follow-up. Thus, our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant. INTRODUCTION To compare the clinical effectiveness and safety between the use of denosumab and bisphosphonates on bone density and incidence of adverse events in renal transplant patients. METHODS A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; years 1, 2, and 3; and at final follow-up (average of 3.4 years). RESULTS Absolute change in lumbar spine and femoral neck BMD over the treatment period was 0.029 ± 0.075 g/cm2 and - 0.003 ± 0.064 g/cm2, respectively, in the bisphosphonate group. Absolute change in lumbar spine and femoral neck BMD at final follow-up was 0.072 ± 0.094 g/cm2 and 0.025 ± 0.063 g/cm2, respectively, in the denosumab group. Denosumab resulted in significantly greater increases in lumbar spine BMD (0.045 g/cm2 greater in the denosumab group). Similarly, the absolute change in BMD at the femoral neck was 0.022 g/cm2 greater in the denosumab group as compared with the bisphosphonate group. The denosumab group had one event of severe hypocalcemia following first injection and one report of hospitalized pneumonia. No serious adverse events were reported in the bisphosphonate group. CONCLUSIONS Both treatments increased lumbar spine BMD; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant.
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Affiliation(s)
- H McKee
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
| | - G Ioannidis
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Lau
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - D Treleaven
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Gangji
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - C Ribic
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - M Wong-Pack
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Papaioannou
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - J D Adachi
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Lampertico P, Buti M, Fung S, Ahn SH, Chuang WL, Tak WY, Ramji A, Chen CY, Tam E, Bae H, Ma X, Flaherty JF, Gaggar A, Lau A, Liu Y, Wu G, Suri V, Tan SK, Subramanian GM, Trinh H, Yoon SK, Agarwal K, Lim YS, Chan HLY. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patients with chronic hepatitis B: a randomised, double-blind, phase 3, multicentre non-inferiority study. Lancet Gastroenterol Hepatol 2020; 5:441-453. [PMID: 32087795 DOI: 10.1016/s2468-1253(19)30421-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 08/09/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment with tenofovir disoproxil fumarate has been associated with renal toxicity or reductions in bone mineral density, or both, in some patients with chronic hepatitis B virus (HBV) infection. Tenofovir alafenamide is a tenofovir prodrug with high intrahepatic concentrations of active drug and reduced systemic tenofovir exposures compared with tenofovir disoproxil fumarate. In patients with chronic HBV, tenofovir alafenamide has shown efficacy non-inferior to that of tenofovir disoproxil fumarate with improved renal and bone safety. With this non-inferiority study, we aimed to evaluate the efficacy and safety of tenofovir alafenamide in patients with HBV infection switching from tenofovir disoproxil fumarate who are virally suppressed. METHODS Patients with chronic HBV infection who had been receiving tenofovir disoproxil fumarate for 48 weeks or more and who had HBV DNA less than the lower limit of quantification (LLOQ) for at least 12 weeks were recruited to this randomised, multicentre, double-blind, phase 3 non-inferiority study. Patients were randomly assigned in a 1:1 ratio to receive tenofovir alafenamide 25 mg once a day or to continue tenofovir disoproxil fumarate 300 mg once a day. The primary efficacy endpoint was loss of virological control, defined as the proportion of patients who received at least one dose of study drug who had HBV DNA of at least 20 IU/mL at week 48 by the modified US Food and Drug Administration (FDA) snapshot algorithm. Key safety endpoints were changes in hip and spine bone mineral density, estimated creatinine clearance by Cockcroft-Gault, and markers of bone turnover and renal tubular function. The study was powered for non-inferiority in efficacy of tenofovir alafenamide versus tenofovir disoproxil fumarate with a 4% margin. Investigators and patients were unaware of treatment allocation and on-treatment results. This trial is ongoing and is registered with ClinicalTrials.gov, number NCT02979613. FINDINGS Participants in this study were enrolled between Dec 29, 2016, and Oct 20, 2017. 541 patients were screened and 490 patients were randomly assigned to switch to tenofovir alafenamide or to stay on tenofovir disoproxil fumarate. Two patients assigned to receive tenofovir alafenamide did not receive treatment; thus the full analysis set for efficacy and safety analyses consisted of 243 patients in the tenofovir alafenamide group and 245 in the tenofovir disoproxil fumarate group. At week 48, one patient from each treatment group (both <1%) had HBV DNA of at least 20 IU/mL (difference in proportion 0·0%, 95% CI -1·9 to 2·0), thereby showing non-inferior efficacy of tenofovir alafenamide to tenofovir disoproxil fumarate. Patients who received tenofovir alafenamide had significantly increased bone mineral density at hip (mean change 0·66% [SD 2·08] vs -0·51% [SD 1·91]; difference in least square means 1·17% [95% CI 0·80 to 1·54; p<0·0001]) and at spine (mean change 1·74% [3·46] vs -0·11% [3·13]; difference in least square means 1·85% [1·24 to 2·46; p<0·0001]), creatinine clearance by Cockcroft-Gault relative to tenofovir disoproxil fumarate (median change 0·94 mL/min [IQR -4·47 to 6·24] vs -2·74 mL/min [-7·89 to 1·88]; p <0·0001), and improved markers of bone turnover and tubular function at week 48. The most common treatment-emergent adverse events were upper respiratory tract infection (18 [7%] of 243 patients in the tenofovir alafenamide group and 16 [7%] of 245 patients in the tenofovir disoproxil fumarate group) and nasopharyngitis (13 [5%] of 243 patients in the tenofovir alafenamide group and 12 [5%] of 245 patients in the tenofovir disoproxil fumarate group). The incidence of grade 3 and above adverse events and serious adverse events was low and similar between groups. No viral resistance was observed in patients who qualified for viral sequencing. INTERPRETATION These findings suggest that tenofovir alafenamide can be substituted for tenofovir disoproxil fumarate in patients with HBV infection for improved safety without a loss of efficacy. FUNDING Gilead Sciences.
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Affiliation(s)
- Pietro Lampertico
- CRC "A M and A Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda Ospedale, Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Maria Buti
- Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Scott Fung
- Toronto General Hospital, Toronto, Ontario, Canada
| | - Sang Hoon Ahn
- Yongsei University, Severance Hospital, Seoul, South Korea
| | - Wan-Long Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Won Young Tak
- School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Alnoor Ramji
- Gastrointestinal Research Institute, Vancouver, British Columbia, Canada
| | - Chi-Yi Chen
- Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Edward Tam
- LAIR Centre, Vancouver, British Columbia, Canada
| | - Ho Bae
- Asian Pacific Liver Center, Los Angeles, CA, USA
| | - Xiaoli Ma
- Hahnemann University Hospital, Philadelphia, PA, USA
| | | | | | | | - Yang Liu
- Gilead Sciences, Foster City, CA, USA
| | - George Wu
- Gilead Sciences, Foster City, CA, USA
| | | | | | | | - Huy Trinh
- Silicon Valley Research Institute, San Jose, CA, USA
| | | | | | - Young-Suk Lim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Shehu E, Roggendorf S, Golla A, Hübner G, Stangl G, Lau A, Diestelhorst A, Vordermark D, Steckelberg A, Schmidt H. DEVELOPMENT OF A COMPLEX SUPPORTIVE INTERVENTION TO PROMOTE PHYSICAL FUNCTIONING OF OLDER CANCER PATIENTS, CONSIDERING INDIVIDUAL PLASTICITY (SIDEKICK). J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Perdrizet K, Stockley T, Law J, Shabir M, Zhang T, Le L, Lau A, Tsao M, Kamel-Reid S, Pal P, Cabanero M, Schwock J, Ko H, Liu G, Bradbury P, Sacher A, Shepherd F, Leighl N. P1.01-30 Non-Small Cell Lung Cancer (NSCLC) Next Generation Sequencing (NGS): Integrating Genomic Sequencing into a Publicly Funded Health Care Model. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.745] [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: 10/25/2022]
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Stewart J, Myrehaug S, Lee Y, Tseng C, Soliman H, Xie J, Campbell M, Lau A, Sahgal A, Ruschin M. Machine Learning-Based Tumor Contour Propagation for MRI Adaptive Radiotherapy of Gliobastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.747] [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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20
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Weiss Y, Chin L, Lau A, Husain Z, Higgins K, Enepekides D, Eskander A, Ho L, Poon I, Karam I. Cine MRI-based Analysis of Intrafractional Motion in Radiation Treatment Planning of Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.378] [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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21
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Stewart J, Myrehaug S, Lee Y, Tseng C, Soliman H, Xie J, Campbell M, Lau A, Sahgal A, Ruschin M. Quantitative Assessment of Tumor Dynamics using Serial MRIs during Post-Operative Radiotherapy of Glioblastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2313] [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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22
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Jackson T, Shenkin A, Moore J, Bunce A, van Emmerik T, Kane B, Burcham D, James K, Selker J, Calders K, Origo N, Disney M, Burt A, Wilkes P, Raumonen P, Gonzalez de Tanago Menaca J, Lau A, Herold M, Goodman RC, Fourcaud T, Malhi Y. An architectural understanding of natural sway frequencies in trees. J R Soc Interface 2019; 16:20190116. [PMID: 31164076 DOI: 10.1098/rsif.2019.0116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The relationship between form and function in trees is the subject of a longstanding debate in forest ecology and provides the basis for theories concerning forest ecosystem structure and metabolism. Trees interact with the wind in a dynamic manner and exhibit natural sway frequencies and damping processes that are important in understanding wind damage. Tree-wind dynamics are related to tree architecture, but this relationship is not well understood. We present a comprehensive view of natural sway frequencies in trees by compiling a dataset of field measurement spanning conifers and broadleaves, tropical and temperate forests. The field data show that a cantilever beam approximation adequately predicts the fundamental frequency of conifers, but not that of broadleaf trees. We also use structurally detailed tree dynamics simulations to test fundamental assumptions underpinning models of natural frequencies in trees. We model the dynamic properties of greater than 1000 trees using a finite-element approach based on accurate three-dimensional model trees derived from terrestrial laser scanning data. We show that (1) residual variation, the variation not explained by the cantilever beam approximation, in fundamental frequencies of broadleaf trees is driven by their architecture; (2) slender trees behave like a simple pendulum, with a single natural frequency dominating their motion, which makes them vulnerable to wind damage and (3) the presence of leaves decreases both the fundamental frequency and the damping ratio. These findings demonstrate the value of new three-dimensional measurements for understanding wind impacts on trees and suggest new directions for improving our understanding of tree dynamics from conifer plantations to natural forests.
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Affiliation(s)
- T Jackson
- 1 Environmental Change Institute, School of Geography and the Environment, University of Oxford , Oxford OX1 3QY , UK
| | - A Shenkin
- 1 Environmental Change Institute, School of Geography and the Environment, University of Oxford , Oxford OX1 3QY , UK
| | - J Moore
- 2 Scion , 49 Sala Street, Rotorua 3010 , New Zealand
| | - A Bunce
- 3 Department of Natural Resources, University of Connecticut , Mansfield, CT 06269 , USA
| | - T van Emmerik
- 4 Water Resources Section, Delft University of Technology , Stevinweg 1, 2628 CN, Delft , The Netherlands.,5 Hydrology and Quantitative Water Management Group, Wageningen University , Wageningen , The Netherlands
| | - B Kane
- 6 Department of Environmental Conservation, University of Massachusetts , Amherst, MA 01003 , USA
| | - D Burcham
- 7 Centre for Urban Greenery and Ecology , National Parks Board, 259569 Singapore
| | - K James
- 8 School of Ecosystem and Forest Sciences, Faculty of Science, University of Melbourne , Melbourne , Australia
| | - J Selker
- 9 Oregon State University , Corvallis, OR 97331 , USA
| | - K Calders
- 10 CAVElab - Computational and Applied Vegetation Ecology, Ghent University , Ghent , Belgium
| | - N Origo
- 11 Earth Observation, Climate and Optical Group, National Physical Laboratory , Hampton Road, Teddington, Middlesex TW11 0LW , UK.,12 Department of Geography, University College London , London WC1E 6BT , UK
| | - M Disney
- 12 Department of Geography, University College London , London WC1E 6BT , UK.,13 NERC National Centre for Earth Observation (NCEO) , Leicester , UK
| | - A Burt
- 12 Department of Geography, University College London , London WC1E 6BT , UK
| | - P Wilkes
- 12 Department of Geography, University College London , London WC1E 6BT , UK.,13 NERC National Centre for Earth Observation (NCEO) , Leicester , UK
| | - P Raumonen
- 14 Tampere University of Technology , Korkeakoulunkatu 10, 33720 Tampere , Finland
| | - J Gonzalez de Tanago Menaca
- 15 Laboratory of Geo-Information Science and Remote Sensing, Wageningen University , Droevendaalsesteeg 3, 6708 PB Wageningen , The Netherlands.,16 Center for International Forestry Research (CIFOR) , PO Box 0113 BOCBD, Bogor 16000 , Indonesia
| | - A Lau
- 15 Laboratory of Geo-Information Science and Remote Sensing, Wageningen University , Droevendaalsesteeg 3, 6708 PB Wageningen , The Netherlands.,16 Center for International Forestry Research (CIFOR) , PO Box 0113 BOCBD, Bogor 16000 , Indonesia
| | - M Herold
- 15 Laboratory of Geo-Information Science and Remote Sensing, Wageningen University , Droevendaalsesteeg 3, 6708 PB Wageningen , The Netherlands
| | - R C Goodman
- 17 Department of Forest Ecology and Management, Swedish University of Agricultural Sciences , Umeå , Sweden
| | - T Fourcaud
- 18 AMAP, University of Montpellier, CIRAD, CNRS, INRA, IRD , Montpellier , France
| | - Y Malhi
- 1 Environmental Change Institute, School of Geography and the Environment, University of Oxford , Oxford OX1 3QY , UK
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Ezeife DA, Melosky B, Tudor R, Lin S, Lau A, Panzarella T, Leighl NB. Afatinib in advanced pretreated non-small-cell lung cancer- a Canadian experience. ACTA ACUST UNITED AC 2018; 25:e385-e390. [PMID: 30464688 DOI: 10.3747/co.25.3914] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Afatinib, an irreversible epidermal growth factor receptor tyrosine kinase inhibitor (egfr tki), is approved for first-line therapy in advanced EGFR mutation-positive non-small-cell lung cancer (nsclc) and has previously demonstrated activity after failure of chemotherapy and reversible egfr tkis, with improved response and progression-free survival, compared with placebo. Outcomes in pretreated patients with advanced nsclc receiving afatinib through a Canadian special access program (sap) are reported here. Methods Patients with nsclc progressing after at least 1 line of chemotherapy and an egfr tki were eligible to enrol in the sap. Characteristics of patients from the two largest accruing Canadian centres were retrospectively reviewed, including demographics, disease and treatment data, and patient outcomes. Results The 53 patients who received afatinib (57% women, 51% never-smokers, 26% of East Asian ethnicity, and 66% with adenocarcinoma) had a median age of 59 years. EGFR mutations were documented in 25%, and EGFR wild-type in 8%. All patients had received prior egfr tki treatment, with 42% achieving a response. Patients took afatinib for a median of 2 months (range: 0-26 months); 17% required 1 or more dose reductions. Of 47 evaluable patients receiving afatinib, 10 experienced tumour shrinkage, and 11, stable disease. Median survival from afatinib initiation was 5 months (95% confidence interval: 2 months to 8 months). Grade 3 or greater diarrhea, rash, paronychia, and stomatitis were seen in 9%, 11%, 6%, and 4% of patients respectively. Conclusions In an unselected population of pretreated patients with advanced nsclc after tki failure, median survival with afatinib therapy was 5 months. Through a sap, afatinib demonstrated activity in clinical practice, with manageable toxicity.
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Affiliation(s)
- D A Ezeife
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - R Tudor
- University of Calgary, Calgary, AB.,London Health Sciences Centre, London, ON
| | - S Lin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,University of Calgary, Calgary, AB
| | - A Lau
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - T Panzarella
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - N B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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Nair V, Nazri D, Hashim R, Lau A, Muniasamy M. Bridging Barriers, Building Partners: Success of a Multistakeholder Collaborative Effort in Building and Implementing a Free Mammography Programme for Underprivileged Malaysian Women. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.66700] [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
Background and context: Research has revealed two large problems in the Malaysian breast cancer control context. First, a large disparity existed in diagnostic stages of Malaysian patients during first presentation; with a large percentage of patients presenting in Stage 3 or 4. Second, patients presenting in later stages of disease were revealed to be of lower socioeconomic backgrounds. Shortcomings are thus thought to exist in the capability of women from lower socioeconomic groups to access breast cancer screening. To address these gaps, the National Cancer Society of Malaysia conceptualized and put together a multistakeholder collaborative project. Aim: The aim of this project was to build, finance and implement a free mammography program for underprivileged Malaysian women. Strategy/Tactics: To ensure geographic equity in provision of this program, 14 individual private hospitals in 10 different states in peninsular Malaysia were negotiated with and agreed to provide the mammogram at highly competitive prices. To address transport and other costs which may have acted as a barrier for patients to attend their screening, transportation costs for groups going for their screening was also subsidized. Additional stakeholders' engaged were nongovernmental organizations (NGOs) especially those working with the economically underprivileged such as religious and other community NGOs. They were roped in as partners to spread the message, identify eligible participants and schedule visits. Some NGOs carried this out as part of their own outreach activities; reserving specific days at the screening centers for themselves. Program/Policy process: The program consisted of a free mammogram provided to Malaysian women above 40 years of age who were determined to be underprivileged; defined for this program as those having a monthly household income below the poverty line (RM5000). If the mammogram was found to be suspicious, a confirmatory breast ultrasound was also performed sans payment. Once conceptualized, the program was successfully pitched by NCSM to ETIQA Insurance, a large Malaysian insurer, who agreed to fund this project as part of their sustainable corporate social responsibility (CSR) initiative. In total, the program funded mammograms for 5000 women over a period of 1 year from July 2017 to July 2018. NCSM advertised the program through various channels; including traditional media, social media, and at various outreach programs and events. Outcomes/What was learned: The program has run for 8 months and has already screened 3550 women nationwide. The multistakeholder collaborative effort has been highly successful at creating awareness on breast cancer screening and providing accurate breast cancer screening for a large number of underprivileged women, some for the first time in their lives.
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Affiliation(s)
- V. Nair
- National Cancer Society Malaysia, Kuala Lumpur, Malaysia
| | - D. Nazri
- National Cancer Society Malaysia, Kuala Lumpur, Malaysia
| | - R. Hashim
- National Cancer Society Malaysia, Kuala Lumpur, Malaysia
| | - A. Lau
- National Cancer Society Malaysia, Kuala Lumpur, Malaysia
| | - M. Muniasamy
- National Cancer Society Malaysia, Kuala Lumpur, Malaysia
- Chulalongkorn University, College of Public Health Sciences, Bangkok, Thailand
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25
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Selwyn D, Lau A. When to refer: Validating the Evidence-based Acute Otitis Externa Score (EARS). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.246] [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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26
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Ling S, Hamm G, Wallez Y, Richards F, Johnson I, Dunlop C, Barry S, Jodrell D, Lau A, Goodwin R. PO-261 Multimodal mass spectrometry imaging to understand drug delivery, metabolism, response and amp; resistance in pancreatic ductal adenocarcinoma. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Boni C, Vecchi A, Rossi M, Laccabue D, Giuberti T, Alfieri A, Lampertico P, Grossi G, Facchetti F, Brunetto MR, Coco B, Cavallone D, Mangia A, Santoro R, Piazzolla V, Lau A, Gaggar A, Subramanian GM, Ferrari C. TLR7 Agonist Increases Responses of Hepatitis B Virus-Specific T Cells and Natural Killer Cells in Patients With Chronic Hepatitis B Treated With Nucleos(T)Ide Analogues. Gastroenterology 2018; 154:1764-1777.e7. [PMID: 29378197 DOI: 10.1053/j.gastro.2018.01.030] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [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] [Received: 09/13/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The oral Toll-like receptor (TLR) 7 agonist GS-9620 has antiviral effects in woodchuck and chimpanzee models of chronic hepatitis B virus (HBV) infection. We investigated, in a clinical trial, the capacity of this agent to reconstitute protective immunity in patients with chronic HBV infection. METHODS We performed a prospective study of 28 patients with suppression of HBV infection by nucleos(t)ide analogue therapy and who tested negative for hepatitis B e antigen at 4 medical centers in Italy. Patients were randomly assigned (1:3:3:3) to groups given placebo or different doses of GS-9620 (1, 2, and 4 mg, weekly for 12 weeks). We added data from 8 patients receiving nucleos(t)ide analogue therapy to the placebo group (controls); 13 treatment-naïve patients with chronic HBV infection and 15 subjects who spontaneously recovered from an acute HBV infection served as additional controls. Peripheral blood mononuclear cells were collected at baseline, during administration of GS-9620 or placebo, and 12 weeks afterward. Phenotype and function of natural killer (NK) and HBV-specific T cells were analyzed by flow cytometry. T cells were expanded by incubation with peptides from the entire HBV proteome and studied after overnight or 10 days culture. NK-cell inhibition of T-cell responses was measured by assessing cytokine production by T cells stimulated with peptides in the presence or absence of NK cells. RESULTS T cells collected at baseline before addition of GS-9620, when patients were receiving only nucleos(t)ide therapy, had greater responses to HBV than T cells from treatment-naïve patients, based on cytokine production in response to HBV peptides. However, during or after administration of GS-9620, T cells produced higher levels of cytokines compared to baseline. NK-cell activation and function increased after patients were given GS-9620, but the ability of NK cells to suppress T-cell responses was lower during GS-9620 therapy than before. Changes in T-cell or NK-cell function did not correlate with levels of hepatitis B surface antigen. Serum levels of hepatitis B surface antigen did not decrease significantly compared to baseline in patients given any dose of GS-9620. CONCLUSIONS Twelve weeks administration of GS-9620 had no significant effect on serum hepatitis B surface antigen levels, but did appear to increase T-cell and NK-cell responses and reduce the ability of NK to suppress T cells. GS-9620 might therefore be included in therapies to increase the immune response to HBV.
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Affiliation(s)
- Carolina Boni
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Andrea Vecchi
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Marzia Rossi
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Diletta Laccabue
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Tiziana Giuberti
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Arianna Alfieri
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Glenda Grossi
- Division of Gastroenterology and Hepatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Floriana Facchetti
- Division of Gastroenterology and Hepatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Maurizia R Brunetto
- Hepatology Unit and Liver Physiopathology Laboratory and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - Barbara Coco
- Hepatology Unit and Liver Physiopathology Laboratory and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - Daniela Cavallone
- Hepatology Unit and Liver Physiopathology Laboratory and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - Alessandra Mangia
- Liver Unit, Istituto di Ricovero e Cura a Carattere Scientifico, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Rosanna Santoro
- Liver Unit, Istituto di Ricovero e Cura a Carattere Scientifico, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Valeria Piazzolla
- Liver Unit, Istituto di Ricovero e Cura a Carattere Scientifico, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Audrey Lau
- Gilead Sciences, Inc, Foster City, California
| | - Anuj Gaggar
- Gilead Sciences, Inc, Foster City, California
| | | | - Carlo Ferrari
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda-Ospedaliero-Universitaria of Parma, Parma, Italy.
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Christianto S, Lau A, Li K, Yang W, Su Y. One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis. Int J Oral Maxillofac Surg 2018; 47:585-594. [DOI: 10.1016/j.ijom.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/24/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
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Long R, Lau A. How R G Ferguson's groundbreaking studies influenced our understanding of tuberculosis reinfection. Where to next? Int J Tuberc Lung Dis 2018; 20:1285-1287. [PMID: 27725035 DOI: 10.5588/ijtld.16.0447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - A Lau
- Department of Medicine, Faculty of Medicine and Dentistry University of Alberta, Edmonton, Alberta, Canada
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Teng N, Cheng D, Stocker R, Lau A. Correlation of Myeloperoxidase Levels in Coronary and Peripheral Arterial Blood With Plaque Morphology by Optical Coherence Tomography in Acute Coronary Syndrome. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.599] [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: 10/28/2022]
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Kastner M, Perrier L, Munce SEP, Adhihetty CC, Lau A, Hamid J, Treister V, Chan J, Lai Y, Straus SE. Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis. Osteoporos Int 2018; 29:5-17. [PMID: 29043392 DOI: 10.1007/s00198-017-4248-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 09/26/2017] [Indexed: 01/06/2023]
Abstract
Osteoporosis is affecting over 200 million people worldwide. Despite available guidelines, care for these patients remains sub-optimal. We developed an osteoporosis tool to address the multiple dimensions of chronic disease management. Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment, so we are revising this tool to include multiple chronic conditions including an update of evidence about osteoporosis. Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis. We searched bibliometric databases for randomized controlled trials (RCTs) in any language evaluating osteoporosis disease management interventions in adults at risk for osteoporosis. Reviewer pairs independently screened citations and full-text articles, extracted data, and assessed risk of bias. Analysis included random effects meta-analysis. Primary outcomes were osteoporosis investigations and treatment, and fragility fractures. Fifty-five RCTs and one companion report were included in the analysis representing 165,703 patients. Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications, and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations. No significant impact was found for any type of intervention to reduce fracture. Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment. Patient education appears to be an important component in osteoporosis disease management.
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Affiliation(s)
- M Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - L Perrier
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - S E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - C C Adhihetty
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A Lau
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Hamid
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - V Treister
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - J Chan
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Y Lai
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - S E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Yau V, Raman S, Pineda S, Le L, Lau A, Bezjak A, Cho J, Sun A, Hope A, Giuliani M. MA 09.02 Ultra-Central Tumors Treated with Stereotactic Body Radiotherapy: A Single Institutional Experience. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yau V, Lindsay P, Hope A, Le L, Glick D, Lau A, Cho J, Bezjak A, Sun A, Giuliani M. Esophageal Toxicity in Thoracic Stereotactic Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2391] [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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Varga Z, Sinn P, McCullough D, Lau A, Stöppler M, Baehner F, Chao C, Seidman A. Summary of head-to-head comparisons of patient (pt) risk classifications by the 21-gene recurrence score (RS) assay and other genomic assays for early breast cancer (EBC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.037] [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: 11/13/2022] Open
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Vijendren A, Coates M, Smith ME, Ajayi OV, Al-Dhahir W, Bewick J, Bowles PF, Coyle P, Davies-Husband CR, Erskine SE, Halliday E, Kaleva AI, Lau A, Langstaff L, Mathew E, Meghji S, Testera A, Thomas JRV, Eisenhut M. Management of pinna haematoma study (MaPHaeS): A multicentre retrospective observational study. Clin Otolaryngol 2017; 42:1252-1258. [PMID: 28247538 DOI: 10.1111/coa.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes. DESIGN Multicentre retrospective observational record-based study. SETTING Eleven hospitals around the UK. PARTICIPANTS Eighty-three patients above the age of 16 with PH. OUTCOME MEASURES The primary outcome measure was recurrence rate of PH over a 6-month period post-treatment, assessed by treatment type (scalpel incision vs needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of 6 months. RESULTS After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of antibiotic cover and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications. CONCLUSIONS Where possible PH should be drained in an operating theatre. Multicentre randomized controlled trials are required to further investigate the impact of drainage technique and post-drainage management on outcome.
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Affiliation(s)
- A Vijendren
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - M Coates
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - M E Smith
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - O V Ajayi
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - W Al-Dhahir
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - J Bewick
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - P F Bowles
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - P Coyle
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | | | - S E Erskine
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - E Halliday
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - A I Kaleva
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - A Lau
- Aintree University Hospital NHS Trust, Liverpool, UK
| | - L Langstaff
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - E Mathew
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - S Meghji
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - A Testera
- East of England ENT Trainee Research Collaborative, Cambridge, UK
| | - J R V Thomas
- Aintree University Hospital NHS Trust, Liverpool, UK
| | - M Eisenhut
- Luton and Dunstable University Hospital NHS Trust, Luton, UK
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Robidoux A, McCullough D, Lau A, Stöppler M, Chao C. Use of the 21-gene Oncotype DX® Breast Recurrence Score™ (RS) assay in the neoadjuvant treatment setting. Breast 2017. [DOI: 10.1016/s0960-9776(17)30262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lau A, Li K, Yang W, Su Y. Induction chemotherapy for squamous cell carcinomas of the oral cavity: a cumulative meta-analysis. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.439] [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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Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [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: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
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Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
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Rodin D, Banihashemi B, Wang L, Lau A, Harris S, Levin W, Dinniwell R, Millar BA, Chung C, Laperriere N, Bezjak A, Wong RKS. The Brain Metastases Symptom Checklist as a novel tool for symptom measurement in patients with brain metastases undergoing whole-brain radiotherapy. ACTA ACUST UNITED AC 2016; 23:e239-47. [PMID: 27330360 DOI: 10.3747/co.23.2936] [Citation(s) in RCA: 8] [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: 11/15/2022]
Abstract
PURPOSE We evaluated the feasibility, reliability, and validity of the Brain Metastases Symptom Checklist (bmsc), a novel self-report measure of common symptoms experienced by patients with brain metastases. METHODS Patients with first-presentation symptomatic brain metastases (n = 137) referred for whole-brain radiotherapy (wbrt) completed the bmsc at time points before and after treatment. Their caregivers (n = 48) provided proxy ratings twice on the day of consultation to assess reliability, and at week 4 after wbrt to assess responsiveness to change. Correlations with 4 other validated assessment tools were evaluated. RESULTS The symptoms reported on the bmsc were largely mild to moderate, with tiredness (71%) and difficulties with balance (61%) reported most commonly at baseline. Test-retest reliability for individual symptoms had a median intraclass correlation of 0.59 (range: 0.23-0.85). Caregiver proxy and patient responses had a median intraclass correlation of 0.52. Correlation of absolute scores on the bmsc and other symptom assessment tools was low, but consistency in the direction of symptom change was observed. At week 4, change in symptoms was variable, with improvements in weight gain and sleep of 42% and 41% respectively, and worsening of tiredness and drowsiness of 62% and 59% respectively. CONCLUSIONS The bmsc captures a wide range of symptoms experienced by patients with brain metastases, and it is sensitive to change. It demonstrated adequate test-retest reliability and face validity in terms of its responsiveness to change. Future research is needed to determine whether modifications to the bmsc itself or correlation with more symptom-specific measures will enhance validity.
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Affiliation(s)
- D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - B Banihashemi
- Department of Radiation Oncology, Lakeridge Health Corporation, Oshawa, ON
| | - L Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - A Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - S Harris
- Palliative Radiation Oncology Program, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - W Levin
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R Dinniwell
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - B A Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - C Chung
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - N Laperriere
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - A Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R K S Wong
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
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Lau A, Liu H, Ren L, Ahmad S, Chen Y. SU-F-I-69: Absorbed Dose Estimation for a Commercially Available MicroCT Scanner with Various Filtration Techniques. Med Phys 2016. [DOI: 10.1118/1.4955897] [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: 11/07/2022] Open
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Ferguson S, Ahmad S, Chen Y, Ferreira C, Islam M, Keeling V, Lau A, Jin H. SU-F-T-143: Implementation of a Correction-Based Output Model for a Compact Passively Scattered Proton Therapy System. Med Phys 2016. [DOI: 10.1118/1.4956279] [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: 11/07/2022] Open
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Wong-Pack M, Rodjanapiches R, Lau A, Ioannidis G, Wade S, Balasubramanian A, Lin C, Roy-Gayos P, Bensen W, Bensen R, Adachi J. FRI0221 Occurrence of Serious Infection in Patients with Rheumatoid Arthritis Treated with Biologics and Denosumab Observed in A Clinical Setting:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1109] [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: 11/03/2022]
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Jin H, Ahmad S, Chen Y, Keeling V, Lau A, Islam M, Ferreira C, Ferguson S. SU-F-T-160: Commissioning of a Single-Room Double-Scattering Proton Therapy System. Med Phys 2016. [DOI: 10.1118/1.4956296] [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: 11/07/2022] Open
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Russ M, Shankar A, Lau A, Bednarek D, Rudin S. TU-FG-209-05: Demonstration of the Line Focus Principle Using the Generalized Measured-Relative Object Detectability (GM-ROD) Metric. Med Phys 2016. [DOI: 10.1118/1.4957575] [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: 11/07/2022] Open
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Boese S, Golla A, Beutner K, Mau W, Jahn P, Bauer A, Schlitt A, Lau A. Exergames als bewegungstherapeutisches Angebot – Nutzerakzeptanz und Beanspruchung im Rahmen der stationären onkologischen Rehabilitation. Phys Med Rehab Kuror 2016. [DOI: 10.1055/s-0041-110399] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Boese
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - A. Golla
- Institut für Rehabilitationsmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - K. Beutner
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - W. Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - P. Jahn
- Stabsstelle Pflegeforschung und Entwicklung, Universitätsklinikum Halle (Saale)
| | - A. Bauer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - A. Schlitt
- Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg
| | - A. Lau
- Department Sportwissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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Chung H, Vilaysane A, Lau A, Stahl M, Morampudi V, Bondzi-Simpson A, Platnich JM, Bracey NA, French MC, Beck PL, Chun J, Vallance BA, Muruve DA. NLRP3 regulates a non-canonical platform for caspase-8 activation during epithelial cell apoptosis. Cell Death Differ 2016; 23:1331-46. [PMID: 26891693 DOI: 10.1038/cdd.2016.14] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/30/2015] [Accepted: 01/20/2016] [Indexed: 12/31/2022] Open
Abstract
Nod-like receptor, pyrin containing 3 (NLRP3) is characterized primarily as a canonical caspase-1 activating inflammasome in macrophages. NLRP3 is also expressed in the epithelium of the kidney and gut; however, its function remains largely undefined. Primary mouse tubular epithelial cells (TEC) lacking Nlrp3 displayed reduced apoptosis downstream of the tumor necrosis factor (TNF) receptor and CD95. TECs were identified as type II apoptotic cells that activated caspase-8, tBid and mitochondrial apoptosis via caspase-9, responses that were reduced in Nlrp3-/- cells. The activation of caspase-8 during extrinsic apoptosis induced by TNFα/cycloheximide (TNFα/CHX) was dependent on adaptor protein apoptosis-associated speck-like protein containing a CARD (ASC) and completely independent of caspase-1 or caspase-11. TECs and primary human proximal tubular epithelial cells (HPTC) did not activate a canonical inflammasome, caspase-1, or IL-1β secretion in response to TNFα/CHX or NLRP3-dependent triggers, such as ATP or nigericin. In cell fractionation studies and by confocal microscopy, NLRP3 colocalized with ASC and caspase-8 in speck-like complexes at the mitochondria during apoptosis. The formation of NLRP3/ASC/caspase-8 specks in response to TNFα/CHX was downstream of TNFR signaling and dependent on potassium efflux. Epithelial ASC specks were present in enteroids undergoing apoptosis and in the injured tubules of wild-type but not Nlrp3-/- or ASC-/- mice following ureteric unilateral obstruction in vivo. These data show that NLRP3 and ASC form a conserved non-canonical platform for caspase-8 activation, independent of the inflammasome that regulates apoptosis within epithelial cells.
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Affiliation(s)
- H Chung
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - A Vilaysane
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - A Lau
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - M Stahl
- Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - V Morampudi
- Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - A Bondzi-Simpson
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - J M Platnich
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - N A Bracey
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - M-C French
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - P L Beck
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - J Chun
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - B A Vallance
- Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - D A Muruve
- Department of Medicine, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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Schmidt H, Boese S, Bauer A, Landenberger M, Lau A, Stoll O, Schmoll HJ, Mauz-Koerholz C, Kuss O, Jahn P. Interdisciplinary care programme to improve self-management for cancer patients undergoing stem cell transplantation: a prospective non-randomised intervention study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 12/14/2022]
Affiliation(s)
- H. Schmidt
- Medical Faculty; Institute for Health and Nursing Science; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - S. Boese
- Medical Faculty; Institute for Health and Nursing Science; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - A. Bauer
- Medical Faculty; Institute for Health and Nursing Science; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - M. Landenberger
- Medical Faculty; Institute for Health and Nursing Science; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - A. Lau
- Department of Sports Science; Institute of Communication, Media and Sports; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - O. Stoll
- Department of Sports Science; Institute of Communication, Media and Sports; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - H.-J. Schmoll
- University Hospital Halle; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - C. Mauz-Koerholz
- University Hospital Halle; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - O. Kuss
- Faculty of Medicine; Centre for Health and Society; Heinrich Heine University; Düsseldorf Germany
- Institute for Biometry and Epidemiology; German Diabetes Center; Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf; Düsseldorf Germany
- Medical Faculty; Institute for Medical Epidemiology, Biostatistics and Informatics; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
| | - P. Jahn
- Medical Faculty; Institute for Health and Nursing Science; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
- University Hospital Halle; Martin Luther University Halle-Wittenberg; Halle (Saale) Germany
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48
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Lau A, Wilkie M, Jones T, Boyd M. P53 can be stabilised by a combination of Nutlin-3 and irradiation in human papillomavirus-positive oropharyngeal carcinoma cells, with no apparent effect on cell growth or clonogenic survival. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Kannan V, Lau A, Hodgson N, Goodin K, Mohamed A, McConahey W, LoVecchio F. 283 The Creation of the Maricopa Integrated Health System Disease Surveillance Project. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.317] [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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50
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Lau A, Spark S, Tomnay J, Temple-Smith M, Fairley CK, Guy R, Donovan B, Hocking JS. P08.30 Chlamydia tests ordered, but not undertaken: socio-demographic and structural barriers in general practice. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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