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Buch A, Jain K, Rathod H, Gore C. Clinicopathological Significance of Tumor Budding in Breast Carcinoma. J Nepal Health Res Counc 2024; 21:417-427. [PMID: 38615212 DOI: 10.33314/jnhrc.v21i3.4538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Tumour budding Tuberculosis is a new prognostic marker whose role in breast cancer is still under evaluation. Our aim was to study Tuberculosis in breast carcinoma and correlate it with other prognostic markers. METHODS A descriptive cross-sectional study was conducted over 2 years on 75 invasive breast carcinoma specimens and biopsies. Hematoxylin and Eosin sections were examined for tumour grade, stage, molecular subtype, necrosis, lymphovascular invasion inflammation and counting of Tuberculosis. Lymph node metastasis was studied only in mastectomies. TB was defined as a cluster of 1-5 tumour cells and counted in 10 consecutive 400X fields. The cut-off for high grade TB was taken as ?10 per 10 HPFs. Immunohistochemical staining was done for molecular subtyping and differentiating Tuberculosis from mimickers. Statistical analysis was done using chi square test and Fischer's exact test. RESULTS Tuberculosis was present in 66/75 cases; 53% (n=35) were high grade. Among these, majority were of T2 (74%, n= 26), grade 2 (52%, n= 18), luminal A (34%, n= 12), had 3+ inflammation (46%, n= 16) and peripheral tumour buds (54%). Necrosis and lymphovascular invasion were absent in 77% and 71%, respectively. Lymph node metastasis was seen in 63% (n= 25/28) cases. Statistically significant association (p= 0.016) was observed between degree of inflammation and Tuberculosis grade. However, no significant association was observed between TB and other prognostic markers of breast carcinoma. CONCLUSIONS In our study, association of Tuberculosis with different prognostic markers was appreciated but was not statistically significant. However, it highlights need for standardization of Tuberculosis reporting.
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Affiliation(s)
- Archana Buch
- Patil Medical College, Hospital and Research Centre, Patil Vidyapeeth, Pimpri, Pune, India
| | - Khushi Jain
- Patil Medical College, Hospital and Research Centre, Patil Vidyapeeth, Pimpri, Pune, India
| | - Hetal Rathod
- Patil Medical College, Hospital and Research Centre, Patil Vidyapeeth, Pimpri, Pune, India
| | - Charusheela Gore
- Patil Medical College, Hospital and Research Centre, Patil Vidyapeeth, Pimpri, Pune, India
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Dharwadkar A, Gore C, Bhuibhar G, Viswanathan V. Unmasking the Mystery of Renal Neoplasm in a Perimenopausal Woman: A Case Report. Cureus 2024; 16:e56970. [PMID: 38665735 PMCID: PMC11044075 DOI: 10.7759/cureus.56970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a benign, complex, and rarely encountered renal neoplasm. This case involves a 46-year-old perimenopausal woman who presented with symptoms, such as abdominal pain, burning sensation during urination, increased urinary frequency, and hesitancy. Computed tomography (CT) urography revealed an exophytic, heterogeneously hyperdense mass originating from the interpolar and lower pole parenchyma of the left kidney, suggesting a neoplastic origin. Due to concerns about malignancy and the presence of local symptoms, a laparoscopic-assisted left radical nephrectomy was performed. Histopathological examination of the excised tissue revealed a biphasic neoplasm consisting of epithelial and stromal elements. The epithelial component exhibited cysts and glands of variable sizes, lined by columnar cells and surrounded by stromal tissue. The diagnosis of MESTs of the kidney was established and confirmed through immunohistochemistry. This unique type of benign kidney tumor can be effectively managed through conservative surgery and is associated with a favorable prognosis.
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Affiliation(s)
- Arpana Dharwadkar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Charusheela Gore
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Gayatri Bhuibhar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Vidya Viswanathan
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
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Iqbal B, Kambale T, Gore C, Choudhury ND, Lahanu PN, Sawaimul K. Primary Cardiac Lesions: A Case Series of Five Rare Cases. Oman Med J 2023. [DOI: 10.5001/omj.2023.95] [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: 01/30/2023] Open
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4
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Iqbal B, Kumar H, Vishwanathan V, Zaheer M, Gore C. Urinary Bladder Primary Squamous Cell Carcinoma: A Rare Case Description and Literature Review. Clin Cancer Investig J 2023. [DOI: 10.51847/nnm18xsmgj] [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: 02/03/2023]
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Londhe M, Garg S, Gurwale S, Gore C. Cystic presentation of primary hepatic neuroendocrine tumour: a case report with a brief review of literature. Explor Target Antitumor Ther 2023; 4:266-272. [PMID: 37205311 PMCID: PMC10185437 DOI: 10.37349/etat.2023.00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/13/2023] [Indexed: 05/21/2023] Open
Abstract
Neuroendocrine tumours (NETs) are a rare type of tumours that arise from the neuroendocrine cells which are distributed throughout the body. Of all the gastrointestinal tumours only 1-2% account for NETs. They have an extremely low incidence of 0.17% arising in the intrahepatic bile duct epithelium. Majority of hepatic NETs occur as a result of metastases from the primary NETs. Most cases of primary hepatic NET (PHNET) present as a solid nodular mass. However, predominantly cystic PHNET is extremely rare which mimics other cystic space-occupying lesions clinically and radiologically as seen in this case.
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Affiliation(s)
- Mangesh Londhe
- Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Sakshi Garg
- Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
- Correspondence: Sakshi Garg, Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India.
| | - Sushama Gurwale
- Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Charusheela Gore
- Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
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Jose M, Chandanwale S, Singh M, Raj A, Gore C. Mesenteric cystic lymphangioma – A rare entity with unusual presentation. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_427_20] [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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7
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Iqbal B, Kambale T, Gore C, Vishwanathan V, Dharwadkar A. Frantz's Tumor an Unusual Pancreatic Neoplasm with Rare Presentation. Clin Cancer Investig J 2022. [DOI: 10.51847/nsr50zkrc5] [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: 01/09/2023]
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Buch A, Naik M, Chandanwale S, Rathod H, Paul B, Gore C. Comparative Analysis of Ki-67 in Different Scoring Patterns and its Association with other Prognostic Markers of Breast Carcinoma. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52704.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Immunohistochemical evaluation of Ki-67 is widely used for estimation of tumour proliferation in breast cancer. Till date, no specific method or a cut-off point for Ki-67 exists. Aim: To perform a comparative analysis between different scoring patterns and mean Ki-67 value and association of mean Ki-67 with other prognostic markers like tumour size, lymph node status, tumour stage and grade and different molecular subtypes of breast cancer. Materials and Methods: A cross-sectional study was conducted at Dr. D.Y Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, between August 2019 to August 2021. Total of 50 new diagnosed cases of breast cancer were studied for the histologic type, grade and stage of the tumour. Immunohistochemistry for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2) and Ki-67 was performed. Association of Ki-67 with other prognostic markers like tumour size, lymph node status, tumour stage and grade and different molecular subtypes of breast cancer was evaluated by expressing Ki-67 as a continuous variable (mean±SD) and also by dividing Ki-67 into different scoring patterns (I: ≤14%, >14%, II: ≤15%, 16- 30%, >30% and III: <20%, 20-50%, ≥50%). Statistical tests like Kruskal-Wallis test (mean Ki-67 with tumour size, tumour grade and molecular subtypes), Mann-Whitney Rank Sum Test (mean Ki-67 with lymph node status) and Analysis of variance (ANOVA) (mean Ki-67 with staging) respectively. Results: Out of 50 patients, 40 (80%) were older than 50-yearold. Twenty six (52%) cases affected the left breast. A total of 49 (98%) were diagnosed as Invasive Ductal Carcinoma (IDC). Among them 26 (52%) cases were of grade III and 25 (50%) cases were of Luminal A. Mean Ki-67 and molecular subtypes of breast cancer had statistically significant association (p= 0.002). No association was found between mean Ki-67 and tumour size (p=0.608), lymph node status (p=0.506) stage (p=0.979) and grade (p=0.095) of the tumour. Although scoring pattern I and III had no remarkable findings. Notably, scoring pattern II showed higher tumour sizes, lymph node positivity, higher stage and grade and basal-like tumours demonstrated a higher Ki-67 index. Conclusion: Evaluation of Ki-67 as a continuous variable yielded significant association with other prognostic markers of breast cancer. There was no single “best” scoring pattern identified. A direct association of Ki-67 was found with molecular subtypes of breast cancer.
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Iqbal B, Raj A, Gurwale S, Gore C, Singh M. Spindle Cell Squamous Cell Carcinoma of the Tongue: A Rare Variant at an Even Rarer Location. Clin Cancer Investig J 2022. [DOI: 10.51847/gznnxp2qlt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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10
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Kambale T, Buch A, Agarwal N, Gore C. Pituitary adenoma with gangliocytoma: A rare mixed tumor in the sellar region. J Clin Sci 2022. [DOI: 10.4103/jcls.jcls_26_22] [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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11
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Ranjan S, Kumar H, Gore C, Chandanwale S, Bhide A, Desai A. Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_653_21] [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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12
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Chugh A, Punia P, Gotecha S, Kiyawat D, Gore C. Meningoids: Lesions mimicking meningiomas. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101302] [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] Open
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13
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Wilson F, Harnik E, Gore C. A labelling system improves parental comfort and willingness to use topical corticosteroids for paediatric atopic dermatitis. Skin Health and Disease 2021; 1:e11. [PMID: 35664821 PMCID: PMC9060095 DOI: 10.1002/ski2.11] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
Objectives In the United Kingdom, atopic dermatitis (AD) affects 20% of children and topical corticosteroids (TCS) are a mainstay of AD treatment regimes. Many TCS have similar packaging despite significant differences in potency frequently leading to confusion, and along with misinformation and steroid phobia, potentially reducing treatment adherence. We aimed to evaluate parents' knowledge/concerns regarding TCS and explore benefits of/preference for a TCS‐labelling system. Method Hundred parents of children with AD attending paediatric dermatology and/or allergy appointments completed mixed‐methodology Survey 1 (knowledge‐quiz, TCS‐labelling options, feedback on what supports AD‐care). Thirty parents, adolescents, and healthcare professionals completed Survey 2. Qualitative/quantitative data was thematically/statistically analysed (SPSS v25) respectively. Results Parents preferred the traffic light system (green = mild, yellow = moderate, red = potent; n = 71/100) and reported significantly increased willingness and comfort in using TCS if a labelling system was used p ≤ 0.001). Knowledge regarding TCS potency was lacking: 62% (n = 46/74) of mild TCS‐users overestimated potency; 51% (n = 67/131) of potent TCS‐users underestimated potency. Common concerns were TCS‐related skin thinning, long‐term side effects and themes for improved AD‐care/support included: better information, written plans, access to advice, involvement of certain staff. Parents wanted accessible information in various formats: verbally, electronic resources, leaflets, and education sessions. Conclusions Parents of children with AD confirmed significant concerns and demonstrated poor knowledge regarding TCS use. Our findings suggest that a simple labelling system may improve TCS adherence. Future work to test refined label prototypes and evaluating their impact on adherence and correct use is needed.
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Affiliation(s)
- F. Wilson
- Department of Medicine Faculty of Medicine Imperial College London London UK
| | - E. Harnik
- Department of Paediatrics Allergies Imperial College Healthcare NHS Trust London UK
| | - C. Gore
- Department of Paediatrics Allergies Imperial College Healthcare NHS Trust London UK
- Section of Inflammation, Repair and Development National Heart and Lung Institute, Imperial College London London UK
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Chandanwale S, Gore C, Singh M, Raj A, Rashmi R. Idiopathic granulomatous lobular mastitis: A rare entity with diagnostic dilemma on fine needle aspiration. J Med Sci 2021. [DOI: 10.4103/jmedsci.jmedsci_26_20] [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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15
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Vishwanathan V, Malhotra A, Dharwadkar A, Vimal S, Gore C, Kumar H. An unusual case of gastric lymphoma presenting as linitus plastica. Med J DY Patil Vidyapeeth 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_274_20] [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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16
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BAVIKAR P, Dighe T, Sajgure A, Bale C, Wakhare P, Shinde N, Chandanwale S, Gore C, Bondge A. SUN-332 POST TRANSPLANT GRAFT ABSCESS IN HEPATITIS-B POSITIVE RECIPIENT. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Bamanikar S, Ranjan S, Kumar H, Gore C, Kambale T. An Atypical Meningioma Presenting at an Unusual Site. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/43014.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Meningiomas are tumours that originate from the arachnoid cells (meningocytes) and the majority are benign grade I tumours according to World Health Organisation (WHO). Chordoid meningioma is an uncommon variant of meningioma and corresponds to grade II tumour in WHO classification of tumours of the Nervous System 2016, because of its more aggressive behaviour and increased likelihood of recurrence. These meningiomas may appear extracranially (i.e. head and neck region, sinonasal tract, ear, temporal bone, scalp, etc) in only 2% cases. The histopathological and immunohistochemical evaluation is usually diagnostic. Here, the authors present a case of Chordoid meningioma in a 32-year-old patient who presented with complaints of nasal obstruction clinically suspected to be due to nasal polyp.
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Gore C, Hill D, Lee S. C-57 Prematurity and Perinatal Insult: Examining the relationships between parent and teacher ratings of executive functioning and academic readiness. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Extremely preterm children and those with a history of perinatal insult (e.g., hemorrhage, hypoxic-ischemic injury) show higher rates of cognitive and academic problems, including executive functioning (EF). EF becomes increasingly important in elementary school as curriculum demands increase. The current study examines the relationship between parent- and teacher-reported EF and early academic performance in this population at school-age.
Method
This study reviewed retrospective neuropsychological evaluations in a sample of 135 patients (ages 3:9-10:5 years, M = 5.8) from an outpatient neurodevelopmental follow-up program for children with perinatal complication. Parent and teacher measures included: Behavior Assessment Scale for Children (BASC-2, 3) and Behavioral Rating Inventory of Executive Functioning (BRIEF, P, 2). Standardized child measures included: Bracken School Readiness (BBCS-III), and subtests from Wechsler Individual Achievement Test (WIAT-III) and Comprehensive Test of Phonological Processing (CTOPP-2).
Results
BRIEF parent ratings of working memory (p = 0.34) and emotional control (p = .025) were negatively correlated with school readiness. BRIEF teacher inhibition and working memory ratings were negatively correlated with math performance (p = .004 to p = .044), as well as rapid naming (p = .002 to p = .047) and school readiness (p = .048). BRIEF teacher ratings of planning/organization (p = .027), shifting (p = .024), and emotional control (p = .010) were negatively correlated with pre-reading measures. A 95% confidence interval was used.
Conclusions
Parent and teacher ratings of EF were significantly correlated with measures of academic readiness, early math skill, and pre-reading measures in this sample of children with a history of perinatal complications. Caregiver ratings can be useful in identifying children at-risk for academic problems upon school entry and requiring further neuropsychological evaluation.
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Hill D, Gore C, Lee S. C-58 Reliable Change Index to Monitor Executive, Adaptive and Behavioral Functioning in Children with Perinatal Complications. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Research demonstrates that children with perinatal complications (i.e., extreme prematurity, hemorrhage, hypoxic-ischemic injury) are at increased-risk for behavior, executive functioning, and adaptive independence problems in their everyday life. The purpose of this study is to demonstrate the importance of monitoring for changes in these domains as these children reach school-age.
Method
The current study reviewed retrospective neuropsychological evaluations for a sample of 8 children (ages 5-10 years) evaluated in an outpatient neurodevelopmental follow-up program for children with perinatal complications. Re-evaluation was completed 1-2 years later. Children with the following standardized parent-report measures were included: Behavior Assessment System for Children (BASC-2,3), Behavior Rating Inventory of Executive Function (BRIEF, 2), and Adaptive Behavior Assessment System (ABAS-3). A reliable change index was calculated for each child to compare individual change in subscales/indices using gender/age standard error of measurement from test manuals.
Results
BRIEF subscale RCI values (≥ 1.96) indicated that most children showed increased problems with inhibition, shifting, working memory, and planning/organizational (range -13 to 13), whereas most showed improved emotional control (range -12 to 3). BASC indices revealed stability in behavioral and externalizing symptoms (range -3 to 2). ABAS RCI values indicated that children tended to improve across skills (range -19 to 27). Figures and tables will be displayed.
Conclusions
This study highlights the utility of RCI values in monitoring neuropsychological changes during the early school years, as this sample of children showed changes across several developing skills. Early identification of behavioral or adaptive deficits allows providers to make recommendations for clinical management and academic planning.
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Abstract
AbstractEpithelioid sarcoma (ES) is a rare mesenchymal tumor of unknown histogenesis which displays multidirectional differentiation, predominantly epithelial. They have no normal cellular counterpart and differ from both synovial sarcoma and other carcinomas. It mainly affects young adults. It has two variants, classic type and proximal type. The more common classic type presents as a slowly growing painless nodule or plaque on the distal extremities. It is rare in children and older individuals. There is male predominance. The size varies from few millimeters to several centimeters. Central deeply seated lesions in pelvis and genital tract are termed as proximal ES. It has a multinodular growth pattern and usually occurs in older patients. These are comparatively more aggressive and metastasize early. On histopathological examination, these lesions need to be distinguished from other tumors showing epithelioid morphology. Primary ES of scalp is an exceedingly rare tumor. We present a case of nodular tumor on the scalp with cervical lymph node metastasis.
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Affiliation(s)
- Sushma Gurwale
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - Charusheela Gore
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - Supreet Kaur
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - Anjali Deshpande
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
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Patro N, Sawaimul K, Gore C, Buch A. Giant pulmonary hamartoma with foci of placental transmogrification of the lung. Med J DY Patil Vidyapeeth 2019. [DOI: 10.4103/mjdrdypu.mjdrdypu_245_18] [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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Gore C, Gore RB, Fontanella S, Haider S, Custovic A. Temperature-controlled laminar airflow (TLA) device in the treatment of children with severe atopic eczema: Open-label, proof-of-concept study. Clin Exp Allergy 2018; 48:594-603. [PMID: 29383776 DOI: 10.1111/cea.13105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression. OBJECTIVE To evaluate the effect of the temperature-controlled laminar airflow (TLA) treatment in children/adolescents with severe AE. METHODS We recruited 15 children aged 2-16 years with long-standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run-in period of 6-10 weeks (3 visits) was followed by 12-month treatment with overnight TLA (Airsonett® , Sweden). The primary outcome was eczema severity (SCORAD-Index and Investigator Global Assessment-IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient-oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773. RESULTS There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12-month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75-45.15] at Baseline to 17.2 [12.95-32.3] at the final visit, and IGA improved significantly from 4 [3-4] to 2 [1-3]. We observed a significant improvement in FDQLI (16.0 [12.25-19.0] to 12 [8-18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6-month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non-responders. CONCLUSION AND CLINICAL RELEVANCE Addition of TLA device to standard pharmacological treatment may be an effective add-on to the management of difficult-to-control AE.
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Affiliation(s)
- C Gore
- Section of Paediatrics, Department of Medicine, Imperial College, London, UK.,Department of Paediatric Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R B Gore
- Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Fontanella
- Section of Paediatrics, Department of Medicine, Imperial College, London, UK
| | - S Haider
- Section of Paediatrics, Department of Medicine, Imperial College, London, UK
| | - A Custovic
- Section of Paediatrics, Department of Medicine, Imperial College, London, UK.,Department of Paediatric Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Papatheodoridis GV, Hatzakis A, Cholongitas E, Baptista-Leite R, Baskozos I, Chhatwal J, Colombo M, Cortez-Pinto H, Craxi A, Goldberg D, Gore C, Kautz A, Lazarus JV, Mendão L, Peck-Radosavljevic M, Razavi H, Schatz E, Tözün N, van Damme P, Wedemeyer H, Yazdanpanah Y, Zuure F, Manns MP. Hepatitis C: The beginning of the end-key elements for successful European and national strategies to eliminate HCV in Europe. J Viral Hepat 2018; 25 Suppl 1:6-17. [PMID: 29508946 DOI: 10.1111/jvh.12875] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [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: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus (HCV) infection is a major public health problem in the European Union (EU). An estimated 5.6 million Europeans are chronically infected with a wide range of variation in prevalence across European Union countries. Although HCV continues to spread as a largely "silent pandemic," its elimination is made possible through the availability of the new antiviral drugs and the implementation of prevention practices. On 17 February 2016, the Hepatitis B & C Public Policy Association held the first EU HCV Policy Summit in Brussels. This summit was an historic event as it was the first high-level conference focusing on the elimination of HCV at the European Union level. The meeting brought together the main stakeholders in the field of HCV: clinicians, patient advocacy groups, representatives of key institutions and regional bodies from across European Union; it served as a platform for one of the most significant disease elimination campaigns in Europe and culminated in the presentation of the HCV Elimination Manifesto, calling for the elimination of HCV in Europe by 2030. The launch of the Elimination Manifesto provides a starting point for action in order to make HCV and its elimination in Europe an explicit public health priority, to ensure that patients, civil society groups and other relevant stakeholders will be directly involved in developing and implementing HCV elimination strategies, to pay particular attention to the links between hepatitis C and social marginalization and to introduce a European Hepatitis Awareness Week.
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Affiliation(s)
- G V Papatheodoridis
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - E Cholongitas
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - R Baptista-Leite
- Institute of Health Sciences, Católica University of Portugal, Lisbon, Portugal.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - J Chhatwal
- Massachusetts General Hospital' s, Institute for Technology Assessment and Harvard Medical School, Boston, MA, USA
| | - M Colombo
- Clinical and Research Center Humanitas, Rozzano, Italy
| | - H Cortez-Pinto
- European Association for the Study of the Liver, Geneva, Switzerland.,Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal
| | - A Craxi
- University of Palermo, Palermo, Italy
| | - D Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - C Gore
- Hepatitis C Trust, World Hepatitis Alliance, London, UK
| | - A Kautz
- Leberhilfe Projekt gUG, Cologne, Germany
| | - J V Lazarus
- Barcelonai Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Mendão
- Portuguese Activist Group for HIV/AIDS Treatment, Lisbon, Portugal.,European AIDS Treatment Group, Brussels, Belgium
| | | | - H Razavi
- Center for Disease Analysis, Lafayette, CO, USA
| | - E Schatz
- Correlation Network, Amsterdam, The Netherlands
| | - N Tözün
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - P van Damme
- Antwerp University, Antwerp, Belgium.,Viral Hepatitis Prevention Board, Antwerp, Belgium
| | | | | | - F Zuure
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Manns
- Hannover Medical School, Hannover, Germany
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24
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Boyle RJ, Umasunthar T, Smith JG, Hanna H, Procktor A, Phillips K, Pinto C, Gore C, Cox HE, Warner JO, Vickers B, Hodes M. A brief psychological intervention for mothers of children with food allergy can change risk perception and reduce anxiety: Outcomes of a randomized controlled trial. Clin Exp Allergy 2017; 47:1309-1317. [DOI: 10.1111/cea.12981] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 05/12/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R. J. Boyle
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - T. Umasunthar
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. G. Smith
- Population Health Research Institute; St. George's, University of London; London UK
| | - H. Hanna
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - A. Procktor
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - K. Phillips
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Pinto
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Gore
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - H. E. Cox
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. O. Warner
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - B. Vickers
- Adolescent Assertive Outreach Team; South West London and St Georges’ Mental Health NHS Trust; London UK
| | - M. Hodes
- Imperial College Healthcare NHS Trust; London UK
- Centre for Mental Health; Imperial College London; London UK
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25
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Gore C, Griffin R, Rothenberg T, Tallett A, Hopwood B, Sizmur S, O'Keeffe C, Warner JO. New patient-reported experience measure for children with allergic disease: development, validation and results from integrated care. Arch Dis Child 2016; 101:935-43. [PMID: 27484970 DOI: 10.1136/archdischild-2015-309598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/31/2015] [Accepted: 04/15/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop and validate a new allergy-specific patient-reported experience measure (PREM) for children and their parents, and to collect feedback in an integrated care setting. DESIGN Two allergy-specific PREMs were produced using focus groups, cognitive testing, two prospective validation studies (collaboration: Royal College of Paediatrics and Child Health, Picker Institute Europe, Imperial College/London): 'Your Allergy Care', for children aged 8-16 years; 'Your Child's Allergy Care', for parents of children aged 0-7 years. SETTING Community event, primary/secondary/tertiary allergy care settings. MAIN OUTCOME MEASURES Performance of PREMs in validation study; reported experience of allergy care. PARTICIPANTS 687 children with allergic conditions and their parents/carers. RESULTS In total, 687 questionnaires were completed; 503/687 (253 child; 250 parent) for the final survey. In both surveys, demographic variations were not associated with differences in results. Although 71% of patients reported one or more allergic conditions (food allergy/eczema/hay fever/asthma), 62% required multiple visits before receiving final diagnosis. Overall, patient experience was good for communication with patient/parent, competence and confidence in ability, and 73% felt looked after 'very well' and 23% 'quite well'. Areas for improvement included communication with nurseries/schools, more information on side effects, allergic conditions and allergen/irritant avoidance. Allergy care in primary/emergency care settings was associated with higher problem-scores (worse experience) than in specialist clinics. CONCLUSIONS These new PREMs will allow allergy-specific patient experience reporting for children and parents and help identification of priority areas for improvement and commissioning of care. Efforts towards better allergy care provision must be targeted at primary and emergency care settings and underpinned by improving communication between healthcare providers and the community.
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Affiliation(s)
- C Gore
- Department of Academic Paediatric Allergy, Imperial College, London, UK Department of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - R Griffin
- Department of Academic Paediatric Allergy, Imperial College, London, UK
| | - T Rothenberg
- Department of Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | - S Sizmur
- Picker Institute Europe, Oxford, UK
| | - C O'Keeffe
- Department of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - J O Warner
- Department of Academic Paediatric Allergy, Imperial College, London, UK
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26
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Umasunthar T, Leonardi-Bee J, Turner PJ, Hodes M, Gore C, Warner JO, Boyle RJ. Incidence of food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 2016; 45:1621-36. [PMID: 25495886 DOI: 10.1111/cea.12477] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/04/2014] [Accepted: 10/15/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Food allergy is a common cause of anaphylaxis, but the incidence of anaphylaxis in food allergic people is unknown. METHODS We undertook a systematic review and meta-analysis, using the inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed study quality using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS and AMED between January 1946 and September 2012 and recent conference abstracts. We included registries, databases or cohort studies which described the number of food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence of food allergy. RESULTS We included data from 34 studies. There was high heterogeneity between study results, possibly due to variation in study populations, anaphylaxis definition and data collection methods. In food allergic people, medically coded food anaphylaxis had an incidence rate of 0.14 per 100 person-years (95% CI 0.05, 0.35; range 0.01, 1.28). In sensitivity analysis using different estimated food allergy prevalence, the incidence varied from 0.11 to 0.21 per 100 person-years. At age 0-19, the incidence rate for anaphylaxis in food allergic people was 0.20 (95% CI 0.09, 0.43; range 0.01, 2.55; sensitivity analysis 0.08, 0.39). At age 0-4, an incidence rate of up to 7.00 per 100 person-years has been reported. In food allergic people, hospital admission due to food anaphylaxis had an incidence rate of 0.09 (95% CI 0.01, 0.67; range 0.02, 0.81) per 1000 person-years; 0.20 (95% CI 0.10, 0.43; range 0.04, 2.25) at age 0-19 and 0.50 (0.26, 0.93; range 0.08, 2.82) at age 0-4. CONCLUSION In food allergic people, the incidence of food allergic reactions which are coded as anaphylaxis by healthcare systems is low at all ages, but appears to be highest in young children.
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Affiliation(s)
- T Umasunthar
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - J Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - P J Turner
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - M Hodes
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.,Centre for Mental Health, Imperial College, London, UK
| | - C Gore
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - J O Warner
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - R J Boyle
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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27
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Harris M, Ward E, Gore C. Finding the undiagnosed: a qualitative exploration of hepatitis C diagnosis delay in the United Kingdom. J Viral Hepat 2016; 23:479-86. [PMID: 26924296 DOI: 10.1111/jvh.12513] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 12/19/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
Hepatitis C virus (HCV)-related morbidity and mortality will continue to rise unless HCV testing and treatment uptake increases. In the European region, an estimated nine million people live with HCV, yet only 10-40% are diagnosed. Over 100 000 undiagnosed people live with HCV in the United Kingdom (UK). For some, a late diagnosis can come too late. The aim of this qualitative study was to explore the context of a diagnosis delay among people living with HCV in the UK. Participants were recruited through two London Hospitals and The Hepatitis C Trust. Eligible participants identified a recent (<3 years) HCV diagnosis and a historical HCV transmission risk period (>15 years). The primary method of data collection was in-depth interviews (12 participants) and focus groups (16 participants). Analysis was informed by grounded theory principles. The sample, 17 men and 11 women, reported an average gap of 28 years between their HCV-risk period and first HCV test. Forty per cent had cirrhosis at HCV diagnosis. Diagnosis delay was attributed to limited HCV relevance, felt wellness, stigma, compartmentalization of former injecting practices, unexplained symptoms and general practitioner inaction. Diagnosis context involved a change of health care providers or a chance medical encounter. Trust in providers was impacted by a delayed diagnosis, with implications for future engagement in care. These data indicate that risk awareness does not necessarily result in action. A multipronged approach is needed to increase HCV case finding in the UK, particularly among 'hidden populations' such as former injectors and transfusion recipients.
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Affiliation(s)
- M Harris
- London School of Hygiene & Tropical Medicine, London, UK
| | - E Ward
- The Hepatitis C Trust, London, UK
| | - C Gore
- The Hepatitis C Trust, London, UK.,The World Hepatitis Alliance, London, UK
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28
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Papatheodoridis G, Thomas HC, Golna C, Bernardi M, Carballo M, Cornberg M, Dalekos G, Degertekin B, Dourakis S, Flisiak R, Goldberg D, Gore C, Goulis I, Hadziyannis S, Kalamitsis G, Kanavos P, Kautz A, Koskinas I, Leite BR, Malliori M, Manolakopoulos S, Matičič M, Papaevangelou V, Pirona A, Prati D, Raptopoulou-Gigi M, Reic T, Robaeys G, Schatz E, Souliotis K, Tountas Y, Wiktor S, Wilson D, Yfantopoulos J, Hatzakis A. Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference. J Viral Hepat 2016; 23 Suppl 1:1-12. [PMID: 26809941 DOI: 10.1111/jvh.12493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/26/2022]
Abstract
In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
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Affiliation(s)
- G Papatheodoridis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - H C Thomas
- Hepatology and Gastroenterology Section, Department of Medicine, Imperial College, London, UK
| | - C Golna
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg
| | - M Bernardi
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - M Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Dalekos
- University of Thessaly Medical School, Karditsa, Greece
| | - B Degertekin
- Acibadem University Medical School, Istanbul, Turkey
| | - S Dourakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R Flisiak
- Medical University of Bialystok, Bialystok, Poland
| | | | - C Gore
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg.,World Hepatitis Alliance, The Hepatitis C Trust, London, UK
| | - I Goulis
- Medical School, Aristotle University, Thessaloniki, Greece
| | - S Hadziyannis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kalamitsis
- Hellenic Liver Patient Association "Prometheus", Athens, Greece
| | - P Kanavos
- London School of Economics, London, UK
| | - A Kautz
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - I Koskinas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - B R Leite
- National Parliament, Lisbon, Portugal
| | - M Malliori
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Manolakopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Matičič
- Viral Hepatitis Department, Infectious Diseases Clinic, University Medical Centre, Ljubljana, Slovenia
| | - V Papaevangelou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Pirona
- European Monitoring Center for Drugs and Drug Addiction, Lisbon, Portugal
| | - D Prati
- Alessandro Manzoni Hospital, Lecco, Italy
| | - M Raptopoulou-Gigi
- Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece
| | - T Reic
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - G Robaeys
- Department of Gastroenterology and Hepaatology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - E Schatz
- Correlation Network, Amsterdam, the Netherlands
| | | | - Y Tountas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Wiktor
- World Health Organization, Geneva, Switzerland
| | | | - J Yfantopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Umasunthar T, Procktor A, Hodes M, Smith JG, Gore C, Cox HE, Marrs T, Hanna H, Phillips K, Pinto C, Turner PJ, Warner JO, Boyle RJ. Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. Allergy 2015; 70:855-63. [PMID: 25850463 PMCID: PMC4654245 DOI: 10.1111/all.12628] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 11/28/2022]
Abstract
Background Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices. Methods We allocated mothers of food‐allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer‐generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi‐Q), without device‐specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events. Results We randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful – RR 1.00 (95% CI 0.68–1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi‐Q (26/28, 93%) than other devices (39/80, 49%; P < 0.001). Conclusions AAI device design is a major determinant of successful adrenaline administration. Success rates were low with several devices, but were high using the audio‐prompt device Auvi‐Q.
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Affiliation(s)
- T. Umasunthar
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - A. Procktor
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - M. Hodes
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
- Academic Unit of Child and Adolescent Psychiatry Imperial College LondonLondon UK
| | - J. G. Smith
- Population Health Research Institute St. George's, University of LondonLondon UK
| | - C. Gore
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - H. E. Cox
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - T. Marrs
- Department of Paediatric Allergy Division of Asthma, Allergy and Lung Biology King's College London London UK
| | - H. Hanna
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - K. Phillips
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - C. Pinto
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - P. J. Turner
- Section of Paediatrics Imperial College LondonLondon UK
| | - J. O. Warner
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - R. J. Boyle
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
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30
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YanHong R, Ihra GC, Gore C. Determination of gas flow through airway exchange catheters: measured and calculated values and dependence on pressure and entrainment. Anaesthesia 2015; 70:1073-8. [PMID: 25959305 DOI: 10.1111/anae.13109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 12/17/2022]
Abstract
Serious complications have been described during oxygenation of patients with airway exchange catheters, due to catheter malpositioning, accidentally applied high airway pressures or high delivered volumes. In this in-vitro study, we analysed gas flow through various airway exchange catheters and described its dependence on driving pressure and entrainment. We applied driving pressures between 0.5 and 2.5 bar and observed maximal flow rates of 3.6 l.s(-1) . Measured gas flow values differed significantly from values calculated according to the Hagen-Poiseuille equation. Although flow restriction in ventilators and small-bore connectors will limit gas flow, large gas volumes may be unintentionally applied via the airway exchange catheters, leading to serious complications.
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Affiliation(s)
- R YanHong
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - G C Ihra
- Department of Anaesthesiology, General Intensive Care Medicine and Pain Therapy, Medical University Vienna, Vienna, Austria
| | - C Gore
- Department of Anaesthesia, Intensive Care and Pain, Imperial College Healthcare NHS Trust, London, UK
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31
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Gore RB, Boyle RJ, Gore C, Custovic A, Hanna H, Svensson P, Warner JO. Effect of a novel temperature-controlled laminar airflow device on personal breathing zone aeroallergen exposure. Indoor Air 2015; 25:36-44. [PMID: 24750266 DOI: 10.1111/ina.12122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 04/12/2014] [Indexed: 05/16/2023]
Abstract
Temperature-controlled laminar airflow improves symptoms in atopic asthmatics, but its effects on personal allergen exposure are unknown. We aimed to evaluate its effects on personal cat allergen and particulate exposures in a simulated bedroom environment. Five healthy volunteers lay under an active and an inactive temperature-controlled laminar airflow device for 175 min, in a simulated bedroom containing bedding from a cat owner. Total airborne particles (≥0.5 - ≥10 μm diameter) were quantified with a laser particle counter. Airborne allergen was sampled with Institute of Occupational Medicine filters. Inhaled exposure was sampled with nasal air samplers. Allergen-containing particles were quantified by immunoassay. Treatment reduced total airborne particles (>0.5 μm diameter) by >99% (P < 0.001) and reduced airborne allergen concentration within the breathing zone (ratio of median counts = 30, P = 0.043). Treatment reduced inhaled allergen (ratio of median counts = 7, P = 0.043). Treatment was not associated with a change in airborne allergen concentration outside of the breathing zone (P = 0.160). Temperature-controlled laminar airflow treatment of individuals in an allergen-rich experimental environment results in significant reductions in breathing zone allergenic and non-allergenic particle exposure, and in inhaled cat allergen exposure. These findings may explain the clinical benefits of temperature-controlled laminar airflow.
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Affiliation(s)
- R B Gore
- Manchester Academic Health Science Centre, University Hospitals of South Manchester, University of Manchester, Manchester, UK; East and North Herts NHS Trust, Stevenage, UK
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Banerjee T, Templeton M, Gore C. Emergency laparotomy clinical outcome according to patient characteristics, level of postoperative care and time of surgery. Crit Care 2015. [PMCID: PMC4471048 DOI: 10.1186/cc14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Umasunthar T, Leonardi-Bee J, Hodes M, Turner PJ, Gore C, Habibi P, Warner JO, Boyle RJ. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 2014; 43:1333-41. [PMID: 24118190 PMCID: PMC4165304 DOI: 10.1111/cea.12211] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/24/2013] [Indexed: 01/12/2023]
Abstract
Background Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population. Methods We undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy. Results We included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0–19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18–6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population. Conclusion Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.
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Affiliation(s)
- T Umasunthar
- Department of Paediatrics, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Cooke GS, Lemoine M, Thursz M, Gore C, Swan T, Kamarulzaman A, DuCros P, Ford N. Viral hepatitis and the Global Burden of Disease: a need to regroup. J Viral Hepat 2013; 20:600-1. [PMID: 23910643 DOI: 10.1111/jvh.12123] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G S Cooke
- Infectious Diseases, Imperial College, London, UK.
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Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M, Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M, Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K, Goldberg D, Goulis I, Hadjichristodoulou C, Hatzigeorgiou T, Hamouda O, Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Matičič M, Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Sočan M, Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns M, Manns M. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat 2013; 20 Suppl 2:1-20. [PMID: 23827008 DOI: 10.1111/jvh.12120] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
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Affiliation(s)
- A Hatzakis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Gore C, Lazarus JV, Peck RJJ, Sperle I, Safreed-Harmon K. Unnecessary injecting of medicines is still a major public health challenge globally. Trop Med Int Health 2013; 18:1157-1159. [PMID: 23876226 DOI: 10.1111/tmi.12151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C Gore
- World Hepatitis Alliance, London, UK
| | - J V Lazarus
- CHIP, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | | | - I Sperle
- CHIP, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - K Safreed-Harmon
- CHIP, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Wu K, Liu J, Tseng SF, Gore C, Ning Z, Sharifi N, Fazli L, Gleave M, Kapur P, Xiao G, Sun X, Oz OK, Min W, Alexandrakis G, Yang CR, Hsieh CL, Wu HC, He D, Xie D, Hsieh JT. The role of DAB2IP in androgen receptor activation during prostate cancer progression. Oncogene 2013; 33:1954-63. [PMID: 23604126 DOI: 10.1038/onc.2013.143] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/30/2013] [Accepted: 02/26/2013] [Indexed: 11/09/2022]
Abstract
Altered androgen-receptor (AR) expression and/or constitutively active AR are commonly associated with prostate cancer (PCa) progression. Targeting AR remains a focal point for designing new strategy of PCa therapy. Here, we have shown that DAB2IP, a novel tumor suppressor in PCa, can inhibit AR-mediated cell growth and gene activation in PCa cells via distinct mechanisms. DAB2IP inhibits the genomic pathway by preventing AR nuclear translocation or phosphorylation and suppresses the non-genomic pathway via its unique functional domain to inactivate c-Src. Also, DAB2IP is capable of suppressing AR activation in an androgen-independent manner. In addition, DAB2IP can inhibit several AR splice variants showing constitutive activity in PCa cells. In DAB2IP(-/-) mice, the prostate gland exhibits hyperplastic epithelia, in which AR becomes more active. Consistently, DAB2IP expression inversely correlates with AR activation status particularly in recurrent or metastatic PCa patients. Taken together, DAB2IP is a unique intrinsic AR modulator in normal cells, and likely can be further developed into a therapeutic agent for PCa.
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Affiliation(s)
- K Wu
- 1] Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA [2] Department of Urology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - J Liu
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S-F Tseng
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - C Gore
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Z Ning
- Department of Urology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - N Sharifi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Fazli
- Vancouver Prostate Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Gleave
- Vancouver Prostate Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - P Kapur
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - G Xiao
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - X Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - O K Oz
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W Min
- Interdepartmental Program in Vascular Biology and Transplantation and Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - G Alexandrakis
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - C-R Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - C-L Hsieh
- 1] Graduate Institute of Cancer Biology, China Medical University Hospital, Taichung, Taiwan [2] Center for Molecular Medicine, China Medical University Hospital, Taichung, Taiwan [3] Department of Biotechnology, Asia University, Taichung, Taiwan
| | - H-C Wu
- 1] Department of Urology, China Medical University Hospital, Taichung, Taiwan [2] School of Medicine, China Medical University, Taichung, Taiwan
| | - D He
- Department of Urology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - D Xie
- Department of General Surgery, Tongji Cancer Research Institute, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - J-T Hsieh
- 1] Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA [2] Graduate Institute of Cancer Biology, China Medical University Hospital, Taichung, Taiwan
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Gore C, Wigmore T. Managing critically ill oncological patients in hospital: a survey across all ICUs in the UK. Crit Care 2012. [PMCID: PMC3363831 DOI: 10.1186/cc11020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gore C, Custovic A, Tannock GW, Munro K, Kerry G, Johnson K, Peterson C, Morris J, Chaloner C, Murray CS, Woodcock A. Treatment and secondary prevention effects of the probiotics Lactobacillus paracasei or Bifidobacterium lactis on early infant eczema: randomized controlled trial with follow-up until age 3 years. Clin Exp Allergy 2011; 42:112-22. [PMID: 22092692 DOI: 10.1111/j.1365-2222.2011.03885.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/25/2011] [Accepted: 08/12/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergic disease has been associated with altered intestinal microbiota. Therefore, probiotics have been suggested as a potential treatment for eczema. OBJECTIVE We investigated whether dietary supplementation of infants with eczema at age 3-6 months with Lactobacillus paracasei CNCM I-2116 or Bifidobacterium lactis CNCM I-3446 had a treatment effect or altered allergic disease progression. METHODS Primary outcome included eczema severity (SCORing Atopic Dermatitis, SCORAD) 3 months post-randomization. Secondary: SCORAD (other visits); infant dermatitis quality of life (IDQoL); gastrointestinal permeability; urinary eosinophilic protein X; allergen-sensitization; allergic symptoms (age 12, 18, 36 months). A total of 208 infants aged 3-6 months with physician-diagnosed eczema were recruited; 137/208 (SCORAD ≥ 10, consuming ≥ 200 mL standard formula/day) were randomized to daily supplements containing L. paracasei or B. lactis or placebo for a 3-month period, while receiving extensively hydrolysed whey-formula (dairy-free diet). There were two open observational groups, one group exclusively breastfed (n = 22) and the other, standard formula-fed (n = 49). TRIAL NUMBER ISRCTN41490500. RESULTS Eczema severity decreased significantly over time in all groups. No significant difference was observed between randomized groups after 12-week treatment-period (SCORAD-score pre-/post-intervention: B. lactis 25.9 [95% CI: 22.8-29.2] to 12.8 [9.4-16.6]; L. paracasei 25.4 [22.1-29] to 12.5 [9.2-16.4]; placebo 26.9 [23.4-30.6] to 11.8 [9.6-14.3]; P = 0.7). Results were similar when analysis was controlled for allergen-sensitization, or when only sensitized infants were analysed. No differences were found for secondary outcomes. No difference was observed in SCORAD-score between randomized and observational groups. CONCLUSION AND CLINICAL RELEVANCE We found no benefit from supplementation with B. lactis or L. paracasei in the treatment of eczema, when given as an adjunct to basic topical treatment, and no effect on the progression of allergic disease from age 1 to 3 years.
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Affiliation(s)
- C Gore
- School of Translational Medicine, University of Manchester, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
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Hatzakis A, Wait S, Bruix J, Buti M, Carballo M, Cavaleri M, Colombo M, Delarocque-Astagneau E, Dusheiko G, Esmat G, Esteban R, Goldberg D, Gore C, Lok ASF, Manns M, Marcellin P, Papatheodoridis G, Peterle A, Prati D, Piorkowsky N, Rizzetto M, Roudot-Thoraval F, Soriano V, Thomas HC, Thursz M, Valla D, van Damme P, Veldhuijzen IK, Wedemeyer H, Wiessing L, Zanetti AR, Janssen HLA. The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference*. J Viral Hepat 2011. [PMID: 21824223 DOI: 10.1111/j.1365-2893.2011.01499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Worldwide, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause, respectively, 600,000 and 350,000 deaths each year. Viral hepatitis is the leading cause of cirrhosis and liver cancer, which in turn ranks as the third cause of cancer death worldwide. Within the WHO European region, approximately 14 million people are chronically infected with HBV, and nine million people are chronically infected with HCV. Lack of reliable epidemiological data on HBV and HCV is one of the biggest hurdles to advancing policy. Risk groups such as migrants and injecting drug users (IDU) tend to be under-represented in existing prevalence studies; thus, targeted surveillance is urgently needed to correctly estimate the burden of HBV and HCV. The most effective means of prevention against HBV is vaccination, and most European Union (EU) countries have universal vaccination programmes. For both HBV and HCV, screening of individuals who present a high risk of contracting the virus is critical given the asymptomatic, and thereby silent, nature of disease. Screening of migrants and IDUs has been shown to be effective and potentially cost-effective. There have been significant advances in the treatment of HCV and HBV in recent years, but health care professionals remain poorly aware of treatment options. Greater professional training is needed on the management of hepatitis including the treatment of liver cancer to encourage adherence to guidelines and offer patients the best possible outcomes. Viral hepatitis knows no borders. EU Member States, guided by the EU, need to work in a concerted manner to implement lasting, effective policies and programmes and make tackling viral hepatitis a public health priority.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Hatzakis A, Wait S, Bruix J, Buti M, Carballo M, Cavaleri M, Colombo M, Delarocque-Astagneau E, Dusheiko G, Esmat G, Esteban R, Goldberg D, Gore C, Lok ASF, Manns M, Marcellin P, Papatheodoridis G, Peterle A, Prati D, Piorkowsky N, Rizzetto M, Roudot-Thoraval F, Soriano V, Thomas HC, Thursz M, Valla D, van Damme P, Veldhuijzen IK, Wedemeyer H, Wiessing L, Zanetti AR, Janssen HLA. The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference*. J Viral Hepat 2011; 18 Suppl 1:1-16. [PMID: 21824223 DOI: 10.1111/j.1365-2893.2011.01499.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [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: 12/14/2022]
Abstract
Worldwide, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause, respectively, 600,000 and 350,000 deaths each year. Viral hepatitis is the leading cause of cirrhosis and liver cancer, which in turn ranks as the third cause of cancer death worldwide. Within the WHO European region, approximately 14 million people are chronically infected with HBV, and nine million people are chronically infected with HCV. Lack of reliable epidemiological data on HBV and HCV is one of the biggest hurdles to advancing policy. Risk groups such as migrants and injecting drug users (IDU) tend to be under-represented in existing prevalence studies; thus, targeted surveillance is urgently needed to correctly estimate the burden of HBV and HCV. The most effective means of prevention against HBV is vaccination, and most European Union (EU) countries have universal vaccination programmes. For both HBV and HCV, screening of individuals who present a high risk of contracting the virus is critical given the asymptomatic, and thereby silent, nature of disease. Screening of migrants and IDUs has been shown to be effective and potentially cost-effective. There have been significant advances in the treatment of HCV and HBV in recent years, but health care professionals remain poorly aware of treatment options. Greater professional training is needed on the management of hepatitis including the treatment of liver cancer to encourage adherence to guidelines and offer patients the best possible outcomes. Viral hepatitis knows no borders. EU Member States, guided by the EU, need to work in a concerted manner to implement lasting, effective policies and programmes and make tackling viral hepatitis a public health priority.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Gore R, Boyle R, Hanna H, Custovic A, Gore C, Svensson P, Warner J. P27 Personal allergen exposures are increased by changes in sleep position and improved by temperature-controlled laminar airflow. Thorax 2010. [DOI: 10.1136/thx.2010.150961.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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Dabrowska D, Gore C, Griffiths S, Mudzingwa M, Varaday S. Anaesthetic management of a pregnant patient with multiple myeloma. Int J Obstet Anesth 2010; 19:336-9. [DOI: 10.1016/j.ijoa.2010.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 09/25/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Garvican L, Martin D, Quod M, Stephens B, Sassi A, Gore C. Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists. Scand J Med Sci Sports 2010; 22:95-103. [DOI: 10.1111/j.1600-0838.2010.01145.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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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Uddin G, Shoeb D, Solaiman S, Marley R, Gore C, Ramsay M, Harris R, Ushiro-Lumb I, Moreea S, Alam S, Thomas HC, Khan S, Watt B, Pugh RN, Ramaiah S, Jervis R, Hughes A, Singhal S, Cameron S, Carman WF, Foster GR. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. J Viral Hepat 2010; 17:327-35. [PMID: 20002307 DOI: 10.1111/j.1365-2893.2009.01240.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.
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Affiliation(s)
- G Uddin
- Queen Marys University of London, Barts and The London School of Medicine, The Liver Unit, 4 Newark Street, London, UK
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Gore C, Jerram T. Charles Patrick Gore. West J Med 2010. [DOI: 10.1136/bmj.c1525] [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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Suazo A, Gore C, Schal C. RNA interference-mediated knock-down of Bla g 1 in the German cockroach, Blattella germanica L., implicates this allergen-encoding gene in digestion and nutrient absorption. Insect Mol Biol 2009; 18:727-736. [PMID: 19758414 DOI: 10.1111/j.1365-2583.2009.00912.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We used RNA interference (RNAi) to silence the expression of a gene encoding Bla g 1, a human allergen produced by the German cockroach, Blattella germanica L., to study its function in cockroach physiology. Females injected with 1 microg of double-stranded RNA contained 64% less Bla g 1 protein and Bla g 1 mRNA abundance was reduced by 91.4% compared to sham-injected females. Bla g 1 knockdown slowed the pace of weight gain, midgut growth, and colleterial gland and basal oocyte maturation, resulting in delayed egg case formation and lower fecundity. Exogenous juvenile hormone treatments rescued reproduction in RNAi-treated females, suggesting that Bla g 1 silencing lowered endogenous juvenile hormone, probably by reducing food intake and nutrient absorption.
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Affiliation(s)
- A Suazo
- Department of Entomology and W. M. Keck Center for Behavioral Biology, North Carolina State University, Raleigh, NC 27695-7613, USA
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Schreiter A, Gore C, Roques B, Stein C, Machelska H. 286 PAIN CONTROL BY PREVENTION OF OPIOID PEPTIDE DEGRADATION IN PERIPHERAL INFLAMED TISSUE. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Schreiter
- Charite‐Campus Benjamin Franklin Anaesthesiologie, Berlin, Germany
| | - C. Gore
- Charite‐Campus Benjamin Franklin Anaesthesiologie, Berlin, Germany
| | | | - C. Stein
- Charite‐Campus Benjamin Franklin Anaesthesiologie, Berlin, Germany
| | - H. Machelska
- Charite‐Campus Benjamin Franklin Anaesthesiologie, Berlin, Germany
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Abstract
The incidence of allergic conditions continues to increase world wide. The underlying mechanisms and in particular the causes are however poorly understood. This article presents the evidence for the hygiene hypothesis which has been proposed in the debate on the causation of allergic disease.
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Affiliation(s)
- C Gore
- North West Lung Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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Machelska H, Labuz D, Schmidt Y, Gore C, Rittner H, Stein C. 275 LEUKOCYTE-DERIVED OPIOIDS INHIBIT NEUROPATHIC PAIN BY ACTIVATING PERIPHERAL OPIOID RECEPTORS. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60278-4] [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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