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King A, Maisey T, Harris EL, Poulter JA, Jayne DG, Khot MI. The contradictory role of febuxostat in ABCG2 expression and potentiating hypericin-mediated photodynamic therapy in colorectal cancers. Photochem Photobiol Sci 2024:10.1007/s43630-024-00575-w. [PMID: 38625651 DOI: 10.1007/s43630-024-00575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
Photodynamic Therapy (PDT) is an emerging method to treat colorectal cancers (CRC). Hypericin (HYP) is an effective mediator of PDT and the ABCG2 inhibitor, Febuxostat (FBX) could augment PDT. HT29 and HEK293 cells showed light dependant cytotoxic response to PDT in both 2D and 3D cell models. FBX co-treatment was not found to improve PDT cytotoxicity. Next, ABCG2 protein expression was observed in HT29 but not in HEK293 cells. However, ABCG2 gene expression analysis did not support protein expression results as ABCG2 gene expression results were found to be higher in HEK293 cells. Although HYP treatment was found to significantly reduce ABCG2 gene expression levels in both cell lines, FBX treatment partially restored ABCG2 gene expression. Our findings indicate that FBX co-treatment may not be suitable for augmenting HYP-mediated PDT in CRC but could potentially be useful for other applications.
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Affiliation(s)
- Aaron King
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK
| | - Thomas Maisey
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK
| | - Erica L Harris
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK
| | - James A Poulter
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK
| | - David G Jayne
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK
| | - M Ibrahim Khot
- School of Medicine, University of Leeds, St James University Hospital, Leeds, LS9 7TF, UK.
- School of Chemistry and Biosciences, University of Bradford, Bradford, BD7 1DP, UK.
- Richmond Building, School of Chemistry and Biosciences, Faculty of Life Sciences, University of Bradford, Bradford, BD7 1DP, UK.
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2
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Khaled YS, Khot MI, Aiyappa-Maudsley R, Maisey T, Pramanik A, Tiernan J, Lintern N, Al-Enezi E, Shamsuddin SH, Tomlinson D, Coletta L, Millner PA, Hughes TA, Jayne DG. Photoactive imaging and therapy for colorectal cancer using a CEA-Affimer conjugated Foslip nanoparticle. Nanoscale 2024; 16:7185-7199. [PMID: 38506227 PMCID: PMC10993305 DOI: 10.1039/d3nr04118b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/08/2023] [Indexed: 03/21/2024]
Abstract
Theranostic nanoparticles hold promise for simultaneous imaging and therapy in colorectal cancer. Carcinoembryonic antigen can be used as a target for these nanoparticles because it is overexpressed in most colorectal cancers. Affimer reagents are synthetic proteins capable of binding specific targets, with additional advantages over antibodies for targeting. We fabricated silica nanoparticles using a water-in-oil microemulsion technique, loaded them with the photosensitiser Foslip, and functionalised the surface with anti-CEA Affimers to facilitate fluorescence imaging and photodynamic therapy of colorectal cancer. CEA-specific fluorescence imaging and phototoxicity were quantified in colorectal cancer cell lines and a LS174T murine xenograft colorectal cancer model. Anti-CEA targeted nanoparticles exhibited CEA-specific fluorescence in the LoVo, LS174T and HCT116 cell lines when compared to control particles (p < 0.0001). No toxicity was observed in LS174T cancer mouse xenografts or other organs. Following photo-irradiation, the anti-CEA targeted particles caused significant cell death in LoVo (60%), LS174T (90%) and HCT116 (70%) compared to controls (p < 0.0001). Photodynamic therapy (PDT) at 24 h in vivo showed a 4-fold reduction in tumour volume compared to control mouse xenografts (p < 0.0001). This study demonstrates the efficacy of targeted fluorescence imaging and PDT using Foslip nanoparticles conjugated to anti-CEA Affimer nanoparticles in in vitro and in vivo colorectal cancer models.
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Affiliation(s)
- Yazan S Khaled
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | - M Ibrahim Khot
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | | | - Thomas Maisey
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | - Arindam Pramanik
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | - Jim Tiernan
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | - Nicole Lintern
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Eiman Al-Enezi
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Shazana H Shamsuddin
- Department of Pathology, School of Medical Sciences, University Sains Malaysia, Malaysia
| | - Darren Tomlinson
- School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Louise Coletta
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
| | - Paul A Millner
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Thomas A Hughes
- School of Medicine, University of Leeds, Leeds, UK
- School of Science, Technology and Health, York St John University, York, UK
| | - David G Jayne
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, United Kingdom.
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3
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Downey CL, Lessing J, Jayne DG. Reporting of health-related quality of life in emergency laparotomy trials: a systematic review and narrative synthesis. Qual Life Res 2024; 33:599-605. [PMID: 37882901 PMCID: PMC10894131 DOI: 10.1007/s11136-023-03531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Emergency laparotomy is associated with high morbidity for the surgical patient. Understanding patients' health-related quality of life after their surgery is important to enhance the informed consent process, and to enable the evaluation and improvement of surgical care. This review aims to summarise the use of health-related quality of life tools in clinical trials involving patients undergoing emergency laparotomy. METHODS A systematic review was undertaken of the scientific literature published in the MEDLINE® and PubMed databases between January 2011 and July 2021. A narrative synthesis approach was chosen to synthesise the diverse range of studies in a structured manner. All included papers were evaluated using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS Eleven studies were selected for inclusion. Most of the studies had a low risk of bias. Two of the studies used health-related quality of life as the primary outcome measure. A variety of health-related quality of life measurement tools were used; the EQ-5D tool was the most popular questionnaire. Protocol adherence was dependent on the length of time which had elapsed after emergency surgery. CONCLUSION There are many perceived challenges to collecting health-related quality of life data in the emergency surgery setting. Many of these can be offset with progressive trial designs. There is a need for further research in the systematic development of patient-reported outcomes for use in emergency surgery.
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Affiliation(s)
- Candice L Downey
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, University of Leeds, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | - J Lessing
- Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, University of Leeds, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK
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4
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Lintern N, Smith AM, Jayne DG, Khaled YS. Photodynamic Stromal Depletion in Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2023; 15:4135. [PMID: 37627163 PMCID: PMC10453210 DOI: 10.3390/cancers15164135] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest solid malignancies, with a five-year survival of less than 10%. The resistance of the disease and the associated lack of therapeutic response is attributed primarily to its dense, fibrotic stroma, which acts as a barrier to drug perfusion and permits tumour survival and invasion. As clinical trials of chemotherapy (CT), radiotherapy (RT), and targeted agents have not been successful, improving the survival rate in unresectable PDAC remains an urgent clinical need. Photodynamic stromal depletion (PSD) is a recent approach that uses visible or near-infrared light to destroy the desmoplastic tissue. Preclinical evidence suggests this can resensitise tumour cells to subsequent therapies whilst averting the tumorigenic effects of tumour-stromal cell interactions. So far, the pre-clinical studies have suggested that PDT can successfully mediate the destruction of various stromal elements without increasing the aggressiveness of the tumour. However, the complexity of this interplay, including the combined tumour promoting and suppressing effects, poses unknowns for the clinical application of photodynamic stromal depletion in PDAC.
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Affiliation(s)
- Nicole Lintern
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Andrew M. Smith
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds LS9 7TF, UK
| | - David G. Jayne
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds LS9 7TF, UK
| | - Yazan S. Khaled
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds LS9 7TF, UK
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5
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Downey CL, Bainbridge J, Jayne DG, Meads DM. Impact of in-hospital postoperative complications on quality of life up to 12 months after major abdominal surgery. Br J Surg 2023; 110:1206-1212. [PMID: 37335925 PMCID: PMC10416679 DOI: 10.1093/bjs/znad167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/15/2023] [Accepted: 05/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Postoperative complications are common, but there are limited data regarding their implications on patients' quality of life. This study aimed to address this gap in the literature by analysing the impact of postoperative complications on patients' health-related quality of life. METHODS Data from the Perioperative Quality Improvement Programme were analysed, and included patient-level data for 19 685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were graded using the Clavien-Dindo classification. Quality of life was assessed by responses to the EuroQol five-dimension five-levels-of-response (EQ-5D-5L™) questionnaire before surgery, and at 6 and 12 months after operation. Ordinal logistic regression was used to estimate the association between Clavien-Dindo grades and quality of life. Tobit and ordinary least squares regression analyses were used to estimate the quality-adjusted life-year (QALY) loss resulting from postoperative complications between admission and 12 months after surgery. RESULTS At 6 and 12 months after surgery, increasingly severe postoperative complications were significantly associated with poorer health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least 12 months after operation. Between admission and 12 months after surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a grade I, II, III, or IV postoperative complication respectively. CONCLUSION Postoperative complications have a significant and sustained effect on patients' quality of life after surgery; this effect worsens as the severity of the complications increases.
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Affiliation(s)
- Candice L Downey
- Leeds Institute of Medical Research at St James’s, Clinical Sciences Building, St James’s University Hospital, University of Leeds, Leeds, UK
| | - Jamie Bainbridge
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James’s, Clinical Sciences Building, St James’s University Hospital, University of Leeds, Leeds, UK
| | - David M Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
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Jolugbo P, Willott T, Lin WH, Maisey T, O'Callaghan D, Green MA, Jayne DG, Khot MI. Fluorescent imaging using novel conjugated polymeric nanoparticles-affimer probes in complex in vitro models of colorectal cancer. Nanoscale 2023. [PMID: 37466243 DOI: 10.1039/d3nr02160b] [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] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
We developed a carcinoembryonic antigen (CEA) conjugated polymer nanoparticle (CPN510-CEA-Af) probe to target CEA-expressing CRC cells in vitro. Its efficacy was evaluated in 2D and 3D cultures of LS174T, LoVo, and HT29 CRC cell lines. CPN510-CEA-Af produced greater fluorescent signal intensity than unconjugated particles in both 2D cells and 3D spheriods, indicating its potential as a probe for image-guided colorectal cancer surgery.
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Affiliation(s)
- Precious Jolugbo
- Leeds Institute of Medical Research at St James', School of Medicine, St James University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
| | - Thomas Willott
- Leeds Institute of Medical Research at St James', School of Medicine, St James University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
| | - Wei-Hsiang Lin
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Thomas Maisey
- Leeds Institute of Medical Research at St James', School of Medicine, St James University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
| | | | - Mark A Green
- Stream Bio Ltd, Alderley Park, Nether Alderley, Cheshire, SK10 4TG, UK
- Department of Physics, Faculty of Natural, Mathematical & Engineering Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James', School of Medicine, St James University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
| | - M Ibrahim Khot
- Leeds Institute of Medical Research at St James', School of Medicine, St James University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
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Bautista MJ, Kowal M, Cave DGW, Downey C, Jayne DG. Clinical applications of contactless photoplethysmography for monitoring in adults: A systematic review and meta-analysis. J Clin Transl Sci 2023; 7:e129. [PMID: 37313385 PMCID: PMC10260340 DOI: 10.1017/cts.2023.547] [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: 11/29/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
Contactless photoplethysmography (cPPG) is a method of physiological monitoring. It differs from conventional monitoring methods (e.g., saturation probe) by ensuring no contact with the subject by use of a camera. The majority of research on cPPG is conducted in a laboratory setting or in healthy populations. This review aims to evaluate the current literature on monitoring using cPPG in adults within a clinical setting. Adhering to the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA, 2020) guidelines, OVID, Webofscience, Cochrane library, and clinicaltrials.org were systematically searched by two researchers. Research articles using cPPG for monitoring purposes in adults within a clinical setting were selected. Twelve studies with a total of 654 individuals were included. Heart rate (HR) was the most investigated vital sign (n = 8) followed by respiratory rate ((n = 2), Sp02 (n = 2), and HR variability (n = 2). Four studies were included in a meta-analysis of HR compared to ECG data which demonstrated a mean bias of -0.13 (95% CI, -1.22-0.96). This study demonstrates cPPG can be a useful tool in the remote monitoring of patients and has demonstrated accuracy for HR. However, further research is needed into the clinical applications of this method.
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8
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Corrigan N, Brown JM, Emsley R, Jayne DG, Walwyn REA. Surgical trial design for incorporating the effects of learning: what is the current methodological guidance, and is it sufficient? Trials 2023; 24:294. [PMID: 37095568 PMCID: PMC10127059 DOI: 10.1186/s13063-023-07265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Surgical interventions are complex. Key elements of this complexity are the surgeon and their learning curve. They pose methodological challenges in the design, analysis and interpretation of surgical RCTs. We identify, summarise, and critically examine current guidance about how to incorporate learning curves in the design and analysis of RCTs in surgery. EXAMINING CURRENT GUIDANCE Current guidance presumes that randomisation must be between levels of just one treatment component, and that the evaluation of comparative effectiveness will be made via the average treatment effect (ATE). It considers how learning effects affect the ATE, and suggests solutions which seek to define the target population such that the ATE is a meaningful quantity to guide practice. We argue that these are solutions to a flawed formulation of the problem, and are inadequate for policymaking in this setting. REFORMULATING THE PROBLEM The premise that surgical RCTs are limited to single-component comparisons, evaluated via the ATE, has skewed the methodological discussion. Forcing a multi-component intervention, such as surgery, into the framework of the conventional RCT design ignores its factorial nature. We briefly discuss the multiphase optimisation strategy (MOST), which for a Stage 3 trial would endorse a factorial design. This would provide a wealth of information to inform nuanced policy but would likely be infeasible in this setting. We discuss in more depth the benefits of targeting the ATE conditional on operating surgeon experience (CATE). The value of estimating the CATE for exploring learning effects has been previously recognised, but with discussion limited to analysis methods only. The robustness and precision of such analyses can be ensured via the trial design, and we argue that trial designs targeting CATE represent a clear gap in current guidance. CONCLUSION Trial designs that facilitate robust, precise estimation of the CATE would allow for more nuanced policymaking, leading to patient benefit. No such designs are currently forthcoming. Further research in trial design to facilitate the estimation of the CATE is needed.
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Affiliation(s)
- Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Rebecca E A Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Smith MAA, Khot MI, Taccola S, Fry NR, Muhonen PL, Tipper JL, Jayne DG, Kay RW, Harris RA. A digitally driven manufacturing process for high resolution patterning of cell formations. Biomed Microdevices 2023; 25:16. [PMID: 37084116 PMCID: PMC10121500 DOI: 10.1007/s10544-023-00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
This paper presents the engineering and validation of an enabling technology that facilitates new capabilities in in vitro cell models for high-throughput screening and tissue engineering applications. This is conducted through a computerized system that allows the design and deposition of high-fidelity microscale patterned coatings that selectively alter the chemical and topographical properties of cell culturing surfaces. Significantly, compared to alternative methods for microscale surface patterning, this is a digitally controlled and automated process thereby allowing scientists to rapidly create and explore an almost infinite range of cell culture patterns. This new capability is experimentally validated across six different cell lines demonstrating how the precise microscale deposition of these patterned coatings can influence spatiotemporal growth and movement of endothelial, fibroblast, neuronal and macrophage cells. To further demonstrate this platform, more complex patterns are then created and shown to guide the behavioral response of colorectal carcinoma cells.
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Affiliation(s)
- Matthew A A Smith
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M Ibrahim Khot
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Silvia Taccola
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Nicholas R Fry
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Pirkko L Muhonen
- Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Joanne L Tipper
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK
- School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - David G Jayne
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Robert W Kay
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Russell A Harris
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, LS2 9JT, UK.
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10
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Kitchen WR, Downey CL, Brown JM, Jayne DG, Randell R. Participants' Perspectives of Their Involvement in Medical Device Trials: A Focus Groups Study. Surg Innov 2022; 29:804-810. [PMID: 35451350 DOI: 10.1177/15533506221089824] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical technologies have the potential to improve quality and efficiency of healthcare. The design of clinical trials should consider participants' perspectives to optimise enrolment, engagement and satisfaction. This study aims to assess patients' perceptions of their involvement in medical device trials, to inform the designs of future medical technology implementation and evaluation. METHODS Four focus groups were undertaken with a total of 16 participants who had participated in a study testing hospital inpatient remote monitoring devices. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. RESULTS Four main themes emerged: patients' motivations for participating in medical device research; patients' perceptions of technology in medicine; patients' understanding of trial methodology; and patients' perceptions of the benefits of involvement in medical device trials. The appeal of new technology is a contributing factor to the decision to consent, although concerns remain regarding risks associated with technology in healthcare settings. Perceived benefits of participating in device trials include extra care, social benefits and comradery with other participants seen using the devices, although there is a perceived lack of confidence in using technology amongst older patients. CONCLUSION Future device trials should prioritise information sharing with participants both before and after the trial. Verbal and written information alongside practical demonstrations can help to combat a lack of confidence with technology. Randomised trials and those with placebo- or sham-controlled arms should not be considered as barriers to participation. Study results should be disseminated to participants in lay format as soon as possible, subject to participant permission.
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Affiliation(s)
- William R Kitchen
- Leeds Teaching Hospitals NHS Trust, 4472St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Candice L Downey
- Leeds Institute of Medical Research at St James's, 560979University of Leeds, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, Worsley Building, 578503University of Leeds, Leeds, LS2 9NL, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James's, 560979University of Leeds, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Rebecca Randell
- Faculty of Health Studies, 14260University of Bradford, Bradford, BD7 1DP, UK
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11
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Helliwell JA, Thompson J, Smart N, Jayne DG, Chapman SJ. Duplication and nonregistration of COVID‐19 systematic reviews: Bibliometric review. Health Sci Rep 2022; 5:e541. [PMID: 35509384 PMCID: PMC9059200 DOI: 10.1002/hsr2.541] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives This study examines the conduct of systematic reviews during the early stages of the COVID‐19 pandemic, including compliance to protocol registration and duplication of reviews on similar topics. The methodological and reporting quality were also explored. Methods A cross‐sectional, bibliometric study was undertaken of all systematic review manuscripts on a COVID‐19 intervention published between January 1st and June 30th, 2020. Protocol registration on a publicly accessible database was recorded. Duplication was determined by systematically recording the number of reviews published on each topic of analysis. Methodological quality and reporting quality were assessed using the AMSTAR‐2 and PRISMA 2009 instruments, respectively. Results Thirty‐one eligible systematic reviews were identified during the inclusion period. The protocol of only four (12.9%) studies was registered on a publicly accessible database. Duplication was frequent, with 15 (48.4%) of the 31 included studies focusing on either hydroxychloroquine (and/or chloroquine) or corticosteroids. Only one study (3.2%) was of “high” methodological quality, four (12.9%) were “low” quality, and the remainder (n = 26, 83.9%) were of “critically low” quality. The median completeness of reporting was 20 out of 27 items (74.1%) with a range of 5–26 (interquartile range: 14–23). Conclusion Systematic reviews during the early stages of the COVID‐19 pandemic were uncommonly registered, frequently duplicated, and mostly of low methodological quality. In contrast, the reporting quality of manuscripts was generally good but varied substantially across published reports. There is a need for heightened stewardship of systematic review research, particularly during times of medical crisis where the generation of primary evidence may be rapid and unstable.
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Affiliation(s)
- Jack A. Helliwell
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds UK
| | - Joe Thompson
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds UK
| | - Neil Smart
- Department of General Surgery Royal Devon and Exeter Hospital Exeter UK
| | - David G. Jayne
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds UK
| | - Stephen J. Chapman
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds UK
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12
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Kim WS, Khot MI, Woo HM, Hong S, Baek DH, Maisey T, Daniels B, Coletta PL, Yoon BJ, Jayne DG, Park SI. AI-enabled, implantable, multichannel wireless telemetry for photodynamic therapy. Nat Commun 2022; 13:2178. [PMID: 35449140 PMCID: PMC9023557 DOI: 10.1038/s41467-022-29878-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Photodynamic therapy (PDT) offers several advantages for treating cancers, but its efficacy is highly dependent on light delivery to activate a photosensitizer. Advances in wireless technologies enable remote delivery of light to tumors, but suffer from key limitations, including low levels of tissue penetration and photosensitizer activation. Here, we introduce DeepLabCut (DLC)-informed low-power wireless telemetry with an integrated thermal/light simulation platform that overcomes the above constraints. The simulator produces an optimized combination of wavelengths and light sources, and DLC-assisted wireless telemetry uses the parameters from the simulator to enable adequate illumination of tumors through high-throughput (<20 mice) and multi-wavelength operation. Together, they establish a range of guidelines for effective PDT regimen design. In vivo Hypericin and Foscan mediated PDT, using cancer xenograft models, demonstrates substantial suppression of tumor growth, warranting further investigation in research and/or clinical settings.
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Affiliation(s)
- Woo Seok Kim
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - M Ibrahim Khot
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Hyun-Myung Woo
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Sungcheol Hong
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Dong-Hyun Baek
- Department of Display and Semiconductor Engineering, Sun Moon University, Asan-si, Republic of Korea
| | - Thomas Maisey
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Brandon Daniels
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - P Louise Coletta
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Byung-Jun Yoon
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
- Computational Science Initiative, Brookhaven National Laboratory, Upton, NY, USA.
| | - David G Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
| | - Sung Il Park
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
- Institute for Neuroscience, Texas A&M University, College Station, TX, USA.
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13
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Chapman SJ, Naylor M, Czoski Murray CJ, Tolan D, Stocken DD, Jayne DG. Non-invasive, vagus nerve stimulation to reduce ileus after colorectal surgery: protocol for a feasibility trial with nested mechanistic studies. BMJ Open 2021; 11:e046313. [PMID: 34290065 PMCID: PMC8296772 DOI: 10.1136/bmjopen-2020-046313] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Ileus is a common and distressing condition characterised by gut dysfunction after surgery. While a number of interventions have aimed to curtail its impact on patients and healthcare systems, ileus is still an unmet challenge. Electrical stimulation of the vagus nerve is a promising new treatment due to its role in modulating the neuro-immune axis through a novel anti-inflammatory reflex. The protocol for a feasibility study of non-invasive vagus nerve stimulation (nVNS), and a programme of mechanistic and qualitative studies, is described. METHODS AND ANALYSIS This is a participant-blinded, parallel-group, randomised, sham-controlled feasibility trial (IDEAL Stage 2b) of self-administered nVNS. One hundred forty patients planned for elective, minimally invasive, colorectal surgery will be randomised to four schedules of nVNS before and after surgery. Feasibility outcomes include assessments of recruitment and attrition, adequacy of blinding and compliance to the intervention. Clinical outcomes include bowel function and length of hospital stay. A series of mechanistic substudies exploring the impact of nVNS on inflammation and bowel motility will inform the design of the final stimulation schedule. Semistructured interviews with participants will explore experiences and perceptions of the intervention, while interviews with patients who decline participation will explore barriers to recruitment. ETHICS AND DISSEMINATION The protocol has been approved by the Tyne and Wear South National Health Service (NHS) Research Ethics Committee (19/NE/0217) on 2 July 2019. Feasibility, mechanistic and qualitative findings will be disseminated to national and international partners through peer-reviewed publications, academic conferences, social media channels and stakeholder engagement activities. The findings will build a case for or against progression to a definitive randomised assessment as well as informing key elements of study design. TRIAL REGISTRATION NUMBER ISRCTN62033341.
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Affiliation(s)
- Stephen J Chapman
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Maureen Naylor
- West Riding of Yorkshire Ileostomy Association, Leeds, UK
| | | | | | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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14
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Armstrong GR, Khot MI, Tiernan JP, West NP, Perry SL, Maisey TI, Hughes TA, Jayne DG. The utility of c-Met as a diagnostic tissue biomarker in primary colorectal cancer. Int J Exp Pathol 2021; 102:172-178. [PMID: 33951261 PMCID: PMC8139376 DOI: 10.1111/iep.12395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
The transmembrane protein, cMet, is thought to be overexpressed and activated in colorectal cancer (CRC). This study explored its potential as a diagnostic tissue biomarker for CRC in a large human CRC tissue collection obtained from a randomized clinical trial. Tissue microarrays of matched normal colorectal epithelium and primary cancer were prepared from specimens obtained from 280 patients recruited to the MRC CLASICC trial (ISRCTN 74883561) and interrogated using immunohistochemistry for cMet expression. The distribution and intensity of immunopositivity was graded using a validated, semiquantifiable score, and differences in median scores analysed using the Wilcoxon signedrank test. A receiver operating characteristic (ROC) curve was plotted to measure the diagnostic accuracy of cMet as a biomarker in CRC. Epithelial cell membrane expression of cMet differed significantly between CRC and normal colorectal tissue: median 12.00 (Interquartile range (IQR) 615) versus median 6.00 (IQR 2.7012.00) respectively (P=<.0001). ROCAUC analysis of cMet expression yielded a CRC diagnostic probability of 0.66 (95% CI: 0.61 to 0.70; P<.0001). A score of 14.50 showed high specificity at 85.32% (95% CI 80.33%89.45%) but sensitivity of only 30.92% (CI 25.37%36.90%). Thus cMet is consistently overexpressed in human CRC as compared to normal colorectal epithelium tissue. cMet expression may have a role in diagnosis and prognostication if combined with other biomarkers.
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Affiliation(s)
- Gemma R Armstrong
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mohammed Ibrahim Khot
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK
| | | | - Nick P West
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah L Perry
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK
| | - Tom I Maisey
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK
| | - Thomas A Hughes
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
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15
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Chapman SJ, Helliwell JA, Naylor M, Tassinari C, Corrigan N, Jayne DG. Noninvasive vagus nerve stimulation to reduce ileus after major colorectal surgery: early development study. Colorectal Dis 2021; 23:1225-1232. [PMID: 33539637 DOI: 10.1111/codi.15561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/02/2020] [Revised: 01/20/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022]
Abstract
AIM Vagus nerve stimulation has emerged as a plausible intervention to reduce ileus after surgery. An early development study was undertaken with the aim of exploring the feasibility of self-administered, noninvasive vagus nerve stimulation (nVNS) after major colorectal surgery. METHOD A parallel-group, randomized controlled trial was undertaken between 1 January 2018 and 31 August 2019. Forty patients undergoing colorectal surgery for malignancy were allocated equally to Sham and Active stimulation groups. Electrical vagus nerve stimulation was self-administered bilaterally over the cervical surface landmarks for 5 days before and after surgery. Outcomes of interest were postoperative complications and adverse events measured using the Clavien-Dindo scale, treatment compliance, device usability according to the Systems Usability Scale (SUS) and clinical measures of bowel recovery. RESULTS Forty patients were randomized and one withdrew, leaving 39 for analysis. Postoperative complications occurred in 9/19 (47.4%) participants receiving Sham and 11/20 (55.0%) receiving Active stimulation and were mostly minor. Compliance with treatment before surgery was 4.7 ± 0.9 days out of 5 days in the Sham group and 4.7 ± 1.1 in the Active group. Compliance with treatment after surgery was 4.1 ± 1.1 and 4.4 ± 1.5, respectively. Participants considered the intervention to be 'acceptable' according to the SUS. The most prominent differences in bowel recovery were days to first flatus (2.35 ± 1.32 vs 1.65 ± 0.88) and tolerance of solid diet (2.18 ± 2.21 vs 1.75 ± 0.91) for Sham and Active groups, respectively. CONCLUSION This study supports the safety, treatment compliance and usability of self-administered nVNS in patients undergoing major colorectal surgery.
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Affiliation(s)
- Stephen J Chapman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jack A Helliwell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maureen Naylor
- West Yorkshire Ileostomy and Internal Pouch Association, Leeds, UK
| | - Cerys Tassinari
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Neil Corrigan
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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16
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Armstrong G, Toogood G, Jayne DG, Smith AM. P11: NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE FEASIBILITY STUDY. THE OPTIMUM DOSING REGIME, LIMITATIONS AND WHERE NEXT? Br J Surg 2021. [DOI: 10.1093/bjs/znab117.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
This study explored near-infrared fluorescent cholangiography (NIRFC) with Indocyanine Green (ICG) during laparoscopic cholecystectomy (LC) surgery in a tertiary referral hepatobiliary unit. ICG binds to albumin and is excreted in bile. NIRFC utilises the fluorescent and excretory properties of ICG to provide dynamic extrahepatic bile duct mapping during LC.
Method
Non-randomised single centre feasibility study. Twenty-two participants were sequentially allocated to four dosing subgroups prior to NIRFC assisted LC. Each received a single intravenous dose of ICG prior to LC with the Stryker Novadaq NIR laparoscope. The biliary anatomy was assessed with NIRFC at three time-points, detection was compared to radiological cholangiogram where available and surgeon satisfaction was assessed.
Result
Eight participants received 2.5mg ICG 20-40min before surgery, four 0.25mg/kg 20-40min, five 90min – 180min and five 12 – 36 hour pre-operatively. Average age 50 years (S.D±15), BMI 27.5m2 (S.D±3.6), 6/22 were acute LC procedures. The prolonged dosing interval produced increased extrahepatic biliary structure identification (p = 0.016), reduced noise to signal ratio and was consistently preferred by the operating surgeon. NIRFC was inferior to radiological cholangiogram (n = 10) (p = 0.014) for bile duct mapping. We observed iatrogenic bile spillage saturating the field and obscuring structure differentiation and peri-hilar inflammation impeding fluorescent detection in acute LC.
Conclusion
The dosing regimen 0.25mg/kg ICG 12 to 36 hours prior to surgery provides optimum NIRFC structure visualisation. Fluorescent tissue penetrance is limited in acute peri-hilar inflammation. More research in to the efficiency of NIRFC in emergency LC is required.
Take-home message
An intravenous dose of 0.25mg/kg of Indocyanine Green 12 to 36 hours before surgery is the optimum dosing regimen for increased extra-hepatic bile duct structures with near infrared fluorescent cholangiography. The role of NIRFC in acute laparoscopic cholecystectomy surgery remains ill-defined.
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Affiliation(s)
| | - G Toogood
- University of Leeds, Leeds UK
- Leeds Teaching Hospital Trust, Leeds, UK
| | - DG Jayne
- University of Leeds, Leeds UK
- Leeds Teaching Hospital Trust, Leeds, UK
| | - AM Smith
- University of Leeds, Leeds UK
- Leeds Teaching Hospital Trust, Leeds, UK
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17
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Khot MI, Levenstein M, Coppo R, Kondo J, Inoue M, Kapur N, Jayne DG. O23: CHARACTERISING PATIENT-DERIVED COLORECTAL CANCER TISSUE-ORIGINATED ORGANOIDAL SPHEROIDS FOR HIGH-THROUGHPUT MICROFLUIDIC APPLICATIONS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Three-dimensional (3D) cell models have gained reputation as better representations of in vivo cancers as compared to monolayered cultures. Recently, patient tumour tissue-derived organoids have advanced the scope of complex in vitro models, by allowing patient-specific tumour cultures to be generated for developing new medicines and patient-tailored treatments. Integrating 3D cell and organoid culturing into microfluidics, can streamline traditional protocols and allow complex and precise high-throughput experiments to be performed with ease.
Method
Patient-derived colorectal cancer tissue-originated organoidal spheroids (CTOS) cultures were acquired from Kyoto University, Japan. CTOS were cultured in Matrigel and stem-cell media. CTOS were treated with 5-fluorouracil and cytotoxicity evaluated via fluorescent imaging and ATP assay. CTOS were embedded, sectioned and subjected to H&E staining and immunofluorescence for ABCG2 and Ki67 proteins. HT29 colorectal cancer spheroids were produced on microfluidic devices using cell suspensions and subjected to 5-fluorouracil treatment via fluid flow. Cytotoxicity was evaluated through fluorescent imaging and LDH assay.
Result
5-fluorouracil dose-dependent reduction in cell viability was observed in CTOS cultures (p<0.01). Colorectal CTOS cultures retained the histology, tissue architecture and protein expression of the colonic epithelial structure. Uniform 3D HT29 spheroids were generated in the microfluidic devices. 5-fluorouracil treatment of spheroids and cytotoxic analysis was achieved conveniently through fluid flow.
Conclusion
Patient-derived CTOS are better complex models of in vivo cancers than 3D cell models and can improve the clinical translation of novel treatments. Microfluidics can streamline high-throughput screening and reduce the practical difficulties of conventional organoid and 3D cell culturing.
Take-home message
Organoids are the most advanced in vitro models of clinical cancers. Microfluidics can streamline and improve traditional laboratory experiments.
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Affiliation(s)
- MI Khot
- School of Medicine, University of Leeds, UK
- School of Mechanical Engineering, University of Leeds, UK
| | - M Levenstein
- School of Mechanical Engineering, University of Leeds, UK
| | - R Coppo
- Graduate School of Medicine, Kyoto University, Japan
| | - J Kondo
- Graduate School of Medicine, Kyoto University, Japan
| | - M Inoue
- Graduate School of Medicine, Kyoto University, Japan
| | - N Kapur
- School of Mechanical Engineering, University of Leeds, UK
| | - DG Jayne
- School of Medicine, University of Leeds, UK
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18
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Armstrong G, Portal C, Khot MI, West NP, Maisey T, Perry S, Tolan D, Jayne DG. O65: C-MET PROTEIN AS A COLORECTAL CANCER BIOMARKER FOR FLUORESCENCE IMAGE-GUIDED SURGERY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The c-Met transmembrane protein is vital for cell differentiation and migration and is overexpressed in many gastrointestinal cancers. This study aimed to investigate a novel c-Met targeted peptide coupled to a fluorophore (EMI-137, Edinburgh Molecular Imaging Ltd.) for use in fluorescence image-guided colorectal cancer (CRC) surgery.
Method
A high c-Met expressing cell-line, HT29, was identified with temporary RNA suppression and used to develop a mouse xenograph CRC model. Tumours were allowed to grow to 10mm. EMI-137 was injected into the tail vein and biodistribution analysed using the IVIS system.
Nine patients undergoing elective surgery for colon cancer received a single IV dose EMI-137 1-3 hours before surgery. Tumour and LN fluorescence was assessed with a prototype Karl Storz laparoscope. Intraoperative fluorescence was correlated with radiological and pathological TNM stage and tissue c-Met expression using immunohistochemistry.
Result
The HT29 xenograph CRC model demonstrated selective EMI-137 uptake and fluorescence 1- 6 hours post administration. Nine participants aged 67-77 years received EMI-137 106 minutes (S.D±17) before surgery. Marked background fluorescence was observed in all patients. 4/9 (44%) patients showed mild increase in tumour fluorescence over background. 5/9 patients had histological LN disease, but no fluorescent nodes were detected intraoperatively. There was no correlation with T-stage. At histopathological assessment 8/9 participants showed moderate or high tumour c-Met expression. 8/8 malignant LNs demonstrated high c-Met expression.
Conclusion
EMI-137 is specific for human c-Met in 2D and xenograph CRC models. EMI-137 is safe for human use but its utility is limited by insufficient tumour-to-background ratios.
Take-home message
This first-in-man study of a novel fluorescent peptide targeted to the c-Met receptor, found EMI-137 lacked the sensitivity and specificity to accurately map the tumour margins and lymph node burden in laparoscopic colonic cancer resection surgery.
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Affiliation(s)
| | - C Portal
- Edinburgh Molecular Imaging Ltd, Edinburgh UK
| | - MI Khot
- University of Leeds, Leeds UK
| | - NP West
- University of Leeds, Leeds UK
- Leeds Teaching Hospital Trust
| | | | - S Perry
- University of Leeds, Leeds UK
| | - D Tolan
- Leeds Teaching Hospital Trust
| | - DG Jayne
- University of Leeds, Leeds UK
- Leeds Teaching Hospital Trust
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19
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Helliwell JA, Chapman SJ, Jayne DG. P14: DISCONTINUATION AND NON-PUBLICATION OF SURGICAL RANDOMISED CONTROLLED TRIALS IN THE SETTING OF ILEUS: OBSERVATIONAL STUDY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Once regarded as an inevitable occurrence after surgery, ileus is now recognised as an unmet clinical need. Despite this, few studies have shown meaningful clinical benefit which may be due to the challenges associated with conducting trials in this setting. The aim of this study was to determine the rate of discontinuation and non-publication of randomised controlled trials (RCTs) in the setting of ileus.
Method
A systematic search of ClinicalTrials.gov was performed using the keyword “ileus”. RCTs registered between 2003-2019 involving abdominal surgery were eligible. Studies were divided according to completion status. Authors were contacted to seek information about the circumstances for discontinuation and non-publication. For completed studies, evidence of a published manuscript was sought.
Result
Of 262 trials identified, 81 were eligible for analysis. Amongst 27 discontinued trials, email addresses were identified for 24 (88.9%) and replies received from 6 (25.1%). The most common reasons for discontinuation were loss of clinical significance (n=2) and insufficient recruitment (n=2). Amongst 54 completed studies, manuscripts were identified for 34 (63.0%). Of these, email addresses were identified for 12 (60.0%) and replies received from 5 (41.7%). The most common reason for non-publication was a lack of time/resources/personnel (n=3).
Conclusion
One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments.
Take-home message
One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments.
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Affiliation(s)
- JA Helliwell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - SJ Chapman
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - DG Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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20
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Suresh N, Karanth R, Jayne DG, Del Galdo F. Fecal incontinence and scleroderma: Pathogenesis and unmet needs. Best Pract Res Clin Rheumatol 2021; 35:101686. [PMID: 33895093 DOI: 10.1016/j.berh.2021.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Scleroderma is a chronic autoimmune disorder involving multiple organs and very commonly the gastrointestinal (GI) system; nevertheless, data on the involvement of the anal sphincter and consequent faecal incontinence (FI) are inadequate. FI in scleroderma was first reported in 1994 by Engel and colleagues, but its impact of added health care costs and declining quality of life (QoL) is poorly determined. Up to 40% of patients with GI involvement complain of FI, however, the quality of data available is poor owing to majority of the studies being retrospective and case reports or series of small study size. A direct involvement of internal anal sphincter muscularis propria has been demonstrated on anorectal ultrasound imaging suggesting a thin, atrophic or scarred internal sphincter. Treatment guidelines for incontinence in scleroderma are mainly symptomatic, with radical surgeries burdened by poor outcomes. Sacral neuromodulation is being used with good outcomes in a subgroup of patients, but larger, controlled studies are required to assess its efficacy on symptoms and prognosis.
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Affiliation(s)
- Nikhil Suresh
- Raynaud's and Scleroderma Programme, NIHR Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Ranjitha Karanth
- Raynaud's and Scleroderma Programme, NIHR Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - David G Jayne
- St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Francesco Del Galdo
- Raynaud's and Scleroderma Programme, NIHR Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
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21
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Khan JS, Ahmad A, Odermatt M, Jayne DG, Ahmad NZ, Kandala N, West NP. Robotic complete mesocolic excision with central vascular ligation for right colonic tumours - a propensity score-matching study comparing with standard laparoscopy. BJS Open 2021; 5:6218128. [PMID: 33834204 PMCID: PMC8032963 DOI: 10.1093/bjsopen/zrab016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Laparoscopic complete mesocolic excision (CME) of the right colon with central vascular ligation (CVL) is a technically demanding procedure. This study retrospectively evaluated the feasibility, safety and oncological outcomes of the procedure when performed using the da Vinci® robotic system. METHODS A prospective case series was collected over 3 years for patients with right colonic cancers treated by standardized robotic CME with CVL using the superior mesenteric vessels first approach. The CME group was compared to a 2 : 1 propensity score-matched non-CME group who had conventional laparoscopic right colectomy with D2 nodal dissection. Primary outcomes were total lymph node harvest and length of specimen. Secondary outcomes were operative time, postoperative complications, and disease-free and overall survival. RESULTS The study included 120 patients (40 in the CME group and 80 in the non-CME group). Lymph node yield was higher (29 versus 18, P = 0.006), the specimen length longer (322 versus 260 mm, P = 0.001) and median operative time was significantly longer (180 versus 130 min, P < 0.001) with robotic CME versus laparoscopy, respectively. Duration of hospital stay was longer with robotic CME, although not significantly (median 6 versus 5 days, P = 0.088). There were no significant differences in R0 resection rate, complications, readmission rates and local recurrence. A trend in survival benefit with robotic CME for disease-free (P = 0.0581) and overall survival (P = 0.0454) at 3 years was documented. CONCLUSION Robotic CME with CVL is feasible and, although currently associated with a longer operation time, it provides good specimen quality, higher lymph node yield and acceptable morbidity, with a disease-free survival advantage.
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Affiliation(s)
- J S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, UK.,School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - A Ahmad
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - M Odermatt
- Department of Surgery, Triemli City Hospital, Zurich, Switzerland
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - N Z Ahmad
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - N Kandala
- Faculty of Sciences, School of Health & Care Professions, University of Portsmouth, UK
| | - N P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, UK
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22
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Chapman SJ, Czoski Murray C, Lonsdale MDS, Boyes S, Tiernan JP, Jayne DG. Information needs for recovery after colorectal surgery: a patient focus group study. Colorectal Dis 2021; 23:975-981. [PMID: 33249732 DOI: 10.1111/codi.15459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022]
Abstract
AIM The provision of information to patients is an important part of recovery after colorectal surgery. This study aimed to define patient information needs, barriers to effective understanding and insights into how information provision may be improved. METHOD A patient focus group was convened. This comprised a broad, convenience sample of 11 participants from across the United Kingdom with experience of major colorectal surgery. A semistructured topic guide was used to facilitate discussion about previous experiences of information provision and how this may be improved. Data were analysed thematically and are presented as major themes. RESULTS Overall, participants felt that their information needs are poorly prioritized by healthcare professionals. Barriers to understanding and retaining information include highly emotional situations (such as receiving bad news) and inappropriate information design (such as the use of inaccessible language). Participants expressed how information resources should: (a) address patients' individual information needs; (b) empower patients to take an active role in their recovery; (c) support patients with meaningful education and sign-posted resources; and (d) recognize patients' heightened need for information during recovery at home. CONCLUSION This study provides key insights into the information needs of patients undergoing colorectal surgery. These should inform the development of future information resources, whose format, timing and design are currently supported by low-quality evidence.
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Affiliation(s)
- Stephen J Chapman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | | | - Sheila Boyes
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jim P Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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23
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Jayne DG, Williams AE, Corrigan N, Croft J, Pullan A, Napp V, Kelly R, Meads D, Vargas-Palacios A, Martin A, Hulme C, Brown SR, Nugent K, Lodge J, Protheroe D, Maslekar S, Clarke A, Nisar P, Brown JM. Sacral nerve stimulation versus the magnetic sphincter augmentation device for adult faecal incontinence: the SaFaRI RCT. Health Technol Assess 2021; 25:1-96. [PMID: 33752794 DOI: 10.3310/hta25180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Preliminary studies using the FENIX™ (Torax Medical, Minneapolis, MN, USA) magnetic sphincter augmentation device suggest that it is safe to use for the treatment of adult faecal incontinence, but efficacy data are limited. OBJECTIVE To compare FENIX with sacral nerve stimulation for the treatment of adult faecal incontinence in terms of safety, efficacy, quality of life and cost-effectiveness. DESIGN, SETTING AND PARTICIPANTS Multicentre, parallel-group, unblinded, randomised trial comparing FENIX with sacral nerve stimulation in participants suffering moderate to severe faecal incontinence. INTERVENTIONS Participants were randomised on an equal basis to either sacral nerve stimulation or FENIX. Follow-up occurred 2 weeks postoperatively and at 6, 12 and 18 months post randomisation. MAIN OUTCOME AND MEASURE The primary outcome was success, defined as device in use and ≥ 50% improvement in Cleveland Clinic Incontinence Score at 18 months post randomisation. Secondary outcomes included complication rates, quality of life and cost-effectiveness. Between 30 October 2014 and 23 March 2017, 99 participants were randomised across 18 NHS sites (50 participants to FENIX vs. 49 participants to sacral nerve stimulation). The median time from randomisation to FENIX implantation was 57.0 days (range 4.0-416.0 days), and the median time from randomisation to permanent sacral nerve stimulation was 371.0 days (range 86.0-918.0 days). A total of 45 out of 50 participants underwent FENIX implantation and 29 out of 49 participants continued to permanent sacral nerve stimulation. The following results are reported, excluding participants for whom the corresponding outcome was not evaluable. Overall, there was success for 10 out of 80 (12.5%) participants, with no statistically significant difference between the two groups [FENIX 6/41 (14.6%) participants vs. sacral nerve stimulation 4/39 (10.3%) participants]. At least one postoperative complication was experienced by 33 out of 45 (73.3%) participants in the FENIX group and 9 out of 40 (22.5%) participants in the sacral nerve stimulation group. A total of 15 out of 50 (30%) participants in the FENIX group ultimately had to have their device explanted. Slightly higher costs and quality-adjusted life-years (incremental = £305.50 and 0.005, respectively) were observed in the FENIX group than in the sacral nerve stimulation group. This was reversed over the lifetime horizon (incremental = -£1306 and -0.23 for costs and quality-adjusted life-years, respectively), when sacral nerve stimulation was the optimal option (net monetary benefit = -£3283), with only a 45% chance of FENIX being cost-effective. LIMITATIONS The SaFaRI study was terminated in 2017, having recruited 99 participants of the target sample size of 350 participants. The study is, therefore, substantially underpowered to detect differences between the treatment groups, with significant uncertainty in the cost-effectiveness analysis. CONCLUSIONS The SaFaRI study revealed inefficiencies in the treatment pathways for faecal incontinence, particularly for sacral nerve stimulation. The success of both FENIX and sacral nerve stimulation was much lower than previously reported, with high postoperative morbidity in the FENIX group. FUTURE WORK Further research is needed to clarify the treatment pathways for sacral nerve stimulation and to determine its true clinical and cost-effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN16077538. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David G Jayne
- Academic Surgery, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Annabelle E Williams
- Colorectal and General Surgery, Milton Keynes University Hospital, Milton Keynes, UK
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alison Pullan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Vicky Napp
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rachel Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Armando Vargas-Palacios
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Steven R Brown
- Department of Colorectal Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Jen Lodge
- Bowel Health and Pelvic Floor Dysfunction Community Urology and Colorectal Service (CUCS), Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Protheroe
- Department of Liaison Psychiatry, Leeds General Infirmary, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Sushil Maslekar
- St James's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Pasha Nisar
- St Peter's Hospital, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Julia M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Jayne DG, Scholefield J, Tolan D, Gray R, Senapati A, Hulme CT, Sutton AJ, Handley K, Hewitt CA, Kaur M, Magill L. A Multicenter Randomized Controlled Trial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis Anal Fistula Plug Versus Surgeon's Preference for Transsphincteric Fistula-in-Ano: The FIAT Trial. Ann Surg 2021; 273:433-441. [PMID: 32516229 DOI: 10.1097/sla.0000000000003981] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To undertake a randomized comparison of the Biodesign Surgisis anal fistula plug against surgeon's preference in treating cryptoglandular transsphincteric fistula-in-ano. SUMMARY BACKGROUND DATA The efficacy of the Biodesign Surgisis anal fistula plug in healing anal fistulae is uncertain. METHODS Participants were randomized to the fistula plug with surgeon's preference (advancement flap, cutting seton, fistulotomy, Ligation of the Intersphincteric Fistula Tract procedure). The primary outcome was faecal incontinence quality of life (FIQoL) at 12-months. Secondary outcomes were fistula healing, incontinence rates, and complication and reintervention rates. RESULTS Between May 2011 and March 2016, 304 participants were randomized to fistula plug or surgeon's preference. No differences were seen in FIQoL between the 2 groups at 12 months. Clinical fistula healing was reported in 66/122 (54%) of the fistula plug and 66/119 (55%) of the surgeon's preference groups at 12 months. Fecal incontinence rates improved marginally in both the groups. Complications and reinterventions were frequent, with significantly more complications in the fistula plug group at 6-weeks (49/142, 35% vs 25/137, 18%; P=0.002). The mean total costs were £2738 (s.d. £1151) for the fistula plug and £2308 (s.d. £1228) for the surgeon's preference group (mean difference +£430, P=0.0174). The average total quality adjusted life years (QALYs) gained was marginally higher in the fistula plug group. The fistula plug was 35% to 45% likely to be cost-effective across a willingness to pay threshold of £20,000 to £30,000 / QALY. CONCLUSIONS The Biodesign Surgisis anal fistula plug is associated with similar FIQoL and healing rates to surgeon's preference at 12 months. Higher costs and highly uncertain gains in QALYs mean that the fistula plug may not be considered as a cost-effective treatment in the UK NHS.
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Affiliation(s)
| | | | | | - Richard Gray
- Nuffield Department of Population Health Medicine Sciences Division, University of Oxford, Oxford, UK
| | | | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Kelly Handley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Manjinder Kaur
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
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Stefan S, Khan JS, Ahmad A, Odermatt M, Jayne DG, Ahmad NZ, Kandala N, West NP. Robotic complete mesocolic excision with central vascular ligation for right colonic tumours—technical notes and oncological outcomes compared to a propensity score-matched laparoscopic group. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Maslekar T, Peat S, Karim J, Moriarty C, Jayne DG, Chapman SJ. The reporting of coenrolment in protocols of publicly funded randomized controlled trials was infrequent and variable. J Clin Epidemiol 2021; 133:94-100. [PMID: 33484839 DOI: 10.1016/j.jclinepi.2021.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/12/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the approach to participant coenrolment in publicly funded randomized controlled trials (RCTs) and to consider its impact on study recruitment. STUDY DESIGN AND SETTING A cross-sectional study of the UK National Institute for Health Research Journals Library was undertaken. RCTs funded between 2010 and 2019 were eligible. The reporting of coenrolment criteria was assessed through inspection of publicly available study protocols. Where present, the approach to coenrolment was examined, including circumstances in which it was permitted/prohibited and the mechanism for decision-making. For completed RCTs, the impact on recruitment was explored by comparing rates of early recruitment (completion before the expected end date) and extensions (completion after the expected end date) between studies, which did and did not permit coenrolment. RESULTS Of 219 eligible protocols, coenrolment was addressed in 94 (42.9%). Twenty-three (24.5%) of these did not allow recruitment to multiple studies, while 71 (75.5%) permitted it according to a series of caveats, including considerations of study outcomes, intervention type, and patient burden. The final decision for coenrolment rested with the local recruitment team in 57 (60.6%) and with the central organizing team in 37 (39.4%). Early completion of recruitment occurred in 8 of 64 (12.5%) RCTs where coenrolment was permitted and 5 of 20 (25.0%) where it was not (P = 0.285). An extension to recruitment time was required in 31 of 64 (48.4%) RCTs where coenrolment was permitted and 9 of 11 (45.0%) where it was not (P = 0.788). CONCLUSIONS The reporting of coenrolment in protocols of publicly funded RCTs is infrequent, and where present, the approach to decision-making is widely variable. In this study, policies of coenrolment were not associated with gains in trial recruitment.
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Affiliation(s)
- Tanaya Maslekar
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Samuel Peat
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jamshaid Karim
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Catherine Moriarty
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Stephen J Chapman
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
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Stefan S, Newbury C, Ahmad A, Odermatt M, Jayne DG, Ahmad NZ, West NP, Khan JS. SMV first approach for robotic complete mesocolic excision with central vascular ligation for right colonic tumours—comparison to a propensity score-matched laparoscopic group. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Khot MI, Inoue M, Kapur N, Jayne DG. Patient-derived colorectal organoids for microfluidics applications. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yiasemidou M, Mushtaq F, Basheer M, Galli R, Panagiotou D, Stock S, Preston N, Mon-Williams M, Jayne DG, Miskovic D. Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open 2020. [PMCID: PMC7944490 DOI: 10.1093/bjsopen/zraa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery. Methods In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT. Results Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 <0.001, where pη2 is indicative of effect size) or OCHRA scores (anterior, posterior, right and left lateral planes, transection P>0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212). Conclusion Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Academic Surgery, University of Hull, Hull, UK
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - M Basheer
- Department of Colorectal Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - R Galli
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Panagiotou
- General Surgery, York Teaching Hospital, York, UK
| | - S Stock
- General and Trauma Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - N Preston
- School of Psychology, University of Leeds, Leeds, UK
| | | | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Miskovic
- Department of Colorectal Surgery, St Mark’s Hospital, Harrow, London, UK
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Chapman SJ, Helliwell JA, Lonsdale MDS, Tiernan JP, Jayne DG. Patient education about recovery after colorectal surgery: systematic scoping review. Colorectal Dis 2020; 22:1842-1849. [PMID: 32865317 DOI: 10.1111/codi.15337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
AIM Enhanced recovery after surgery (ERAS) protocols aim to optimize recovery through a series of evidence-based recommendations. A key component of ERAS is the provision of patient education. Whilst the recommendation for this is strong, the evidence to inform its format, timing and delivery is unclear. The aim of this review was to describe previous educational interventions used to improve recovery after colorectal surgery and to explore opportunities for future research. METHODS A systematic scoping review was performed. MEDLINE and Embase databases were searched between 1 January 1990 and 12 February 2020. Studies which described or assessed the effectiveness of a patient education or information resource to improve recovery after colorectal surgery were eligible. Outcomes of interest included the format, timing and delivery of interventions, as well as key features of intervention and study design. A narrative synthesis of data was produced through a process of charting and summarizing key results. RESULTS A total of 1298 papers were inspected, and 11 were eligible for inclusion. Five papers were reports of randomized controlled trials, and others reported a mix of non-randomized and qualitative studies. The design of educational interventions included audio-visual resources (n = 3), smartphone device applications (n = 3) and approaches to facilitate person-to-person counselling (n = 5). Most of the counselling interventions reported positive outcomes (mainly in length of hospital stay), whereas the other types reported mixed results. Patients and the public were seldom involved as collaborators in the design of interventions. CONCLUSIONS Patient education is generally advantageous, but there is insufficient evidence to optimize its design and delivery in the setting of colorectal surgery.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - J A Helliwell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - J P Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Allen APT, Bolton WS, Jalloh MB, Halpin SJ, Jayne DG, Scott JDA. Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone - a multidisciplinary patient and service provider perspective. Disabil Rehabil 2020; 44:2392-2399. [PMID: 33261506 DOI: 10.1080/09638288.2020.1836043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018. MATERIALS AND METHODS A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11). RESULTS Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services. CONCLUSIONS A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery.Implications for RehabilitationComprehensive and accessible amputee rehabilitation services can enable people with amputations to regain their independence and aid their participation in their community and workplace.There are numerous barriers to both accessing and providing amputee rehabilitation services in the Western Area, Sierra Leone, chiefly financial. We recommend a revised effort by the Sierra Leonean government to implement the progressive policies on disability they have already adopted into law, which will aid the improvement of amputee rehabilitation services. New education and training programmes for all levels of prosthetic and orthotic professions are needed to secure the future of prosthetics and orthotics in Sierra Leone.
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Affiliation(s)
- Archie P T Allen
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - William S Bolton
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Mohamed B Jalloh
- Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Stephen J Halpin
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Julian D A Scott
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds Vascular Institute, Leeds, UK
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Downey CL, Croft J, Ainsworth G, Buckley H, Shinkins B, Randell R, Brown JM, Jayne DG. Trial of remote continuous versus intermittent NEWS monitoring after major surgery (TRaCINg): a feasibility randomised controlled trial. Pilot Feasibility Stud 2020; 6:183. [PMID: 33292669 PMCID: PMC7684886 DOI: 10.1186/s40814-020-00709-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient's mobility. The aim of this study was to evaluate the feasibility, acceptability and clinical outcomes of continuous remote monitoring after major surgery. METHODS The study was a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery were randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring was achieved using the SensiumVitals® wireless patch which is worn on the patient's chest and monitors heart rate, respiratory rate and temperature continuously, and alerts the nurse when there is deviation from pre-set physiological norms. Feasibility was assessed by evaluating recruitment rate, adherence to protocol and randomisation and the amount of missing data. Clinical outcomes included time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of hospital readmission within 30 days of discharge. RESULTS One hundred and thirty-six patients were randomised between October 2018 and April 2019: 67 to the control group and 69 to the intervention group. Recruitment was completed prior to the 12 month target with a high rate of eligibility and consent. Missing data was limited only to questionnaire responses; no participants were lost to follow-up and only one participant was withdrawn due to loss of capacity. The number of patients classed as 'drop-out' due to design (8.1%) were less than anticipated, and there were no participants who crossed over into the alternative trial allocation group. Seventeen participants in the intervention group (28%) did not adhere to the monitoring protocol. No formal comparisons between arms was undertaken; however, participants had fewer unplanned critical care admissions (1 versus 5) and had a shorter average length of hospital stay (11.6 days (95% confidence interval 9.5-13.7 days) versus 16.2 days (95% confidence interval 11.3-21.2 days)) in the continuous vital signs monitoring group. The time taken to receive antibiotics in cases of sepsis was similar in both arms. A cost-utility analysis indicated that the remote monitoring system was cost-saving when compared to standard NEWS monitoring alone. CONCLUSIONS It is feasible to perform a large-scale randomised controlled trial of continuous remote monitoring after major surgery. Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring. TRIAL REGISTRATION ISRCTN registry with study ID ISRCTN16601772 . Registered 30 August 2017.
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Affiliation(s)
- C L Downey
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK.
- St James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | - J Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - G Ainsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - H Buckley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - B Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9NL, UK
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, UK
| | - J M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
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Beck RJ, Bitharas I, Hand DP, Maisey T, Moore AJ, Shires M, Thomson RR, West NP, Jayne DG, Shephard JD. Dynamics of picosecond laser ablation for surgical treatment of colorectal cancer. Sci Rep 2020; 10:20261. [PMID: 33219260 PMCID: PMC7679462 DOI: 10.1038/s41598-020-73349-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022] Open
Abstract
Endoluminal surgery for the treatment of colorectal neoplasia is typically carried out using electrocautery tools which imply limited precision and the risk of harm through collateral thermal damage to the adjacent healthy tissue. As a potential alternative, we present the successful colonic epithelial laser ablation by means of picosecond laser pulses. Laser ablation studies performed in ex-vivo colon tissue result in cavities with comparable thickness to early stage colorectal cancers. The corresponding histology sections exhibit only minimal collateral damage to the surrounding tissue and the depth of the ablation can be controlled precisely by means of the pulse energy. High-speed imaging has been used for the first time to visualize picosecond laser ablation of cancerous tissue in a clinically relevant model. This information was correlated with histopathology and optical surface profilometry revealing the dynamic nature of the laser tissue interaction and the need for temporal or spatial separation of pulses for optimum efficacy with regards to tissue removal. Overall, the application of picosecond laser pulses to ablate endoluminal bowel lesions demonstrates significantly improved precision and reduced thermal damage to the adjacent tissue in comparison to conventional procedures and hence will enable more precise surgical treatment of cancers.
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Affiliation(s)
- R J Beck
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK.
| | - I Bitharas
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - D P Hand
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - T Maisey
- Leeds Institute of Medical Research At St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - A J Moore
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - M Shires
- Leeds Institute of Medical Research At St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - R R Thomson
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - N P West
- Leeds Institute of Medical Research At St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - D G Jayne
- Leeds Institute of Medical Research At St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - J D Shephard
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
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Bolton WS, Aruparayil NK, Chauhan M, Kitchen WR, Gnanaraj KJN, Benton AM, Hutchinson SE, Burke JR, Gnanaraj J, Jayne DG, Culmer PR. Gasless Laparoscopic Surgery for Minimally Invasive Surgery in Low-Resource Settings: Methods for Evaluating Surgical Field of View and Abdominal Wall Lift Force. Surg Innov 2020; 28:513-515. [PMID: 33021887 PMCID: PMC8381594 DOI: 10.1177/1553350620964331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William S Bolton
- Leeds Institute of Medical Research at St James's, 4468University of Leeds, UK
| | - Noel K Aruparayil
- Leeds Institute of Medical Research at St James's, 4468University of Leeds, UK
| | - Manish Chauhan
- School of Mechanical Engineering, 4468University of Leeds, UK
| | - William R Kitchen
- School of Clinical Medicine, Cambridge Biomedical Campus, 2152University of Cambridge, UK
| | - Kevin J N Gnanaraj
- Department of Mechanical Engineering, 7235University of Saskatchewan, Canada
| | - Alice M Benton
- School of Mechanical Engineering, 4468University of Leeds, UK
| | | | - Joshua R Burke
- Leeds Institute of Medical Research at St James's, 4468University of Leeds, UK
| | - Jesudian Gnanaraj
- 121735Karunya Institute of Technology and Science, Coimbatore, India
| | - David G Jayne
- Leeds Institute of Medical Research at St James's, 4468University of Leeds, UK
| | - Peter R Culmer
- School of Mechanical Engineering, 4468University of Leeds, UK
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Jayne DG, Scholefield J, Tolan D, Gray R, Edlin R, Hulme CT, Sutton AJ, Handley K, Hewitt CA, Kaur M, Magill L. Anal fistula plug versus surgeon's preference for surgery for trans-sphincteric anal fistula: the FIAT RCT. Health Technol Assess 2020; 23:1-76. [PMID: 31113531 DOI: 10.3310/hta23210] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of fistula surgery is to eradicate the disease while preserving anal sphincter function. The efficacy of the Surgisis® anal fistula plug (Cook Medical, Bloomington, IN, USA) in the treatment of trans-sphincteric fistula-in-ano has been variably reported. OBJECTIVES To undertake a randomised comparison of the safety and efficacy of the Surgisis anal fistula plug in comparison with surgeon's preference for the treatment of trans-sphincteric anal fistulas. DESIGN A randomised, unblinded, parallel-arm, prospective, multicentre clinical trial. SETTING Hospitals in the UK NHS involving colorectal surgeons accredited by the Association of Coloproctology of Great Britain and Ireland. PARTICIPANTS Adult patients suffering from trans-sphincteric fistula-in-ano of cryptoglandular origin. INTERVENTIONS Patients were randomised on a 1 : 1 basis to either the fistula plug or the surgeon's preference [e.g. fistulotomy, cutting seton, advancement flap or ligation of intersphincteric fistula tract (LIFT) procedure]. MAIN OUTCOME MEASURES The primary outcome measure was quality of life as measured by the Faecal Incontinence Quality of Life (FIQoL) questionnaire at 12-month follow-up. Secondary outcome measures included clinical and radiological fistula healing rates, faecal incontinence rates, complications rates, reintervention rates and cost-effectiveness. RESULTS Between May 2011 and March 2016, 304 participants were recruited (152 fistula plug vs. 152 surgeon's preference). No difference in FIQoL score between the two trial groups was seen at the 6-week, 6-month or 12-month follow-up. Clinical evidence of fistula healing was reported in 66 of 122 (54%) participants in the fistula plug group and in 66 of 119 (55%) participants in the surgeon's preference group at 12 months. Magnetic resonance imaging (MRI) showed fistula healing in 54 of 110 (49%) participants in the fistula plug group and in 63 of 112 (56%) participants in the surgeon's preference group. Variation in 12-month clinical healing rates was observed: 55%, 64%, 75%, 53% and 42% for fistula plug, cutting seton, fistulotomy, advancement flap and LIFT procedure, respectively. Faecal incontinence rates were low at baseline, with small improvement in both groups post treatment. Complications and reinterventions were frequent. The mean total costs were £2738 [standard deviation (SD) £1151] in the fistula plug group and £2308 (SD £1228) in the surgeon's preference group. The average total quality-adjusted life-years (QALYs) gain was much smaller in the fistula plug group (0.829, SD 0.174) than in the surgeon's preference group (0.790, SD 0.212). Using multiple imputation and probabilistic sensitivity analysis, and adjusting for differences in baseline EuroQol-5 Dimensions, three-level version utility, there was a 35-45% chance that the fistula plug was as cost-effective as surgeon's preference over a range of thresholds of willingness to pay for a single QALY of £20,000-30,000. LIMITATIONS Limitations include a smaller sample size than originally calculated, a lack of blinding that perhaps biased patient-reported outcomes and a lower compliance rate with MRI at 12-month follow-up. CONCLUSIONS The Surgisis anal fistula plug is associated with similar FIQoL score to surgeon's preference at 12-month follow-up. The higher costs and highly uncertain and small gains in QALYs associated with the fistula plug mean that this technology is unlikely to be considered a cost-effective use of resources in the UK NHS. FUTURE WORK Further in-depth analysis should consider the clinical and MRI characteristics of fistula-in-ano in an attempt to identify predictors of fistula response to treatment. TRIAL REGISTRATION Current Controlled Trials ISRCTN78352529. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Damian Tolan
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Richard Gray
- Nuffield Department of Population Health Medicine Sciences Division, University of Oxford, Oxford, UK
| | - Richard Edlin
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew J Sutton
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kelly Handley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manjinder Kaur
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Helliwell JA, Bolton WS, Burke JR, Tiernan JP, Jayne DG, Chapman SJ. Global academic response to COVID-19: Cross-sectional study. Learn Publ 2020; 33:385-393. [PMID: 32836910 PMCID: PMC7362145 DOI: 10.1002/leap.1317] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022]
Abstract
This study explores the response to COVID‐19 from investigators, editors, and publishers and seeks to define challenges during the early stages of the pandemic. A cross‐sectional bibliometric review of COVID‐19 literature was undertaken between 1 November 2019 and 24 March 2020, along with a comparative review of Middle East respiratory syndrome (MERS) literature. Investigator responsiveness was assessed by measuring the volume and type of research published. Editorial responsiveness was assessed by measuring the submission‐to‐acceptance time and availability of original data. Publisher‐responsiveness was assessed by measuring the acceptance‐to‐publication time and the provision of open access. Three hundred and ninety‐eight of 2,835 COVID‐19 and 55 of 1,513 MERS search results were eligible. Most COVID‐19 studies were clinical reports (n = 242; 60.8%). The submission‐to‐acceptance [median: 5 days (IQR: 3–11) versus 71.5 days (38–106); P < .001] and acceptance‐to‐publication [median: 5 days (IQR: 2–8) versus 22.5 days (4–48·5‐; P < .001] times were strikingly shorter for COVID‐19. Almost all COVID‐19 (n = 396; 99.5%) and MERS (n = 55; 100%) studies were open‐access. Data sharing was infrequent, with original data available for 104 (26.1%) COVID‐19 and 10 (18.2%) MERS studies (P = .203). The early academic response was characterized by investigators aiming to define the disease. Studies were made rapidly and openly available. Only one‐in‐four were published alongside original data, which is a key target for improvement.
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Affiliation(s)
- Jack A Helliwell
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
| | - William S Bolton
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
| | - Joshua R Burke
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
| | - Jim P Tiernan
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
| | - David G Jayne
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
| | - Stephen J Chapman
- Leeds Institute of Medical Research at St. James's University of Leeds Leeds LS9 7TF UK
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Moorcroft SCT, Roach L, Jayne DG, Ong ZY, Evans SD. Nanoparticle-Loaded Hydrogel for the Light-Activated Release and Photothermal Enhancement of Antimicrobial Peptides. ACS Appl Mater Interfaces 2020; 12:24544-24554. [PMID: 32312040 DOI: 10.1021/acsami.9b22587] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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] [Indexed: 06/11/2023]
Abstract
Rising concerns over multidrug-resistant bacteria have necessitated an expansion to the current antimicrobial arsenal and forced the development of novel delivery strategies that enhance the efficacy of existing treatments. Antimicrobial peptides (AMPs) are a promising antibiotic alternative that physically disrupts the membrane of bacteria, resulting in rapid bactericidal activity; however, clinical translation of AMPs has been hindered by their susceptibility to protease degradation. Through the co-loading of liposomes encapsulating model AMP, IRIKIRIK-CONH2 (IK8), and gold nanorods (AuNRs) into a poly(ethylene glycol) (PEG) hydrogel, we have demonstrated the ability to protect encapsulated materials from proteolysis and provide the first instance of the triggered AMP release. Laser irradiation at 860 nm, at 2.1 W cm-2, for 10 min led to the photothermal triggered release of IK8, resulting in bactericidal activity against Gram-negative Pseudonomas aeruginosa and Gram-positive Staphylococcus aureus. Furthermore, by increasing the laser intensity to 2.4 W cm-2, we have shown the thermal enhancement of AMP activity. The photothermal triggered release, and enhancement of AMP efficacy, was demonstrated to treat two rounds of fresh S. aureus, indicating that the therapeutic gel has the potential for multiple rounds of treatment. Taken together, this novel therapeutic hydrogel system demonstrates the stimuli-responsive release of AMPs with photothermal enhanced antimicrobial efficacy to treat pathogenic bacteria.
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Affiliation(s)
- Samuel C T Moorcroft
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Lucien Roach
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - David G Jayne
- School of Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Zhan Yuin Ong
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
- School of Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Stephen D Evans
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
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Poulton T, Hogston SP, Bolton WS, Burke JR, Jayne DG. Anaesthetic management of subcutaneous abscesses: current status. Br J Anaesth 2020; 125:e227-e229. [PMID: 32386836 DOI: 10.1016/j.bja.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
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Ng KS, West NP, Scott N, Holzgang M, Quirke P, Jayne DG. What factors determine specimen quality in colon cancer surgery? A cohort study. Int J Colorectal Dis 2020; 35:869-880. [PMID: 32112199 DOI: 10.1007/s00384-020-03541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Tenets of 'good quality' colon cancer surgery include mesocolic plane dissection to preserve an intact mesocolic fascia/peritoneum, and excision of sufficient mesocolon for adequate lymphadenectomy. However, it remains controversial what clinicopathological factors determine 'good quality' surgery, and whether quality of surgery influences morbidity/mortality. This study documents the quality of colon cancer surgery at a quaternary referral centre and identifies factors that influence quality of surgery and post-operative outcomes. METHODS Consecutive patients who underwent resection for colon adenocarcinoma at St. James's University Hospital, Leeds, UK (2015-2017), were included. Primary outcome measures included (i) plane of mesocolic dissection, prospectively assessed; and (ii) tissue morphometry (area of mesentery and vascular pedicle length). Other histopathological data were extracted from a prospective database. Clinical data were obtained from the National Bowel Cancer Audit and individual records. RESULTS Four hundred five patients were included (mean 69.6 years). The majority (67.4%) of specimens were mesocolic plane dissections. Median area of mesentery excised was 12,085.4 mm2. Median vascular pedicle length was 89.3 mm. Post-operative complication was recorded in one-third of patients. Mesocolic plane excision was associated with open surgery (OR 1.80, 95% CI 1.05-3.09), especially in emergency colectomy. Open resections also had a greater mesentery excised (P = 0.002), but incurred more post-operative complication (OR 2.11, 95% CI 1.12-3.99). Post-operative complication was not associated with plane of excision or tissue morphometry. CONCLUSION Majority of resections were 'optimal' mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency.
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Affiliation(s)
- Kheng-Seong Ng
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK. .,RPA Institute of Academic Surgery, University of Sydney, 145-147 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Nicholas P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Nigel Scott
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Melanie Holzgang
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK
| | - Phil Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David G Jayne
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK.,Academic Surgery, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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40
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Chapman SJ, Lee MJ, Blackwell S, Arnott R, Ten Broek RPG, Delaney CP, Dudi-Venkata NN, Hind D, Jayne DG, Mellor K, Mishra A, O'Grady G, Sammour T, Thorpe G, Wells CI, Wolthuis AM, Fearnhead NS. Establishing core outcome sets for gastrointestinal recovery in studies of postoperative ileus and small bowel obstruction: protocol for a nested methodological study. Colorectal Dis 2020; 22:459-464. [PMID: 31701620 DOI: 10.1111/codi.14899] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction. METHOD An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co-developed and may be combined to form a common output with disease-specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal-group stakeholder discussions; online-facilitated Delphi surveys via international networks; and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized. DISSEMINATION AND IMPLEMENTATION The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi-faceted, quality improvement campaign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - M J Lee
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | | | - R Arnott
- Patient Representative, Green Templeton College, Oxford, UK
| | - R P G Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - C P Delaney
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - N N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - D Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - K Mellor
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - A Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - G O'Grady
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - G Thorpe
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - C I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gill M, Fligelstone L, Keating J, Jayne DG, Renton S, Shearman CP, Carlson GL. Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery. Br J Surg 2020; 106:1156-1166. [PMID: 31304580 PMCID: PMC6772077 DOI: 10.1002/bjs.11177] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023]
Abstract
Background Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre‐existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Methods These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer‐reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. Results These guidelines encompass the risk factors (both patient‐ and procedure‐related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. Conclusion All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life‐changing complication.
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Affiliation(s)
- M Gill
- Department of Surgery, East Lancashire NHS Trust, Blackburn, UK
| | - L Fligelstone
- Department of Vascular Surgery, Swansea Bay University Health Board, Swansea, UK
| | - J Keating
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - D G Jayne
- Department of Surgery, University of Leeds, Leeds, UK
| | - S Renton
- Department of Surgery, Northwick Park Hospital, Harrow, UK
| | - C P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G L Carlson
- Department of Surgery, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
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Mohanan SMPC, Beck RJ, West NP, Shires M, Perry SL, Jayne DG, Hand DP, Shephard JD. Preclinical evaluation of porcine colon resection using hollow core negative curvature fibre delivered ultrafast laser pulses. J Biophotonics 2019; 12:e201900055. [PMID: 31240824 DOI: 10.1002/jbio.201900055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/08/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
Ultrashort pulse lasers offer great promise for tissue resection with exceptional precision and minimal thermal damage. Surgery in the bowel requires high precision and minimal necrotic tissue to avoid severe complications such as perforation. The deployment of ultrashort lasers in minimally invasive or endoscopic procedures has been hindered by the lack of suitable optical fibres for high peak powers. However, recent developments of hollow core microstructured fibres provide potential for delivery of such pulses throughout the body. In this study, analysis of laser ablation via a scanning galvanometer on a porcine colon tissue model is presented. A thermally damaged region (<85 μm) and fine depth control of ablation using the pulse energies 46 and 33 μJ are demonstrated. It is further demonstrated that such pulses suitable for precision porcine colon resection can be flexibly delivered via a hollow core negative curvature fibre (HC-NCF) and again ablation depth can be controlled with a thermally damaged region <85 μm. Ablation volumes are comparable to that of early stage lesions in the inner lining of the colon. This study concludes that the combination of ultrashort pulses and flexible fibre delivery via HC-NCF present a viable route to new minimally invasive surgical procedures.
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Affiliation(s)
- Syam M P C Mohanan
- School of Engineering and Physical Sciences, Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
| | - Rainer J Beck
- School of Engineering and Physical Sciences, Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
| | - Nicholas P West
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Michael Shires
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Sarah L Perry
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Duncan P Hand
- School of Engineering and Physical Sciences, Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
| | - Jonathan D Shephard
- School of Engineering and Physical Sciences, Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
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Khot MI, Downey CL, Armstrong G, Svavarsdottir HS, Jarral F, Andrew H, Jayne DG. The role of ABCG2 in modulating responses to anti-cancer photodynamic therapy. Photodiagnosis Photodyn Ther 2019; 29:101579. [PMID: 31639455 DOI: 10.1016/j.pdpdt.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/03/2019] [Accepted: 10/11/2019] [Indexed: 01/10/2023]
Abstract
The ATP-binding cassette (ABC) superfamily G member 2 (ABCG2) transmembrane protein transporter is known for conferring resistance to treatment in cancers. Photodynamic therapy (PDT) is a promising anti-cancer method involving the use of light-activated photosensitisers to precisely induce oxidative stress and cell death in cancers. ABCG2 can efflux photosensitisers from out of cells, reducing the capacity of PDT and limiting the efficacy of treatment. Many studies have attempted to elucidate the relationship between the expression of ABCG2 in cancers, its effect on the cellular retention of photosensitisers and its impact on PDT. This review looks at the studies which investigate the effect of ABCG2 on a range of different photosensitisers in different pre-clinical models of cancer. This work also evaluates the approaches that are being investigated to address the role of ABCG2 in PDT with an outlook on potential clinical validation.
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Affiliation(s)
- M Ibrahim Khot
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK.
| | - Candice L Downey
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | - Gemma Armstrong
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | | | - Fazain Jarral
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | - Helen Andrew
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | - David G Jayne
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
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Chapman SJ, Aldaffaa M, Downey CL, Jayne DG. Research waste in surgical randomized controlled trials. Br J Surg 2019; 106:1464-1471. [PMID: 31393612 DOI: 10.1002/bjs.11266] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/22/2019] [Accepted: 05/17/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research waste is a major challenge for evidence-based medicine. It implicates misused resources and increased risks for research participants. The aim of this study was to quantify constituent components of waste in surgical RCTs and explore targets for improvement. METHODS ClinicalTrials.gov was searched for RCTs registered between January 2011 and December 2012 using the keyword 'surgery'. The primary outcome was research waste, defined as non-publication, inadequate reporting or presence of an avoidable design limitation. Serial systematic searches of PubMed and Scopus databases were performed to determine publication status. Adequacy of reporting was assessed using the CONSORT checklist. Avoidable design limitations were evaluated according to the presence of bias and/or the absence of a cited systematic review of the literature. RESULTS Of 5617 registered RCTs, 304 met all eligibility criteria. Overall, 259 of 304 (85·2 per cent) demonstrated at least one feature of waste. Of these, 221 (72·7 per cent) were published in a peer-reviewed journal and 219 were accessible for full-text review. Only 73 of 131 (55·7 per cent) RCTs with a pharmacological intervention and 24 of 88 (27 per cent) with a non-pharmacological intervention were reported adequately, and 159 of 219 (72·6 per cent) demonstrated an avoidable design limitation. Multicentre (odds ratio 0·31, 95 per cent c.i. 0·11 to 0·88) and externally funded (OR 0·35, 0·15 to 0·82) RCTs were less associated with research waste. CONCLUSION This study identified a considerable burden of research waste in surgical RCTs. Future initiatives should target improvements in single-centre, poorly supported RCTs.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - M Aldaffaa
- School of Medicine, University of Leeds, Leeds, UK
| | - C L Downey
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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45
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Abstract
Vital and evolving
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Affiliation(s)
- D G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
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46
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Khot MI, Andrew H, Svavarsdottir HS, Armstrong G, Quyn AJ, Jayne DG. A Review on the Scope of Photothermal Therapy-Based Nanomedicines in Preclinical Models of Colorectal Cancer. Clin Colorectal Cancer 2019; 18:e200-e209. [PMID: 30852125 DOI: 10.1016/j.clcc.2019.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
Oncologic thermal ablation involves the use of hyperthermic temperatures to damage and treat solid cancers. Thermal ablation is being investigated as a method of treatment in colorectal cancers and has the potential to complement conventional anticancer treatments in managing local recurrence and metastatic disease. Photothermal therapy utilizes photosensitive agents to generate local heat and induce thermal ablation. There is growing interest in developing nanotechnology platforms to deliver such photosensitive agents. An advantage of nanomedicines is their multifunctionality, with the capability to deliver combinations of chemotherapeutics and cancer-imaging agents. To date, there have been no clinical studies evaluating photothermal therapy-based nanomedicines in colorectal cancers. This review presents the current scope of preclinical studies, investigating nanomedicines that have been developed for delivering multimodal photothermal therapy to colorectal cancers, with an emphasis on potential clinical applications.
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Affiliation(s)
- M Ibrahim Khot
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK.
| | - Helen Andrew
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | | | - Gemma Armstrong
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | - Aaron J Quyn
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
| | - David G Jayne
- School of Medicine, St James's University Hospital, University of Leeds, Leeds, UK
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Vallance AE, Young AL, Kuryba A, Braun M, Hill J, Jayne DG, van der Meulen J, Lodge JP, Walker K. The impact of advancing age on incidence of hepatectomy and post-operative outcomes in patients with colorectal cancer liver metastases: a population-based cohort study. HPB (Oxford) 2019; 21:167-174. [PMID: 30076012 DOI: 10.1016/j.hpb.2018.06.1808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical outcomes for elderly patients undergoing liver resection for colorectal cancer (CRC) liver metastases are poorly characterised. This study aimed to investigate the impact of advancing age on the incidence of liver resection and post-operative outcomes. METHODS Patients in the National Bowel Cancer Audit undergoing major CRC resection from 2010 to 2016 in England were included. Liver resection was identified from linked Hospital Episode Statistics data. A Cox-proportional hazards model was used to compare 3-year mortality. RESULTS Of 117,005 patients, 6081 underwent liver resection. For patients <65 years there was 1 liver resection per 12 cases, 65-74, 1 per 17, and ≥75, 1 per 40. 90-day mortality after liver resection increased with advancing age (<65 0.9% (26/2829), 65-74 2.8% (57/2070), ≥75 4.0% (47/1182); P < 0.001). Age was an independent risk factor for 3-year mortality. Patients 65-74 did not have adjusted mortality higher than those <65, yet age ≥75 was associated with increased overall mortality (Hazard ratio (HR) 1.47 (95% CI 1.30-1.68)) and cancer-specific mortality (HR 1.30 (95% CI 1.13-1.49)). CONCLUSION Although advancing age was associated with higher rates of 90-day mortality following liver resection, 3-year mortality for patients 65-74 years was comparable to younger patients. These results will aid clinicians and patients in pre-operative decision-making.
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Affiliation(s)
- Abigail E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK.
| | - Alastair L Young
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Angela Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK
| | - Michael Braun
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - James Hill
- Department of Colorectal Surgery, Manchester Royal Infirmary, Manchester, M13 9WL, UK
| | - David G Jayne
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Jeremy P Lodge
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Kate Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
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Bolton WS, Aruparayil N, Quyn A, Scott J, Wood A, Bundu I, Gnanaraj J, Brown JM, Jayne DG. Disseminating technology in global surgery. Br J Surg 2019; 106:e34-e43. [DOI: 10.1002/bjs.11036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care.
Methods
This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included.
Results
Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery.
Conclusion
Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.
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Affiliation(s)
- W S Bolton
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - N Aruparayil
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A Quyn
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - J Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Wood
- Department of Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - I Bundu
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - J Gnanaraj
- Karunya Institute of Technology and Science, Karunya Nagar, Coimbatore, India
| | - J M Brown
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - D G Jayne
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Downey C, Randell R, Brown J, Jayne DG. Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial. J Med Internet Res 2018; 20:e10802. [PMID: 30538086 PMCID: PMC6305881 DOI: 10.2196/10802] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 04/17/2018] [Revised: 08/22/2018] [Accepted: 09/24/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Vital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards. OBJECTIVE The aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial. METHODS We performed a prospective, cluster-randomized, parallel-group, unblinded, controlled pilot study. Patients admitted to 2 surgical wards at a large tertiary hospital received either continuous and intermittent vital signs monitoring or intermittent monitoring alone using an early warning score system. Continuous monitoring was provided by a wireless patch, worn on the patient's chest, with data transmitted wirelessly every 2 minutes to a central monitoring station or a mobile device carried by the patient's nurse. The primary outcome measure was time to administration of antibiotics in sepsis. The secondary outcome measures included the length of hospital stay, 30-day readmission rate, mortality, and patient acceptability. RESULTS Overall, 226 patients were randomized between January and June 2017. Of 226 patients, 140 were randomized to continuous remote monitoring and 86 to intermittent monitoring alone. On average, patients receiving continuous monitoring were administered antibiotics faster after evidence of sepsis (626 minutes, n=22, 95% CI 431.7-820.3 minutes vs 1012.8 minutes, n=12, 95% CI 425.0-1600.6 minutes), had a shorter average length of hospital stay (13.3 days, 95% CI 11.3-15.3 days vs 14.6 days, 95% CI 11.5-17.7 days), and were less likely to require readmission within 30 days of discharge (11.4%, 95% CI 6.16-16.7 vs 20.9%, 95% CI 12.3-29.5). Wide CIs suggest these differences are not statistically significant. Patients found the monitoring device to be acceptable in terms of comfort and perceived an enhanced sense of safety, despite 24% discontinuing the intervention early. CONCLUSIONS Remote continuous vital signs monitoring on surgical wards is practical and acceptable to patients. Large, well-controlled studies in high-risk populations are required to determine whether the observed trends translate into a significant benefit for continuous over intermittent monitoring. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN60999823; http://www.isrctn.com /ISRCTN60999823 (Archived by WebCite at http://www.webcitation.org/73ikP6OQz).
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Affiliation(s)
- Candice Downey
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Rebecca Randell
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - David G Jayne
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom
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Moorcroft SCT, Jayne DG, Evans SD, Ong ZY. Stimuli‐Responsive Release of Antimicrobials Using Hybrid Inorganic Nanoparticle‐Associated Drug‐Delivery Systems. Macromol Biosci 2018; 18:e1800207. [DOI: 10.1002/mabi.201800207] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/24/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Stephen D. Evans
- School of Physics and AstronomyUniversity of Leeds Leeds LS2 9JT UK
| | - Zhan Yuin Ong
- School of Physics and AstronomyUniversity of Leeds Leeds LS2 9JT UK
- School of MedicineUniversity of Leeds Leeds LS2 9JT UK
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