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Redhead ECG, Paessler A, Arslan Z, Patel P, Minhas K, Forman C, Hollis P, Lava S, Ionescu F, Manuel D, Ray S, Kessaris N, Giardini A, Ratnamma V, Dobby N, Tullus K, Simmonds J, Stojanovic J. Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions. Pediatr Nephrol 2024; 39:521-530. [PMID: 37658875 PMCID: PMC10728245 DOI: 10.1007/s00467-023-06123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention. METHODS All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention. RESULTS One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy. CONCLUSIONS Our study reports improvement in cardiac outcomes after endovascular + / - surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. A higher resolution version of the Graphical abstract is available as Supplementary information. SUPPLEMENTARY INFORMATION
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Affiliation(s)
- Emily C G Redhead
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Zainab Arslan
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kishore Minhas
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Forman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Paolo Hollis
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Sebastiano Lava
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Florin Ionescu
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Devi Manuel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Samiran Ray
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nicos Kessaris
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Alessandro Giardini
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Vineetha Ratnamma
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nadine Dobby
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kjell Tullus
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jelena Stojanovic
- University College London Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
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Bartsota M, Jowett V, Manuel D, Mortensen K, Wolfenden J, Marek J, Carvalho JS. Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome. Ultrasound Obstet Gynecol 2023; 62:69-74. [PMID: 36864493 DOI: 10.1002/uog.26186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the prenatal characteristics of double aortic arch (DAA), assess the relative size of the arches and their growth during pregnancy, describe associated cardiac, extracardiac and chromosomal/genetic abnormalities and review postnatal presentation and clinical outcome. METHODS This was a retrospective cohort study of all fetuses with a confirmed diagnosis of DAA seen in five specialized referral centers in London, UK, between October 2012 and November 2019. Cases were identified from the hospitals' fetal databases. Fetal echocardiographic findings, intracardiac and extracardiac abnormalities, genetic defects, computed tomography (CT) findings and postnatal clinical presentation and outcome were evaluated. RESULTS A total of 79 fetuses with DAA were included. Of those assessed postnatally, 48.6% had an atretic left aortic arch (LAA), while 5.1% had an atretic LAA at the first fetal scan and were misdiagnosed antenatally with right aortic arch (RAA). The LAA was atretic in 55.8% of those who underwent CT. DAA was an isolated abnormality in 91.1% of cases; 8.9% of patients had an additional intracardiac abnormality and 2.5% had both intra- and extracardiac abnormalities. Among the 52 cases that underwent genetic testing, 11.5% had genetic abnormalities and, specifically, the 22q11 microdeletion was identified in 3.8% of patients. At a median follow-up of 993.5 days, 42.5% of patients had developed symptoms of tracheoesophageal compression (5.5% during the first month after birth) and 56.2% had undergone intervention. Statistical analysis using the χ-square test showed no significant relationship between morphology of DAA (patency of both aortic arches vs atretic LAA) and the need for intervention (P = 0.134), development of vascular ring symptoms (P = 0.350) or evidence of airway compression on CT (P = 0.193). CONCLUSIONS Most cases of DAA can be diagnosed easily at midgestation, as typically both arches are patent with a dominant RAA at this stage. However, we found that the LAA had become atretic in approximately half of the cases postnatally, supporting the theory of differential growth of the arches during pregnancy. DAA is usually an isolated abnormality; however, thorough assessment is required to exclude associated intra- and extracardiac anomalies and to determine the need for invasive prenatal genetic testing. Postnatally, early clinical assessment is needed and CT scan should be considered, irrespective of the presence of symptoms. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Bartsota
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | - V Jowett
- Great Ormond Street Hospital, London, UK
| | - D Manuel
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | | | | | - J Marek
- Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Kuenzig E, Manuel D, Donelle J, Benchimol EI. A2 LIFE EXPECTANCY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): A POPULATION-BASED MATCHED COHORT STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Kuenzig
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - E I Benchimol
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Manuel D, Ghosh G, Joseph G, Lahiri A, George PV. Criss-cross heart: Transthoracic echocardiographic features. Indian Heart J 2018; 70:71-74. [PMID: 29455791 PMCID: PMC5902827 DOI: 10.1016/j.ihj.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/21/2017] [Accepted: 03/19/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To study the echocardiographic features of criss-cross heart (CCH), a congenital cardiac anomaly characterized by crossed ventricular inflow streams, in Indian patients. Methods In this retrospective observational study, all pediatric echocardiograms performed in a single tertiary care institution in South India over a three-year period were scrutinized for a diagnosis of CCH. Demographic, clinical and echocardiographic data were collected from patients’ medical records and echocardiographic database. Crossed ventricular inflow streams was identified when there was inability to visualize both atrio-ventricular valves in a single imaging plane in cardiac four chamber view. Results CCH was diagnosed in five patients from 10,500 pediatric echocardiographic studies. The age at diagnosis ranged from one month to 8 years. Cyanosis was present in all but one of the five cases. Crossed ventricular inflow streams was present by definition in all cases, whereas superior-inferior ventricular relationship was present in only three cases. All cases were associated with ventricular septal defects. Atrio-ventricular discordance was seen in three cases and concordance in two. Ventriculo-arterial discordance was seen in three cases, concordance in one and double outlet right ventricle in one. Three cases had pulmonary stenosis and the other two had pulmonary arterial hypertension. Straddling of AV valve was observed in four cases and hypoplastic aortic arch in one case. Conclusion CCH is an extremely rare congenital cardiac anomaly. Superior-inferior ventricular relationship often co-exists with CCH, but is not necessarily present in all cases. CCH requires early diagnosis because of its common association with diverse cardiac anomalies.
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Affiliation(s)
- Devi Manuel
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Gopal Ghosh
- Department of Cardiology, Christian Medical College, Vellore, India
| | - George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India.
| | | | - Paul V George
- Department of Cardiology, Christian Medical College, Vellore, India
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Nelson RL, Manuel D, Gumienny C, Spencer B, Patel K, Schmitt K, Castillo D, Bravo A, Yeboah-Sampong A. A systematic review and meta-analysis of the treatment of anal fissure. Tech Coloproctol 2017; 21:605-625. [PMID: 28795245 DOI: 10.1007/s10151-017-1664-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anal fissure has a very large number of treatment options. The choice is difficult. In an effort to assist in that, choice presented here is a systematic review and meta-analysis of all published treatments for anal fissure that have been studied in randomized controlled trials. METHODS Randomized trials were sought in the Cochrane Controlled Trials Register, Medline, EMBASE and the trials registry sites clinicaltrials.gov and who/int/ictrp/search/en. Abstracts were screened, full-text studies chosen, and finally eligible studies selected and abstracted. The review was then divided into those studies that compared two or more surgical procedures and those that had at least one arm that was non-surgical. Studies were further categorized by the specific interventions and comparisons. The outcome assessed was treatment failure. Negative effects of treatment assessed were headache and anal incontinence. Risk of bias was assessed for each study, and the strength of the evidence of each comparison was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS One hundred and forty-eight eligible trials were found and assessed, 31 in the surgical group and 117 in the non-surgical group. There were 14 different operations described in the surgical group and 29 different non-surgical treatments in the non-surgical group along with partial lateral internal sphincterotomy (LIS). There were 61 different comparisons. Of these, 47 were reported in 2 or fewer studies, usually with quite small patient samples. The largest single comparison was glyceryl trinitrate (GTN) versus control with 19 studies. GTN was more effective than control in sustained cure (OR 0.68; 95% CI 0.63-0.77), but the quality of evidence was very poor because of severe heterogeneity, and risk of bias due to inadequate clinical follow-up. The only comparison to have a GRADE quality of evidence of high was a subgroup analysis of LIS versus any medical therapy (OR 0.12; CI 0.07-0.21). Most of the other studies were downgraded in GRADE due to imprecision. CONCLUSIONS LIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE quality of evidence. All other GRADE evaluations of procedures were low to very low due mostly to imprecision.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, 1603 West Taylor Room 956, Chicago, IL, 60612, USA.
| | - D Manuel
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Gumienny
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - B Spencer
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - K Patel
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - K Schmitt
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - D Castillo
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Bravo
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Yeboah-Sampong
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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Fatayer H, Sharma N, Manuel D, Kim B, Keding A, Perren T, Velikova G, Lansdown M, Shaaban AM, Dall B. Serial MRI scans help in assessing early response to neoadjuvant chemotherapy and tailoring breast cancer treatment. Eur J Surg Oncol 2016; 42:965-72. [PMID: 27260848 DOI: 10.1016/j.ejso.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/07/2015] [Revised: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Tailoring neoadjuvant chemotherapy (NAC) during breast cancer treatment is performed to improve overall tumour response, with increasing evidence to support its role. This study evaluates our breast unit's experience in MRI assessment of tumour response as an aid in tailoring NAC. MATERIALS AND METHODS This is a retrospective study of patients treated with NAC for breast cancer between 2005 and 2009 who underwent MRI to assess tumour response. Response to NAC was monitored before NAC and after 2 and/or 4 cycles of anthracycline and cyclophosphamide (AC) chemotherapy. Taxane was substituted for AC if MRI response was deemed inadequate. Tumour response on last MRI was correlated with final pathology against different tumour subtypes and in inflammatory tumours. Strength of agreement was measured using Kappa analysis. Potential predictive factors for MRI response were assessed for significance. RESULTS 166 tumours were assessed with serial MRI scans. MRI showed high sensitivity rate (93.1%) in predicting response to NAC particularly for tumours showing partial (PR) or complete (CR) response on pathology (p < 0.001) with fair agreement on Kappa analysis (K = 0.31). MRI seems more accurate in triple negative, HR+/HER2+ and high-grade tumours. Early identification of non-responders on MRI resulted in early tailoring of NAC, with improved rates of tumour response seen in 74.2% following switching NAC. Logistic regression showed that PR or CR observed on MRI after 2 NAC cycles significantly predicted pCR (p < 0.001). CONCLUSION Serial MRI can be used to assess patterns of tumour response to NAC. This study shows that tailoring NAC according to pattern of response can improve overall tumour response rates.
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Affiliation(s)
- H Fatayer
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
| | - N Sharma
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - D Manuel
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - B Kim
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - A Keding
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - T Perren
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - G Velikova
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK; University of Leeds, Leeds Institute of Cancer and Pathology, UK
| | - M Lansdown
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - A M Shaaban
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - B Dall
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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Mullen K, Manuel D, Younger J, Hawken S, Coyle D, Jones L, Wells G, Pipe A, Reid R. HEALTH, HEALTHCARE, AND ECONOMIC IMPACTS OF A HOSPITAL-INITIATED SMOKING CESSATION INTERVENTION. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Maclagan L, Park J, Sanmartin C, Roth D, Manuel D, Tu J. Development and Validation of an Ideal Cardiovascular Health Index for the Canadian Population. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fatayer H, Kim B, Dall B, Sharma N, Manuel D, Shabaan A, Perren T, Velikova G, Horgan K, Lansdown M. Abstract P4-01-14: Can MRI predict the response to neoadjuvant chemotherapy in breast cancer accurately? Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-01-14] [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: 11/16/2022]
Abstract
Abstract
Introduction: Magnetic resonance imaging (MRI) has been increasingly used to assess response to neoadjuvant chemotherapy (NAC). The aim of this retrospective study was to investigate the accuracy of MRI in predicting pathological complete response (pCR) and residual disease in patients treated with NAC.
Methods: 152 patients with invasive breast cancer were treated with NAC (2005–2009). In our institute the response to neoadjuvant anthracycline (AC) based chemotherapy is monitored with MRI scanning before NAC and after 2 and 4 cycles. Taxane based chemotherapy was substituted for AC chemotherapy if MRI response was deemed inadequate.
Response to NAC was measured using the modified response evaluation criteria in solid tumours (RECIST). Tumour extent and response on final MRI were correlated with the pathological findings on post-surgical specimens. pCR was defined as absence of invasive cancer. Sensitivity and specificity of MRI reporting was determined against response on histopathology. Potential predictive factors for response on MRI were assessed for significance.
Results: In total, patients had 2(14.5%), 3(60.5%) or 4(25%) MRI scans. pCR was seen in 37(24.3%) patients. After 2 cycles of NAC, positive response (partial or complete) was seen on MRI in 76(50%) patients. Response was more likely in focal tumours versus multifocal tumours (chi square (χ2) 3.83, p = 0.05). In the non-responding group (n = 76), 74 had their treatment switched and a later response was detected in 50(67.6%) cases on MRI.
In the 133 patients with 3 or more MRI scans, final MRI size was compared to tumour size on pathology. Median tumour extent on final MRI was 25.5mm (range 0–120) and median whole tumour size on pathology was 22.5mm (range 0–120). MRI response was apparent in 115 (75.7%) cases (sensitivity = 92.3%, specificity = 56.3% and PPV = 93.9%). In a 2-tailed analysis MRI response showed strong correlation with actual pathological response (spearman's = 0.501, p < 0.0001). MRI correctly diagnosed pCR in 15 of 37(40.5%) patients with pCR. Linear regression shows that overall tumour extent on MRI was highly predictive of whole tumour size on pathology (coefficient = 0.459, p < 0.0001). However, MRI overestimated residual disease in 24(18%) cases (median size difference of 39mm, range 12–120mm) and underestimated minimal residual disease in 12(9%) cases.
In univariate analysis, time of response to NAC was a predictor of pCR (p = 0.013), with greater number of early responders having pCR than late responders. Complete response on MRI was a significant predictor of pCR (p < 0.0001), with a greater proportion of patients having pCR compared to those not showing complete response on MRI. Both complete response on final MRI (p = 0.276) and pCR (p = 0.069) show favourable disease-free survival (DFS), however neither reaches statistical significance on Kaplan-Meier curve (Median follow up of 43 months, range 13–78).
Conclusions: Early responders and tumours achieving complete response on MRI are significant predictors of histopathological response. Serial MRI is predictive of response to NAC and possibly also a predictor of DFS. In this series MRI overestimated residual disease in nearly 1 in 5 patients.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-01-14.
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Affiliation(s)
- H Fatayer
- Leeds General Infirmary; St James's University Hospital
| | - B Kim
- Leeds General Infirmary; St James's University Hospital
| | - B Dall
- Leeds General Infirmary; St James's University Hospital
| | - N Sharma
- Leeds General Infirmary; St James's University Hospital
| | - D Manuel
- Leeds General Infirmary; St James's University Hospital
| | - A Shabaan
- Leeds General Infirmary; St James's University Hospital
| | - T Perren
- Leeds General Infirmary; St James's University Hospital
| | - G Velikova
- Leeds General Infirmary; St James's University Hospital
| | - K Horgan
- Leeds General Infirmary; St James's University Hospital
| | - M Lansdown
- Leeds General Infirmary; St James's University Hospital
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Bacon S, Dall B, Sharma N, Manuel D, Wilson D. Breast MRI quality assurance in practice. Breast Cancer Res 2012. [PMCID: PMC3542689 DOI: 10.1186/bcr3313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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May RD, Monk PD, Cohen ES, Manuel D, Dempsey F, Davis NHE, Dodd AJ, Corkill DJ, Woods J, Joberty-Candotti C, Conroy LA, Koentgen F, Martin EC, Wilson R, Brennan N, Powell J, Anderson IK. Preclinical development of CAT-354, an IL-13 neutralizing antibody, for the treatment of severe uncontrolled asthma. Br J Pharmacol 2012; 166:177-93. [PMID: 21895629 PMCID: PMC3415647 DOI: 10.1111/j.1476-5381.2011.01659.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE IL-13 is a pleiotropic Th2 cytokine considered likely to play a pivotal role in asthma. Here we describe the preclinical in vitro and in vivo characterization of CAT-354, an IL-13-neutralizing IgG4 monoclonal antibody (mAb), currently in clinical development. EXPERIMENTAL APPROACH In vitro the potency, specificity and species selectivity of CAT-354 was assayed in TF-1 cells, human umbilical vein endothelial cells and HDLM-2 cells. The ability of CAT-354 to modulate disease-relevant mechanisms was tested in human cells measuring bronchial smooth muscle calcium flux induced by histamine, eotaxin generation by normal lung fibroblasts, CD23 upregulation in peripheral blood mononuclear cells and IgE production by B cells. In vivo CAT-354 was tested on human IL-13-induced air pouch inflammation in mice, ovalbumin-sensitization and challenge in IL-13 humanized mice and antigen challenge in cynomolgus monkeys. KEY RESULTS CAT-354 has a 165 pM affinity for human IL-13 and functionally neutralized human, human variant associated with asthma and atopy (R130Q) and cynomolgus monkey, but not mouse, IL-13. CAT-354 did not neutralize human IL-4. In vitro CAT-354 functionally inhibited IL-13-induced eotaxin production, an analogue of smooth muscle airways hyperresponsiveness, CD23 upregulation and IgE production. In vivo in humanized mouse and cynomolgus monkey antigen challenge models CAT-354 inhibited airways hyperresponsiveness and bronchoalveolar lavage eosinophilia. CONCLUSIONS AND IMPLICATIONS CAT-354 is a potent and selective IL-13-neutralizing IgG4 mAb. The preclinical data presented here support the trialling of this mAb in patients with moderate to severe uncontrolled asthma.
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Affiliation(s)
- R D May
- MedImmune, Abington, Cambridge, UK.
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Pong RW, DesMeules M, Heng D, Lagacé C, Guernsey JR, Kazanjian A, Manuel D, Pitblado JR, Bollman R, Koren I, Dressler MP, Wang F, Luo W. Patterns of Health Services Utilization in Rural Canada. ACTA ACUST UNITED AC 2011. [DOI: 10.24095/hpcdp.31.s1.01] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Canadians value ease of access to their health services. Although many studies have focused on accessibility to health services in Canada, few have examined rural-urban differences in this aspect, particularly from a national perspective. Yet disparities in access to health services exist between rural and urban populations, as do the challenges of delivering health care to more remote areas or to those with small populations.
“Canada’s Rural Communities: Understanding Rural Health and Its Determinants” is a three-year research project co-funded by the Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC). It involves investigators from the Public Health Agency of Canada, the Centre for Rural and Northern Health Research (CRaNHR) at Laurentian University, and other researchers. The first publication of the research project was How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants;Footnote 1a1a this, the second publication, is a descriptive analysis of the utilization patterns of a broad range of health services by rural residents compared to their urban counterparts.
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Affiliation(s)
- RW Pong
- Centre for Rural and Northern Health Research, Laurentian University
| | | | - D Heng
- Centre for Rural and Northern Health Research, Laurentian University
| | | | | | | | - D Manuel
- Institute for Clinical Evaluative Sciences
| | - JR Pitblado
- Centre for Rural and Northern Health Research, Laurentian University
| | | | - I Koren
- Centre for Rural and Northern Health Research, Laurentian University
| | | | - F Wang
- Public Health Agency of Canada
| | - W Luo
- Public Health Agency of Canada
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Pong RW, DesMeules M, Heng D, Lagacé C, Guernsey JR, Kazanjian A, Manuel D, Pitblado JR, Bollman R, Koren I, Dressler MP, Wang F, Luo W. Patterns of health services utilization in rural Canada. Chronic Dis Inj Can 2011; 31 Suppl 1:1-36. [PMID: 22047772] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT OF THIS STUDY: Canadians value ease of access to their health services. Although many studies have focused on accessibility to health services in Canada, few have examined rural-urban differences in this aspect, particularly from a national perspective. Yet disparities in access to health services exist between rural and urban populations, as do the challenges of delivering health care to more remote areas or to those with small populations. "Canada's Rural Communities: Understanding Rural Health and Its Determinants" is a three-year research project co-funded by the Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC). It involves investigators from the Public Health Agency of Canada, the Centre for Rural and Northern Health Research (CRaNHR) at Laurentian University, and other researchers. The first publication of the research project was How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants; this, the second publication, is a descriptive analysis of the utilization patterns of a broad range of health services by rural residents compared to their urban counterparts.
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Affiliation(s)
- R W Pong
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada.
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15
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Creatore M, Moineddin R, Booth G, Manuel D, DesMeules M, McDermott S, Ruddick E, Glazier R. Prevalence of diabetes among immigrants to canada. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33240-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manuel D, Cutler A, Goldstein J, Fennerty MB, Brown K. Decreasing prevalence combined with increasing eradication of Helicobacter pylori infection in the United States has not resulted in fewer hospital admissions for peptic ulcer disease-related complications. Aliment Pharmacol Ther 2007; 25:1423-7. [PMID: 17539981 DOI: 10.1111/j.1365-2036.2007.03340.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Helicobacter pylori infection is a major cause of peptic ulcer disease, but the prevalence of this infection has been decreasing steadily. Additionally, eradication of H. pylori decreases ulcer recurrence and prevents ulcer complications such as bleeding. AIM To examine whether the decreased prevalence of H. pylori and increased use of eradication regimens have affected the prevalence of peptic ulcer disease-related hospitalizations. METHODS We chose to study a period between 1996 and 2005. The number of gastric and duodenal ulcers as primary or secondary hospital discharge diagnoses per year for the 10-year span was collected from five large US hospitals. Collected data were analysed using Spearman correlation. RESULTS No statistically significant trend was observed in the number of gastric or duodenal ulcers listed as primary or secondary discharge diagnoses at any of the five healthcare centres. CONCLUSIONS Despite a decreasing prevalence of H. pylori and the increasing use of successful H. pylori eradication regimens, the prevalence of peptic ulcer disease and its complications has not changed. In the US other aetiologies, including non-steroidal anti-inflammatory drugs, may be playing a larger role than once thought.
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Affiliation(s)
- D Manuel
- Providence Hospital and Medical Center, Southfield, MI, USA.
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17
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18
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Lim J, Manuel D, Mustard C. Population Impact of Breast Cancer Risk Reduction Strategies in Canadian Women. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s100-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Widjaja E, Manuel D, Hodgson TJ, Connolly DJA, Coley SC, Romanowski CAJ, Gaines P, Cleveland T, Thomas S, Griffiths PD, Doyle C, Venables GS. Imaging findings and referral outcomes of rapid assessment stroke clinics. Clin Radiol 2005; 60:1076-82. [PMID: 16179167 DOI: 10.1016/j.crad.2005.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 04/01/2005] [Accepted: 04/06/2005] [Indexed: 11/29/2022]
Abstract
AIM A rapid assessment stroke clinic (RASC) was established to provide a rapid diagnostic service to individuals with suspected transient cerebral or ocular ischaemia or recovered non-hospitalized strokes. In this report we review imaging findings and clinical outcomes of patients proceeding to the carotid surgery programme. METHODS Between October 2000 and December 2002, 1339 people attended the RASC. The findings of head CT and carotid Doppler ultrasound of the 1320 patients who underwent brain and carotid imaging were reviewed, and the number subsequently proceeding to carotid angiography and intervention was reported. RESULTS CT head scans were normal in 57% of cases; 38% demonstrated ischaemia or infarction; and 3% yielded incidental or other significant findings not related to ischaemia. On screening with carotid Doppler ultrasound, 7.5% showed greater than 50% stenosis on the symptomatic side. A total of 83 patients (6.2%) proceeded to cerebral angiography and 65 (4.8%) underwent carotid endarterectomy or endovascular repair. CONCLUSION Rapid-access neurovascular clinics are efficient in selecting patients for carotid intervention, but this is at a cost and the number of potential strokes prevented is small. Alternative management pathways based on immediate medical treatment need to be evaluated.
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Affiliation(s)
- E Widjaja
- Radiology Department, Royal Hallamshire Hospital, Sheffield, UK.
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McDermott S, DesMeules M, Kazanjian A, Kliewer E, Manuel D, Ruddick E, Vissandjee B, Mao Y. 367: A Linkage Follow-Up Study of Health and Health Service Utilization Among Canada's Immigrant Populations. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s92b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S McDermott
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - M DesMeules
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - A Kazanjian
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - E Kliewer
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - D Manuel
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - E Ruddick
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - B Vissandjee
- Public Health Agency of Canada, Ottawa, ONT Canada
| | - Y Mao
- Public Health Agency of Canada, Ottawa, ONT Canada
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Guttmann A, To T, Dick PT, Manuel D, Shi J. The Quality of Primary Care Received by Young Children in Ontario. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.30ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Manuel D, Schultz S. Increasing longevity and future hospital use. Hosp Q 2001; 4:17. [PMID: 11508167 DOI: 10.12927/hcq..16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- D Manuel
- Institute for Clinical Evaluative Sciences, Department of Public Health Sciences, University of Toronto
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23
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Narayanan A, Manuel D, Ford L, Tallis D, Yazdani M. Language visualisation: Applications and theoretical foundations of a primitive-based approach. Artif Intell Rev 1995. [DOI: 10.1007/bf00849181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rowe PC, Orrbine E, Ogborn M, Wells GA, Winther W, Lior H, Manuel D, McLaine PN. Epidemic Escherichia coli O157:H7 gastroenteritis and hemolytic-uremic syndrome in a Canadian inuit community: intestinal illness in family members as a risk factor. J Pediatr 1994; 124:21-6. [PMID: 8283372 DOI: 10.1016/s0022-3476(94)70249-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection. DESIGN Case-control study. SETTING Remote Inuit community of Arviat in northern Canada. PARTICIPANTS Of the 565 Arviat residents less than 15 years of age, 19 had HUS and 65 more had E. coli O157:H7 gastroenteritis. The 19 children with HUS were compared with 19 age- and gender-matched children with uncomplicated E. coli O157:H7 gastroenteritis, and both HUS and gastroenteritis patients were compared with 19 healthy control subjects. INTERVENTIONS Questionnaire administered face-to-face to parents of participants in the home. MAIN OUTCOME MEASURES Rates of exposure to foods, travel, sources of water, and gastrointestinal illness in family members. RESULTS Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p < 0.01). Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection. CONCLUSIONS These findings emphasize the potential for extensive intrafamilial transmission of verotoxin-producing E. coli once infection is introduced into certain communities.
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Affiliation(s)
- P C Rowe
- Canadian Pediatric Kidney Disease Reference Centre, Ottawa, Ontario
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Garrett A, Manuel D, Vincent C. Conceptual framework. J Nurs Educ 1976; 15:9-21. [PMID: 10357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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