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Cartwright E, Slater S, Saffery C, Tran A, Turkes F, Smith G, Aresu M, Kohoutova D, Terlizzo M, Zhitkov O, Rana I, Johnston EW, Sanna I, Smyth E, Mansoor W, Fribbens C, Rao S, Chau I, Starling N, Cunningham D. Phase II trial of domatinostat (4SC-202) in combination with avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal adenocarcinoma: EMERGE. ESMO Open 2024; 9:102971. [PMID: 38518549 PMCID: PMC10972804 DOI: 10.1016/j.esmoop.2024.102971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Most oesophagogastric adenocarcinomas (OGAs) and colorectal cancers (CRCs) are mismatch repair proficient (MMRp), responding poorly to immune checkpoint inhibition. We evaluated the safety and efficacy of domatinostat (histone deacetylase inhibitor) plus avelumab (anti-PD-L1 antibody) in patients with previously treated inoperable, advanced/metastatic MMRp OGA and CRC. PATIENTS AND METHODS Eligible patients were evaluated in a multicentre, open-label dose escalation/dose expansion phase II trial. In the escalation phase, patients received escalating doses of domatinostat [100 mg once daily (OD), 200 mg OD, 200 mg twice daily (BD)] orally for 14 days followed by continuous dosing plus avelumab 10 mg/kg administered intravenously 2-weekly (2qw) to determine the recommended phase II dose (RP2D). The trial expansion phase evaluated the best objective response rate (ORR) during 6 months by RECIST version 1.1 using a Simon two-stage optimal design with 2/9 and 1/10 responses required to proceed to stage 2 in the OGA and CRC cohorts, respectively. RESULTS Patients (n = 40) were registered between February 2019 and October 2021. Patients in the dose escalation phase (n = 12) were evaluated to confirm the RP2D of domatinostat 200 mg BD plus avelumab 10 mg/kg. No dose-limiting toxicities were observed. Twenty-one patients were treated at the RP2D, 19 (9 OGA and 10 CRC) were assessable for the best ORR; 2 patients with CRC did not receive combination treatment and were not assessable for the primary endpoint analysis. Six patients were evaluated in the dose escalation and expansion phases. In the OGA cohort, the best ORR was 22.2% (95% one-sided confidence interval lower bound 4.1) and the median duration of disease control was 11.3 months (range 9.9-12.7 months). No responses were observed in the CRC cohort. No treatment-related grade 3-4 adverse events were reported at the RP2D. CONCLUSIONS Responses in the OGA cohort met the criteria to expand to stage 2 of recruitment with an acceptable safety profile. There was insufficient signal in the CRC cohort to progress to stage 2. TRIAL REGISTRATION NCT03812796 (registered 23rd January 2019).
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Affiliation(s)
- E Cartwright
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Slater
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - C Saffery
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - A Tran
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - F Turkes
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - G Smith
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Aresu
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Kohoutova
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Terlizzo
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - O Zhitkov
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Rana
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E W Johnston
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Sanna
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E Smyth
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - W Mansoor
- Oesophago-Gastric Cancer Services, The Christie NHS Foundation Trust, Manchester, UK
| | - C Fribbens
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Rao
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - N Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London.
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Shitara K, Fleitas T, Kawakami H, Curigliano G, Narita Y, Wang F, Wardhani SO, Basade M, Rha SY, Wan Zamaniah WI, Sacdalan DL, Ng M, Yeh KH, Sunpaweravong P, Sirachainan E, Chen MH, Yong WP, Peneyra JL, Ibtisam MN, Lee KW, Krishna V, Pribadi RR, Li J, Lui A, Yoshino T, Baba E, Nakayama I, Pentheroudakis G, Shoji H, Cervantes A, Ishioka C, Smyth E. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer. ESMO Open 2024; 9:102226. [PMID: 38458658 PMCID: PMC10937212 DOI: 10.1016/j.esmoop.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/10/2024] Open
Abstract
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer (GC), published in late 2022 and the updated ESMO Gastric Cancer Living Guideline published in July 2023, were adapted in August 2023, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with GC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with GC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), coordinated by ESMO and the Japanese Society of Medical Oncology (JSMO). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian regions represented by the 10 oncological societies. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with GC across the different regions of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling and age and stage at presentation. Attention is drawn to the disparity in the drug approvals and reimbursement strategies, between the different regions of Asia.
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Affiliation(s)
- K Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - T Fleitas
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
| | - H Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy
| | - Y Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - F Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Mainland China
| | - S O Wardhani
- Department of Internal Medicine Division of Medical Hematology-Oncology, Brawijaya University, Dr. Saiful Anwar General Hospital Malang, East Java, Indonesia
| | - M Basade
- Department of Medical Oncology, Jaslok Hospital and Breach Candy Hospital, Mumbai, India
| | - S Y Rha
- Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - W I Wan Zamaniah
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - D L Sacdalan
- Division of Medical Oncology, Department of Medicine, University of the Philippines, Manila, The Philippines
| | - M Ng
- Department of GI Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - K H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - P Sunpaweravong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla
| | - E Sirachainan
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - M-H Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - W P Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - J L Peneyra
- St. Peregrine Oncology Unit, San Juan de Dios Hospital, Pasay City, The Philippines
| | - M N Ibtisam
- Institute of Radiotherapy and Oncology, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - K-W Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - V Krishna
- Department of Medical Oncology, AIG Hospital, Hyderabad, India
| | - R R Pribadi
- Division of Gastroenterology, Pancreatobiliary Oncology and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - J Li
- Department of Oncology, University of Tongji, Shanghai East Hospital, Shanghai, Mainland China
| | - A Lui
- Section of Medical Oncology, Department of Internal Medicine, Southern Philippines Medical Center ESM, Davao City, The Philippines
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - I Nakayama
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - H Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - C Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - E Smyth
- Department of Oncology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
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Smyth E, Steel C, Ellett L. The prevalence of non-affective psychosis in refugee populations: A systematic review. Schizophr Res 2023; 260:99-112. [PMID: 37634388 DOI: 10.1016/j.schres.2023.08.011] [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: 07/13/2021] [Revised: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND As we face the largest refugee crisis since World War Two, research is increasingly examining the impact of forced displacement. The risk of non-affective psychosis in refugees is evidenced to be significantly greater than non-refugees, and the role of pre-, peri- and post-migratory trauma and dissociation is increasingly implicated. AIMS To determine the prevalence of non-affective psychosis in refugee populations. METHOD PRISMA guidelines were followed. Three key databases (PubMed, PsychINFO and Web of Science), Google scholar and study references were searched. The full-text of 62 studies were screened and 23 studies were eligible for inclusion. A narrative synthesis was undertaken and the Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. (PROSPERO registration CRD42019152170). RESULTS The results were widely heterogeneous. The combined weighted average prevalence of non-affective psychosis in refugee populations was 0.9 %. Psychosis prevalence for individual psychotic symptoms was 28.4 %; 0.5 % for schizophrenia; 1.0 % for psychosis; 0.6 % for mixed psychotic disorders and 2.9 % for psychotic episodes. CONCLUSIONS Variations in examined populations, diagnostic and prevalence classifications, and study designs and methodologies likely contributed to heterogeneity across the data. The findings highlight a greater need to provide more specialist mental health services and trauma-focused interventions, as well as transculturally sensitive assessment and treatment to address refugee vulnerability to psychosis. Future research should examine psychosis prevalence longitudinally and in refugees-only, address methodological bias and further examine the role of trauma and dissociation in refugee psychosis prevalence.
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Affiliation(s)
- Emily Smyth
- Psychology Department, Royal Holloway, University of London, Egham Hill, Egham TW20 0EX, UK.
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Lyn Ellett
- School of Psychology, University of Southampton, UK.
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Ku G, Di Bartolomeo M, Smyth E, Chau I, Park H, Siena S, Lonardi S, Wainberg Z, Ajani J, Chao J, Barlaskar F, Kawaguchi Y, Qin A, Singh J, Meinhardt G, Van Cutsem E. 1205MO Updated analysis of DESTINY-Gastric02: A phase II single-arm trial of trastuzumab deruxtecan (T-DXd) in western patients (Pts) with HER2-positive (HER2+) unresectable/metastatic gastric/gastroesophageal junction (GEJ) cancer who progressed on or after trastuzumab-containing regimen. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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5
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Turkes F, Crux R, Tran A, Cartwright E, Rana I, Johnston E, Dunlop A, Thomas J, Smith A, Smyth E, Fribbens C, Rao S, Watkins D, Chau I, Starling N, Cunningham D. 1253P Safety and efficacy of Wnt inhibition with a DKK1 inhibitor, DKN-01, in combination with atezolizumab in patients with advanced oesophagogastric adenocarcinoma: Phase IIa results of the WAKING trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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6
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Baker H, Ford H, O'Neill R, Panagiotopoulou I, Smyth E. P-280 Can immune checkpoint inhibitors plus surgery cure advanced mismatch repair-deficient cancer? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Slater S, Cartwright E, Saffery C, Tran A, Smith G, Bacason M, Zhitkov O, Rana I, Johnston E, Sanna I, Aresu M, Kohoutova D, Terlizzo M, Turkes F, Smyth E, Mansoor W, Fribbens C, Rao S, Watkins D, Starling N, Chau I, Cunningham D. PD-2 EMERGE: A multi-centre, non-randomised, single-arm phase II study investigating domatinostat plus avelumab in patients with previously treated advanced mismatch repair-proficient oesophagogastric and colorectal adenocarcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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8
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Koessler T, Alsina M, Arnold D, Ben-Aharon I, Collienne M, Lutz MP, Neuzillet C, Obermannova R, Peeters M, Sclafani F, Smyth E, Valle JW, Wagner AD, Wyrwicz L, Fontana E, Moehler M. ESMO Congress 2021: highlights from the EORTC gastrointestinal tract cancer group's perspective. ESMO Open 2022; 7:100392. [PMID: 35180656 PMCID: PMC8857487 DOI: 10.1016/j.esmoop.2022.100392] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Abstract
There has been no major change of practice in gastrointestinal oncology at the European Society for Medical Oncology (ESMO) symposium 2021, but confirmation that immunotherapy in combination with chemotherapy has become standard of care in several indications. The European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Track Cancer Group has selected important phase II and III trials presented during the symposium across all gastrointestinal cancers as well as early reports on new drugs or new combinations that may change practice in the future.
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Affiliation(s)
- T Koessler
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland; Swiss Cancer Center Leman (SCCL), University of Geneva, Lausanne, Switzerland.
| | - M Alsina
- Hospital Universitario de Navarra (HUN), Medical Oncology Department, Pamplona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - D Arnold
- Department of Oncology, Haematology and Palliative Care, Asklepios Klinik Altona, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - I Ben-Aharon
- Division of Oncology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - M Collienne
- Department of Oncology, Haematology and Palliative Care, Asklepios Klinik Altona, Asklepios Tumorzentrum Hamburg, Hamburg, Germany; European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - M P Lutz
- Caritasklinikum, Saarbrucken, Germany
| | - C Neuzillet
- GI Oncology, Medical Oncology Department, Institut Curie Saint-Cloud, Versailles Saint Quentin University, Saint-Cloud, France
| | - R Obermannova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno; Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Peeters
- Department of Oncology, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
| | - F Sclafani
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - E Smyth
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - J W Valle
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A D Wagner
- Department of Oncology, Division of Medical Oncology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - L Wyrwicz
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - E Fontana
- Sarah Cannon Research Institute, London, UK
| | - M Moehler
- Department of Internal Medicine, Johannes-Gutenberg University, Mainz, Germany
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Brennan L, Sheill G, O’Neill L, O’Connor L, Smyth E, Guinan E. Physical Therapists in Oncology Settings: Experiences in Delivering Cancer Rehabilitation Services, Barriers to Care, and Service Development Needs. Phys Ther 2022; 102:6515750. [PMID: 35084029 PMCID: PMC8887570 DOI: 10.1093/ptj/pzab287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/15/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Physical therapist-delivered rehabilitation aims to manage the side effects of cancer and its treatments. Although access to cancer rehabilitation is not yet a standard of care in many countries, physical therapists practice in many types of cancer services with different cancer populations. The purpose of this study was to explore the experiences of physical therapists in cancer care practice with regard to their role, the factors influencing service delivery and development, and physical therapists' professional development needs. METHODS In this qualitative study with semistructured interviews, physical therapists in cancer care settings in the Republic of Ireland were interviewed via telephone. Participants (n = 17) represented a variety of clinical settings and roles. Two researchers performed thematic analysis of transcriptions using a semantic, inductive approach. Key themes and codes were identified and illustrative quotes were selected. RESULTS Six main themes were found: the need for more services, barriers to service development and delivery, a lack of awareness of the role of physical therapy, facilitators to service development, goals for the future of oncology physical therapy, and training needs of staff. CONCLUSIONS Physical therapists provide valuable interventions across the spectrum of cancer care but experience barriers to the delivery and development of services. Investment in oncology physical therapy and developing international standards of care will allow physical therapists to meet the rehabilitation needs of survivors of cancer. IMPACT As international guidelines increasingly recommend development of cancer rehabilitation programs, it is important to understand physical therapists' experiences of working in cancer care to assist in the development of effective oncology physical therapy services. This study demonstrates that physical therapist-led cancer rehabilitation services need investment and public promotion to enable the provision of optimal services to all patients with cancer and to meet standards of care.
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Affiliation(s)
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland,Trinity St James's Cancer Institute, Dublin, Ireland,Physiotherapy Department, St James's Hospital, Dublin, Ireland
| | - Linda O’Neill
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland,Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise O’Connor
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland,Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland,Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Creedon M, Humphreys H, Connolly R, Gaughan L, Skally M, Caird J, Duddy J, O'Halloran P, Mandiwanza T, Burns K, Dinesh B, Smyth E, O'Connell K, Fitzpatrick F. Multidisciplinary neurosurgical rounds incorporating antimicrobial stewardship. Are they of benefit? Brain and Spine 2022; 2:100885. [PMID: 36248101 PMCID: PMC9560698 DOI: 10.1016/j.bas.2022.100885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 01/01/2023]
Abstract
Background In an era of increasing antimicrobial resistance, appropriate antimicrobials are essential to optimise patient outcomes. In 2017, antimicrobial use prevalence (AMU) on the two neurosurgical wards in our tertiary teaching hospital varied from 23% on ward A to 33% on ward B with 67% and 100% ‘appropriate’ prescriptions, respectively. In July 2018, a weekly antimicrobial stewardship multidisciplinary round led by a senior neurosurgery registrar commenced, attended by the antimicrobial stewardship team (AST). Research question This report evaluates whether a multi-disciplinary approach on neurosurgical prescribing was beneficial, specifically in reducing AMU. Materials and methods The following data was collected on AST rounds for 30 weeks in total from August 2018 to July 2019: number of patients on antimicrobials, appropriateness and stewardship actions. A questionnaire was distributed to neurosurgical doctors on two occasions to canvass opinions and attitudes on antimicrobial prescribing. Results 1716 prescriptions were reviewed (mean 57.2 per week). Of these 321 (18.7%) included antimicrobial prescriptions; 200 on ward A (19.8%), and 121 on ward B (17%), representing a decrease in AMU from 2017. The majority of antimicrobial prescriptions, 271 (84.4%) were deemed appropriate. Stewardship actions were taken in 215 (67%) prescriptions. Fifteen questionnaires were completed by neurosurgical doctors. The majority, 87%, stated the AST round was helpful overall. 93% indicated that informal training on the AST round was a source of education in antibiotic prescribing. Discussion and conclusion The weekly AST round provided a timely opportunity for multidisciplinary discussion, implementation of antimicrobial stewardship actions and opportunistic antimicrobial stewardship education. Surgeons need to be directly involved in antimicrobial stewardship to optimise patient outcomes and reduce antimicrobial resistance. A multidisciplinary antimicrobial stewardship (AST) ward round led by neurosurgery commenced in our hospital in 2018. Antimicrobial stewardship actions were taken in 67% of prescriptions, and antimicrobial use prevalence reduced in 2018 compared to 2017. A questionnaire distributed to neurosurgical doctors on the value of the AST round indicated that 87% of neurosurgical doctors found it helpful. We believe leadership and accountability were crucial to the success of the ward round, as neurosurgeons contributed directly to decision making.
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Cullen J, Chambers A, Smyth E, Mackey PL, Hunt L, Bamford R. 1277 A Closed-Loop Audit of the use of qFIT in Symptomatic “Two Week Wait” referrals in Somerset Foundation Trust. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.425] [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
Quantitative faecal immunochemical test (qFIT) is recommended as the replacement test for faecal occult blood testing by NICE. We audited qFIT use in two week-wait (2WW) referrals in Somerset Foundation Trust (SFT) following its introduction in 2019.
Method
Following qFIT being made available to general practitioners, all 2WW referrals received before (July 2019) and after (December 2019) the introduction of the new 2WW referral form were reviewed. Electronic patient records were analysed to determine investigations performed and if a diagnosis of cancer was made.
Results
July 2019: 288 2WW referrals with 74 patients eligible for qFIT – only 7 of these underwent qFIT; total of 93 qFIT performed by GPs with 11 positive tests. December 2019: 222 2WW referrals with 18 patients eligible for qFIT – all of whom underwent qFIT; total of 155 qFIT performed by GPs with 18 positive (and 137 negative) tests. 1 patient with a positive qFIT was found to have colorectal malignancy (qFIT = 267 g/dL, investigation showed benign TVA). An increase in qFIT was observed over time, coinciding with a reduction in 2WW referrals, including reduction in patients who were qFIT eligible. The 2WW service identified 11 (3.8%) cases of colorectal cancer in July 2019 compared to 12 (5.4%) cases in December 2019, showing an increased pickup rate.
Conclusions
High proportions of 2WW referrals undergo investigation. The results of this audit highlight the utility of qFIT in screening 2WW referrals and reducing burden on the service, particularly where access to investigations is severely restricted due to coronavirus.
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Affiliation(s)
- J Cullen
- Southmead Hospital, Bristol, United Kingdom
| | - A Chambers
- Musgrove Park Hospital, Taunton, United Kingdom
| | - E Smyth
- Musgrove Park Hospital, Taunton, United Kingdom
| | - P l Mackey
- Musgrove Park Hospital, Taunton, United Kingdom
| | - L Hunt
- Musgrove Park Hospital, Taunton, United Kingdom
| | - R Bamford
- Musgrove Park Hospital, Taunton, United Kingdom
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12
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de la Fouchardiere C, Decoster L, Samalin E, Terret C, Kenis C, Droz JP, Coutzac C, Smyth E. Advanced oesophago-gastric adenocarcinoma in older patients in the era of immunotherapy. A review of the literature. Cancer Treat Rev 2021; 100:102289. [PMID: 34583303 DOI: 10.1016/j.ctrv.2021.102289] [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] [Received: 08/06/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022]
Abstract
Gastric (G) and gastro-esophageal junction (GEJ) adenocarcinomas are of the most common and deadly cancers worldwide and affect mainly patients over 70 years at diagnosis. Older age has been associated in gastric cancers with distal tumour location, well-differentiated adenocarcinoma and microsatellite instability and is not identified itself as an independent prognostic factor. As immune checkpoint inhibitors recently changed the landmark of advanced G and GEJ adenocarcinomas treatment, we decided to perform a literature review to define the evidence-level of clinical data in older patients. This work underlined the lasting low -inclusion rate of older patients and -implementation rate of frailty screening tools in clinical trials in G/GEJ carcinomas. In the first-line metastatic setting, two prospective randomized phase III studies have specifically assessed the efficacy of chemotherapy in older patients with HER2-negative gastric cancers, demonstrating the feasibility of reduced dose oxaliplatin-based chemotherapy regimen in this population. Only few data are available in HER2-positive tumors, or in the second-line setting. Furthermore, no specific trial with immune checkpoint inhibitors was performed in older frail patients whereas their benefit/adverse events ratio make them attractive candidates in this patient's population. We conclude that older fit patients can be treated in the same way as younger ones and included in clinical trials. Improving the outcome of older frail patients should be the oncology community next focus by implementing targeted interventions before initiating cancer therapy and designing specific clinical trials. Frailty screening tools and geriatric data collection have to be implemented in routine-practice and clinical trials.
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Affiliation(s)
| | - L Decoster
- Department of Medical Oncology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - E Samalin
- Medical Oncology Department, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France.
| | - C Terret
- Medical Oncology Department, Centre Léon Bérard, 28 rue Laennec, Lyon, France
| | - C Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.
| | - J P Droz
- Medical Oncology, Claude-Bernard Lyon1 University, Lyon, France.
| | - C Coutzac
- Medical Oncology Department, Centre Léon Bérard, 28 rue Laennec, Lyon, France.
| | - E Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
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13
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Hannon C, Paula B, Goksu M, Corbett G, Carroll N, Sousa C, Smyth E. 1412P Palliative stents in a large cohort of advanced gastroesophageal cancers (GOC): Factors associated with long term survival. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Cartwright E, Turkes F, Saffery C, Tran A, Smith G, Moreno SE, Hatt S, Renn A, Johnston E, Kohoutova D, Begum R, Smyth E, Peckitt C, Fribbens C, Rao S, Watkins D, Chau I, Starling N, Cunningham D. 443P EMERGE: A phase II trial assessing the efficacy of domatinostat plus avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal cancers – phase IIA dose finding. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Smyth E, O'Connor L, Mockler D, Reynolds JV, Hussey J, Guinan E. Preoperative high intensity interval training for oncological resections: A systematic review and meta-analysis. Surg Oncol 2021; 38:101620. [PMID: 34161894 DOI: 10.1016/j.suronc.2021.101620] [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] [Received: 12/04/2020] [Revised: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 12/25/2022]
Abstract
Exercise prehabilitation prior to major surgery targets a reduction in postoperative complications through improved conditioning and respiratory function. However its effectiveness in cancer surgery is unclear. The objective of this review was to determine if preoperative high-intensity interval training (HIIT) improves preoperative fitness in patients scheduled for oncologic resection, and whether postoperative complications are impacted. METHODS: CINAHL, AMED, PEDro, EMBASE, The Cochrane Library and PubMed/MEDLINE were searched until April 2021 using predefined search strategy and accompanied by manual forward and backwards citation review. Screening of titles, abstracts, full-texts, data extraction, risk of bias assessment and methodologic quality was performed independently by two reviewers. Mean difference (MD) with 95% confidence intervals (CI) was compared and heterogeneity assessed using Chi Squared Test and I2 statistic. Six randomised controlled trials (RCTs) were included in the systematic review. Interventions prescribed bouts of high-intensity exercise [80-115% peak work rate (WRp)] interspaced with low-intensity (rest-50% WRp) exercise. The meta-analysis included five RCTs reporting peak oxygen consumption (VO2peak). Preoperative HIIT did not result in significantly higher VO2peak in comparison to usual care or moderate intensity exercise (MD 0.83, 95%CI-0.51-2.17) kg/ml/min, p = 0.12). Studies were insufficiently powered with respect to postoperative complications, but there is no evidence of significant impact. No adverse events occurred and high adherence rates were reported. Results of this systematic review and meta-analysis demonstrate there is insufficient evidence to support HIIT as a method of improving preoperative fitness prior to oncologic resection. Further work is needed to determine if specific HIIT parameters can be adapted to improve efficacy over short time-frames.
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Affiliation(s)
- Emily Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland
| | - John V Reynolds
- Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
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16
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O'Connor L, Smyth E, Bennett AE, Smith V, O'Neill L, Reynolds JV, Hussey J, Guinan E. Identifying outcomes reported in exercise interventions in oesophagogastric cancer survivors: a systematic review. BMC Cancer 2021; 21:586. [PMID: 34022821 PMCID: PMC8141124 DOI: 10.1186/s12885-021-08290-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/10/2020] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Research investigating exercise interventions in oesophagogastric cancer survivors is sparse, and the outcomes are varied. The aim of this systematic review is to identify the domains and outcomes reported in exercise interventions in oesophagogastric cancer survivors to be included in a Delphi study, with a view to informing the development of a core outcome set (COS). METHODS EMBASE, PubMed, CINHAL, Cochrane Library, SCOPUS, and PEDro were searched up to March 2020 using a predefined search strategy. The outcomes identified during data extraction were categorised using the core areas outlined in the OMERACT Filter 2.0. RESULTS Fourteen domains and 63 outcomes were identified. The most frequently reported outcomes were in the domains of quality of life using the EORTC-QLQ-C30 questionnaire and the relevant disease-specific modules (100%), exercise capacity/fitness/physical function (100%), anthropometrics (83.33%), physical activity (66.67%), and biomarker analysis (50%). CONCLUSION This systematic review quantifies and describes the domains and outcomes examined in exercise interventions in oesophagogastric cancer survivors. Some inconsistency exists within the domains and outcomes used, and little attention was given to nutritional or economic endpoints. In order to develop a COS, a Delphi consensus process with key stakeholders is needed to identify the relevant domains and outcomes for inclusion.
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Affiliation(s)
- Louise O'Connor
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Linda O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - John V Reynolds
- Department of Survery St James's Hospital and Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
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17
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O'Neill L, Guinan E, Brennan L, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2021; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Louise Brennan
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V. Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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18
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Ococks E, Frankell AM, Masque Soler N, Grehan N, Northrop A, Coles H, Redmond AM, Devonshire G, Weaver JMJ, Hughes C, Lehovsky K, Blasko A, Nutzinger B, Fitzgerald RC, Smyth E. Longitudinal tracking of 97 esophageal adenocarcinomas using liquid biopsy sampling. Ann Oncol 2021; 32:522-532. [PMID: 33359547 DOI: 10.1016/j.annonc.2020.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The incidence of esophageal adenocarcinoma (EAC) is rapidly rising and has a 5-year survival rate of <20%. Beyond TNM (tumor-node-metastasis) staging, no reliable risk stratification tools exist and no large-scale studies have profiled circulating tumor DNA (ctDNA) at relapse in EAC. Here we analyze the prognostic potential of ctDNA dynamics in EAC, taking into account clonal hematopoiesis with indeterminate potential (CHIP). PATIENTS AND METHODS A total of 245 samples from 97 patients treated with neoadjuvant chemotherapy and surgery were identified from the prospective national UK Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium data set. A pan-cancer ctDNA panel comprising 77 genes was used. Plasma and peripheral blood cell samples were sequenced to a mean depth of 7082× (range 2196-28 524) and ctDNA results correlated with survival. RESULTS Characteristics of the 97 patients identified were as follows: 83/97 (86%) male, median age 68 years (SD 9.5 years), 100% cT3/T4, 75% cN+. EAC-specific drivers had higher variant allele fractions than passenger mutations. Using stringent quality criteria 16/79 (20%) were ctDNA positive following resection; recurrence was observed in 12/16 (75%) of these. As much as 78/97 (80%) had CHIP analyses that enabled filtering for CHIP variants, which were found in 18/78 (23%) of cases. When CHIP was excluded, 10/63 (16%) patients were ctDNA positive and 9/10 of these (90%) recurred. With correction for CHIP, median cancer-specific survival for ctDNA-positive patients was 10.0 months versus 29.9 months for ctDNA-negative patients (hazard ratio 5.55, 95% confidence interval 2.42-12.71; P = 0.0003). Similar outcomes were observed for disease-free survival. CONCLUSIONS We demonstrate in a large, national, prospectively collected data set that ctDNA in plasma following surgery for EAC is prognostic for relapse. Inclusion of peripheral blood cell samples can reduce or eliminate false positives from CHIP. In future, post-operative ctDNA could be used to risk stratify patients into high- and low-risk groups for intensification or de-escalation of adjuvant chemotherapy.
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Affiliation(s)
- E Ococks
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - A M Frankell
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - N Masque Soler
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - N Grehan
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - A Northrop
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - H Coles
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - A M Redmond
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - G Devonshire
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - J M J Weaver
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - C Hughes
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - K Lehovsky
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - A Blasko
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - B Nutzinger
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - R C Fitzgerald
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK.
| | - E Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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19
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Sheill G, Guinan E, O'Neill L, Smyth E, Normand C, L. Doyle S, Moore S, Newell J, McDermott G, Ryan R, V. Reynolds J, Hussey J. Prehabilitation during a pandemic: preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus, the PRE-HIIT trial: an updated study protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13198.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pre-operative fitness is an established predictor of postoperative outcome; accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation for patients with cancer of the lung or oesophagus is challenging to implement due to the short opportunity for intervention between diagnosis and surgery. In addition, there are now additional challenges to providing prehabilitation during the coronavirus disease 2019 (COVID-19) pandemic due to concerns about social distancing and minimising patient contact. The PRE-HIIT project will examine the influence of virtually delivered exercise prehabilitation on physiological outcomes and postoperative recovery. Methods: The PRE-HIIT randomised controlled trial (RCT) will compare a 2-week high intensity interval training programme to standard preoperative care in a cohort of patients with thoracic and oesophageal cancers. A protocol for this study has been published previously. As a result of the COVID-19 pandemic, changes to the study assessment battery and the mode of intervention delivery have been made. The PRE-HIIT programme will now be a home-based intervention. Both the exercise intervention and standard care will be delivered via telehealth. The recruitment target for the study remains 78 participants. There is no change to the primary outcome of the study; cardiorespiratory fitness. Secondary outcomes include measures of pulmonary and physical function, quality of life and post-operative morbidity. Outcomes will be measured at baseline and post-intervention. The impact of PRE-HIIT on well-being will be examined qualitatively with interviews post-intervention (T1). This revised protocol will also explore participant’s satisfaction with delivery of prehabilitation via telehealth. The healthcare costs associated with the PRE-HITT programme will also be examined. Discussion: The overall aim of this RCT is to examine the effect of tailored, individually prescribed high intensity interval training on pre-operative fitness and postoperative recovery for patients undergoing complex surgical resections. Trial registration: ClinicalTrials.Gov NCT03978325 07/06/2019
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20
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Cardone C, Pihlak R, Smyth E. ESMO20 YO for YO: highlights on upper GI tumours. ESMO Open 2020; 6:100023. [PMID: 33399085 PMCID: PMC7807969 DOI: 10.1016/j.esmoop.2020.100023] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- C Cardone
- Experimental Clinical Abdominal Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
| | - R Pihlak
- The Christie NHS Foundation Trust, Manchester, UK
| | - E Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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21
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Gupta A, Liao M, Smyth E, Vahl TP, Finn M, Fidlow K, Nazif T, Leon MB, Kodali SK, Kirtane AJ. Bleeding Outcomes in Patients Undergoing Combined Percutaneous Coronary Interventions+Transcatheter Aortic Valve Replacement: Time for an Adjustment to the CathPCI Bleeding Model? Circ Cardiovasc Interv 2020; 14:e009806. [PMID: 33355005 DOI: 10.1161/circinterventions.120.009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aakriti Gupta
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Ming Liao
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Emily Smyth
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Torsten P Vahl
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Matthew Finn
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Kathryn Fidlow
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Tamim Nazif
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Martin B Leon
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Susheel K Kodali
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Ajay J Kirtane
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
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22
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O'Neill L, Guinan E, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2020; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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Ococks E, Ng A, Devonshire G, Dashner S, Chan WC, Sharma S, Wu HT, Redmond A, Northrop A, Grehan N, Sethi H, Zimmermann B, Smyth E, Aleshin A, Fitzgerald R. 370P Bespoke circulating tumour DNA assay for the detection of minimal residual disease in esophageal adenocarcinoma patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.594] [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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Concannon J, Hynes N, McMullen M, Smyth E, Moerman K, McHugh PE, Sultan S, Karmonik C, McGarry JP. A Dual-VENC Four-Dimensional Flow MRI Framework for Analysis of Subject-Specific Heterogeneous Nonlinear Vessel Deformation. J Biomech Eng 2020; 142:1087598. [DOI: 10.1115/1.4048649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 12/19/2022]
Abstract
Abstract
Advancement of subject-specific in silico medicine requires new imaging protocols tailored to specific anatomical features, paired with new constitutive model development based on structure/function relationships. In this study, we develop a new dual-velocity encoding coefficient (VENC) 4D flow MRI protocol that provides unprecedented spatial and temporal resolution of in vivo aortic deformation. All previous dual-VENC 4D flow MRI studies in the literature focus on an isolated segment of the aorta, which fail to capture the full spectrum of aortic heterogeneity that exists along the vessel length. The imaging protocol developed provides high sensitivity to all blood flow velocities throughout the entire cardiac cycle, overcoming the challenge of accurately measuring the highly unsteady nonuniform flow field in the aorta. Cross-sectional area change, volumetric flow rate, and compliance are observed to decrease with distance from the heart, while pulse wave velocity (PWV) is observed to increase. A nonlinear aortic lumen pressure–area relationship is observed throughout the aorta such that a high vessel compliance occurs during diastole, and a low vessel compliance occurs during systole. This suggests that a single value of compliance may not accurately represent vessel behavior during a cardiac cycle in vivo. This high-resolution MRI data provide key information on the spatial variation in nonlinear aortic compliance, which can significantly advance the state-of-the-art of in-silico diagnostic techniques for the human aorta.
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Affiliation(s)
- J. Concannon
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - N. Hynes
- Department of Vascular and Endovascular Surgery, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - M. McMullen
- Department of Radiology, Galway Clinic, Doughiska, Galway H91 HHT0, Ireland
| | - E. Smyth
- Department of Radiology, Galway Clinic, Doughiska, Galway H91 HHT0, Ireland
| | - K. Moerman
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - P. E. McHugh
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - S. Sultan
- Department of Vascular and Endovascular Surgery, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - C. Karmonik
- MRI Core, Houston Methodist Debakey Heart and Vascular Center, Houston, TX 77030
| | - J. P. McGarry
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
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Little R, Murray J, Smyth E, Pawlikowska T. Checking the Checklists: Hospitals Are Not Airplanes. Ir Med J 2020; 113:40. [PMID: 32815682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- R Little
- Royal College of Surgeons in Ireland, Dublin 2
| | - J Murray
- Royal College of Surgeons in Ireland, Dublin 2
| | - E Smyth
- Royal College of Surgeons in Ireland, Dublin 2
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Cafferkey J, O’Connor M, Doyle D, Skally M, Fitzpatrick M, Burns K, O’Connell K, Fitzpatrick F, Smyth E, Humphreys H. Improving the processing time for the detection of carbapenemase-producing enterobacterales using an evolving algorithm. Br J Biomed Sci 2020; 77:97-100. [DOI: 10.1080/09674845.2019.1704357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Cafferkey
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M O’Connor
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - D Doyle
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
| | - K O’Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - E Smyth
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Cleary SJ, Rauzi F, Smyth E, Correia A, Hobbs C, Emerson M, Page CP, Pitchford SC. Radiolabelling and immunohistochemistry reveal platelet recruitment into lungs and platelet migration into airspaces following LPS inhalation in mice. J Pharmacol Toxicol Methods 2019; 102:106660. [PMID: 31838234 DOI: 10.1016/j.vascn.2019.106660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/21/2019] [Accepted: 12/01/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Platelets are under investigation for their role in host defence and inflammatory lung diseases and have been demonstrated to be recruited to the lung. However, the mechanisms and consequences of platelet recruitment into lungs are poorly understood. We have utilised a murine model to investigate the mechanisms of platelet involvement in lung inflammation induced by intranasal administration of LPS. OBJECTIVES Our aim was to characterise lung platelet recruitment following LPS inhalation in mice using immunohistochemistry, and non-invasive and invasive radiolabelled platelet tracking techniques. RESULTS Intranasal administration of LPS caused an increase in lung platelet staining in lung tissue and elicited the recruitment of radiolabelled platelets into the lung. Prior to these responses in the lung, we observed an earlier decrease in blood platelet counts, temporally associated with platelet recruitment to the liver and spleen. Non-invasive measurements of thoracic radioactivity reflected changes in blood counts rather than extravascular lung platelet recruitment. However, both in situ counting of radiolabelled platelets and immunostaining for platelet surface markers showed LPS-induced increases in extravascular platelets into lung airspaces suggesting that some of the platelets recruited to the lung enter air spaces. CONCLUSIONS Intranasal administration of LPS activates the innate immune response which includes a fall in peripheral blood platelet counts with subsequent platelet recruitment to the lung, spleen and liver, measured by immunohistochemistry and radiolabelling techniques.
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Affiliation(s)
- S J Cleary
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - F Rauzi
- National Heart & Lung Institute, Imperial College London, London, UK
| | - E Smyth
- National Heart & Lung Institute, Imperial College London, London, UK
| | - A Correia
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - C Hobbs
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - M Emerson
- National Heart & Lung Institute, Imperial College London, London, UK
| | - C P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - S C Pitchford
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK.
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Ococks E, Frankell A, Masque-Soler N, Northrop A, Devonshire G, Hughes C, Grehan N, Smyth E, Blasko A, Fitzgerald R. Assessing the clinical utility of circulating tumour DNA through longitudinal liquid biopsy sampling in oesophageal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.148] [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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29
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Smyth E. A prospective study of injury epidemiology at the 2018 17/U and 19/U Australian National Netball Championships. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cafferkey J, Skally M, Finn C, Donlon S, Fitzpatrick M, Burns K, O'Connell K, Fitzpatrick F, Smyth E, Humphreys H. Value of a hospital-wide point prevalence survey of carbapenemase-producing Enterobacterales – low-level prevalence confirmed. J Hosp Infect 2019; 101:191-194. [DOI: 10.1016/j.jhin.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Fitzpatrick F, Skally M, O'Hanlon C, Foley M, Houlihan J, Gaughan L, Smith O, Moore B, Cunneen S, Sweeney E, Dinesh B, O'Connell K, Smyth E, Humphreys H, Burns K. Food for thought. Malnutrition risk associated with increased risk of healthcare-associated infection. J Hosp Infect 2018; 101:300-304. [PMID: 30590089 DOI: 10.1016/j.jhin.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infection and malnutrition are interconnected. UK and Irish guidelines recommend the Malnutrition Universal Screening Tool (MUST) for nutritional risk screening. Patients with a MUST score of ≥2 are considered at high risk of malnutrition and referral for nutritional assessment is recommended. AIM To explore the association between healthcare-associated infection (HCAI) and the MUST score categories of patients. METHODS This was a cross-sectional study in May 2017 on ten representative wards in our institution. Patient demographics, MUST score, presence of medical devices, HCAI and antimicrobial use were collected. FINDINGS Of 240 patients, the HCAI prevalence was 10.4% (N = 25) and 26% (N = 63) were at high risk of malnutrition (MUST score ≥2). Patients with HCAI were more likely to have had surgery (odds ratio (OR): 5.5; confidence interval (CI): 2.1-14.3; P < 0.001), a central vascular catheter (OR: 10.0; CI: 3.6-27.2; P < 0.001), or a urinary catheter in situ (OR: 7.5; CI: 2.8-20.0; P < 0.001), and to have a high risk of malnutrition (OR: 4.3; CI: 1.7-11.2; P < 0.001). A higher MUST score remained a significant predictor of a patient having HCAI on multivariate regression analysis (CI: 0.2-0.6; P < 0.001). CONCLUSION Patients at risk of malnutrition when assessed with the MUST were more likely to have HCAI. However, prospective studies are required to investigate the temporal association between MUST and HCAI and which interventions best address malnutrition risk and HCAI reduction in different settings.
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Affiliation(s)
- F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - C O'Hanlon
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - M Foley
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - J Houlihan
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - L Gaughan
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - O Smith
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - B Moore
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - S Cunneen
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - E Sweeney
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - B Dinesh
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - E Smyth
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Health Protection Surveillance Centre, Dublin, Ireland
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Davies AR, Myoteri D, Zylstra J, Baker CR, Wulaningsih W, Van Hemelrijck M, Maisey N, Allum WH, Smyth E, Gossage JA, Lagergren J, Cunningham D, Green M. Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma. Br J Surg 2018; 105:1639-1649. [PMID: 30047556 DOI: 10.1002/bjs.10900] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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] [Received: 02/06/2018] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. METHODS Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10-50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan-Meier and Cox regression analysis. RESULTS Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. CONCLUSION Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.
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Affiliation(s)
- A R Davies
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - D Myoteri
- Department of Cellular Pathology, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Zylstra
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C R Baker
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
| | - W Wulaningsih
- Translational Oncology and Urology Research, School of Cancer Sciences, King's College London, London, UK
| | - M Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer Sciences, King's College London, London, UK
| | - N Maisey
- Department of Oncology, Guy's Cancer Centre, Guy's Hospital, London, UK
| | - W H Allum
- Department of Oncology, Royal Marsden Hospital, London, UK
| | - E Smyth
- Department of Oncology, Royal Marsden Hospital, London, UK
| | - J A Gossage
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Lagergren
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - D Cunningham
- Department of Oncology, Royal Marsden Hospital, London, UK
- Institute of Cancer Research, London, UK
| | - M Green
- Department of Cellular Pathology, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
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Davidson M, Nankivell M, Cunningham D, Starling N, Koh DM, Brown G, Allum W, Wotherspoon A, Smyth E, Ly L, Kleovoulou N, Langley R, Riddell A. Magnetic resonance imaging in oesophageal (oes) cancer: Results from the STO3 MRI substudy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Smyth E, Kouvelakis K, Cunningham D, Hahne J, Peckitt C, Vlachogiannis G, Watkins D, Rao S, Starling N, Wilson S, Waddell T, Okines A, Crosby T, Mansoor W, Wadsley J, Middleton G, Wotherspoon A, Chau I, Valeri N. EGFR amplification (amp) and survival in the REAL-3 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gupta A, Finn M, Vahl T, Nazif T, Smyth E, Fidlow K, Leon M, Kodali S, Kirtane AJ. TCT-538 Bleeding Outcomes in Patients Undergoing Combined TAVR/PCI: Time for an Adjustment to the CathPCI Bleeding Model? J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1722] [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: 10/28/2022]
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Murray MM, Eardley AF, Edginton T, Oyekan R, Smyth E, Matusz PJ. Sensory dominance and multisensory integration as screening tools in aging. Sci Rep 2018; 8:8901. [PMID: 29891964 PMCID: PMC5995929 DOI: 10.1038/s41598-018-27288-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/31/2018] [Indexed: 02/07/2023] Open
Abstract
Multisensory information typically confers neural and behavioural advantages over unisensory information. We used a simple audio-visual detection task to compare healthy young (HY), healthy older (HO) and mild-cognitive impairment (MCI) individuals. Neuropsychological tests assessed individuals' learning and memory impairments. First, we provide much-needed clarification regarding the presence of enhanced multisensory benefits in both healthily and abnormally aging individuals. The pattern of sensory dominance shifted with healthy and abnormal aging to favour a propensity of auditory-dominant behaviour (i.e., detecting sounds faster than flashes). Notably, multisensory benefits were larger only in healthy older than younger individuals who were also visually-dominant. Second, we demonstrate that the multisensory detection task offers benefits as a time- and resource-economic MCI screening tool. Receiver operating characteristic (ROC) analysis demonstrated that MCI diagnosis could be reliably achieved based on the combination of indices of multisensory integration together with indices of sensory dominance. Our findings showcase the importance of sensory profiles in determining multisensory benefits in healthy and abnormal aging. Crucially, our findings open an exciting possibility for multisensory detection tasks to be used as a cost-effective screening tool. These findings clarify relationships between multisensory and memory functions in aging, while offering new avenues for improved dementia diagnostics.
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Affiliation(s)
- Micah M Murray
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Department of Ophthalmology, Fondation Asile des Aveugles and University of Lausanne, Lausanne, Switzerland.
- EEG Brain Mapping Core, Center for Biomedical Imaging (CIBM), Lausanne, Switzerland.
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.
| | | | - Trudi Edginton
- Department of Psychology, City, University of London, London, UK
| | - Rebecca Oyekan
- Department of Psychology, University of Westminster, London, UK
| | - Emily Smyth
- Department of Psychology, University of Westminster, London, UK
| | - Pawel J Matusz
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland
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Smyth E, Fassan M, Kouvelakis K, Nankivell M, Peckitt C, Wotherspoon A, Valeri N, Rugge M, Allum W, Langley R, Cunningham D. ATM loss, MSI and survival in the MAGIC trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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O'Donnell S, Gaughan L, Skally M, Baker Z, O'Connell K, Smyth E, Fitzpatrick F, Humphreys H. The potential contribution of 16S ribosomal RNA polymerase chain reaction to antimicrobial stewardship in culture-negative infection. J Hosp Infect 2017; 99:148-152. [PMID: 28838799 DOI: 10.1016/j.jhin.2017.08.016] [Citation(s) in RCA: 9] [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] [Received: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
Empiric broad-spectrum antimicrobial therapy frequently results in culture-negative specimens making rationalization of therapy difficult. We retrospectively reviewed 16S rRNA polymerase chain reaction (PCR) results from 78 specimens in 60 patients. 16S rRNA was detected in 28 (47%) patients with de-escalation of therapy in five (21%). Microbial DNA was not detected in 32 (53%) patients with antimicrobials discontinued in two (8%). Neurosurgical patients had a higher proportion of positive results (53% vs 34%) and treatment rationalizations (17% vs 12%). In specific patient groups, 16s rRNA PCR is a useful antimicrobial stewardship tool for targeting antimicrobial therapy.
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Affiliation(s)
- S O'Donnell
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland.
| | - L Gaughan
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - Z Baker
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Smyth
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Smyth E, Solomon A, Birrell MA, Smallwood MJ, Winyard PG, Tetley TD, Emerson M. Influence of inflammation and nitric oxide upon platelet aggregation following deposition of diesel exhaust particles in the airways. Br J Pharmacol 2017; 174:2130-2139. [PMID: 28437857 PMCID: PMC5466527 DOI: 10.1111/bph.13831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/24/2016] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Exposure to nanoparticulate pollution has been implicated in platelet‐driven thrombotic events such as myocardial infarction. Inflammation and impairment of NO bioavailability have been proposed as potential causative mechanisms. It is unclear, however, whether airways exposure to combustion‐derived nanoparticles such as diesel exhaust particles (DEP) or carbon black (CB) can augment platelet aggregation in vivo and the underlying mechanisms remain undefined. We aimed to investigate the effects of acute lung exposure to DEP and CB on platelet activation and the associated role of inflammation and endothelial‐derived NO. Experimental Approach DEP and CB were intratracheally instilled into wild‐type (WT) and eNOS−/− mice and platelet aggregation was assessed in vivo using an established model of radio‐labelled platelet thromboembolism. The underlying mechanisms were investigated by measuring inflammatory markers, NO metabolites and light transmission aggregometry. Key Results Platelet aggregation in vivo was significantly enhanced in WT and eNOS−/− mice following acute airways exposure to DEP but not CB. CB exposure, but not DEP, was associated with significant increases in pulmonary neutrophils and IL‐6 levels in the bronchoalveolar lavage fluid and plasma of WT mice. Neither DEP nor CB affected plasma nitrate/nitrite concentration and DEP‐induced human platelet aggregation was inhibited by an NO donor. Conclusions and Implications Pulmonary exposure to DEP and subsequent platelet activation may contribute to the reports of increased cardiovascular risk, associated with exposure to airborne pollution, independent of its effects on inflammation or NO bioavailability.
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Affiliation(s)
- E Smyth
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - A Solomon
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - M A Birrell
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M J Smallwood
- Inflammation Research Group, University of Exeter Medical School, Exeter, UK
| | - P G Winyard
- Inflammation Research Group, University of Exeter Medical School, Exeter, UK
| | - T D Tetley
- Lung Cell Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Emerson
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
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Acharya M, Burke JM, Smyth E, Ngere L, Rorie RW. 1724 Serum anti-mullerian hormone as an indicator of fertility in Katahdin ewes. J Anim Sci 2016. [DOI: 10.2527/jam2016-1724] [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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42
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Cafferkey C, Smyth E, Loehr A, Harding T, Raponi M, Okines A, Waddell T, Chau I, Cunningham D. Genomic loss of heterozygosity (LOH) and survival in patients (pts) treated with epirubicin, oxaliplatin, capecitabine (EOC) ± panitumumab (P) in the REAL3 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lote H, Zito D, Burke R, Smyth E, Braconi C, Cunningham D, Valeri N. MicroRNAs as biomarkers of resistance to HER2 inhibitors in combination with chemotherapy in gastro-oesophageal cancer cell lines. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw393.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smyth E, Rowley S, Allum W, Stenning S, Wotherspoon A, Robb C, Grabsch H, Alderson D, Crosby T, Mason R, Griffin M, Mansoor W, Darby S, Seymour M, Thompson J, Sothi S, Sumpter K, Blazeby J, Langley R, Cunningham D. A randomised phase II study of perioperative epirubicin, cisplatin and capecitabine (ECX) ± lapatinib for operable, HER-2 positive gastric, oesophagogastric junctional (OGJ) or lower oesophageal adenocarcinoma: Results from the UK MRC ST03 lapatinib feasibility study (ISRCTN 46020948). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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Sexton T, Creamer E, Turley M, Smyth E, Humphreys E. Persistent environmental reservoirs for Vancomycin-resistant enterococci requiring repeated decontamination to achieve eradication. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175717740200300303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
V ancomycin-resistant enterococci (VRE) are increasingly recognised nosocomial pathogens in clinical areas with high antibiotic usage. Patients with chronic renal failure, including those requiring haemodialysis, are at particular risk. Investigation and control of an outbreak of VRE in two renal wards, highlighting mattresses as reservoirs and environmental measures to control VRE are reported in this paper. Outbreak control measures included standard isolation in accordance with the Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Patients were screened on admission and weekly using a rectal swab. The inanimate environment including mattresses was also screened. Enhanced environmental decontamination was performed on a daily basis. The outbreak continued over a 20-week period with most cases occurring in the first 6 weeks. The results of screening indicated that 59 (13%) of 451 patients and 54 (8.3%) of 647 environmental samples were positive for VRE. VRE was isolated from 35 (8%) of 433 mattresses, 12 (8.1%) of 148 environmental ledges, 4 (8%) of 50 toilets, and 3 (18.8%) of 16 items of cleaning equipment. Molecular typing indicated that a predominant strain was also implicated in mattress contamination, thus highlighting a potential and important reservoir for transmission of VRE. Difficulty with eradication of VRE from the environment was encountered despite enhanced cleaning regimens and a doubling of use of disinfectant was necessary. Restriction of antibiotics, hand hygiene, hygiene and education are the cornerstone of VRE prevention and control. Lessons from this outbreak highlight the role of the environment in VRE transmission and the need for attention to the environment, especially mattress decontamination.
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Affiliation(s)
- T Sexton
- Departments of Infection Control and Microbiology, Beaumont Hospital, Dublin 9
| | - E Creamer
- Departments of Infection Control and Microbiology, Beaumont Hospital, Dublin 9
| | - M Turley
- Departments of Infection Control and Microbiology, Beaumont Hospital, Dublin 9
| | - E Smyth
- Departments of Infection Control and Microbiology, Beaumont Hospital, Dublin 9
| | - E Humphreys
- Departments of Infection Control and Microbiology, Beaumont Hospital, Dublin 9
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Creamer E, McCarthy G, Tighe I, Smyth E. A survey of 554 peripheral intravenous catheters: infection, duration of cannulation and documentation issues. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175717740300400405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on duration of cannulation. The survey was conducted in 20 general wards recording data on the duration of cannulation, site-infection, dating of PVC dressing and documentation in nursing notes. Nursing staff were interviewed on duration of the PVC and a documentation form was introduced during the survey. A total of 554 PVCs in 397 patients were surveyed. Duration of cannulation ranged from one to ten days, with 402 (73%) of PVCs removed by day three. The site-infection rate was 28 (5%) with no cases of blood stream infection. Most site infection (20 of 28 (71%)) occurred within the first three days. The duration of cannulation, from interview, was known by nurses in 416 (75%) of cases and documented in 208 (40%) of cases. Eighteen months after its introduction, the PVC documentation form was in use in 19 of 20 wards for 60 (76%) PVCs. While the infection rate was low and nurses were generally aware of the duration of cannulation, inadequate documentation by nursing and medical staff was a cause for concern. Information on PVCs should be included in standard documentation on all wards and in relevant departments to assist nurses and others in the provision of quality care to patients.
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Affiliation(s)
- E Creamer
- Infection control nurse, Department of Public Health, Eastern Regional Health Authority, Dr Steevens' Hospital, Dublin 8
| | - G McCarthy
- Research Nurse, Beaumont Hospital, Dublin 9
| | - I Tighe
- Research Nurse, Beaumont Hospital, Dublin 9
| | - E Smyth
- Consultant microbiologist, Beaumont Hospital, Dublin 9
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Acharya M, Burke JM, Coffey KP, Kegley EB, Miller JE, Smyth E, Welborn MG, Terrill TH, Mosjidis JA, Rosenkrans C. Changes in concentrations of trace minerals in lambs fed sericea lespedeza leaf meal pellets with or without dietary sodium molybdate12. J Anim Sci 2016; 94:1592-9. [DOI: 10.2527/jas.2015-9910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M. Acharya
- Department of Animal Science, University of Arkansas, Fayetteville 72701
| | - J. M. Burke
- USDA, ARS, Dale Bumpers Small Farms Research Center, Booneville, AR 72927
| | - K. P. Coffey
- Department of Animal Science, University of Arkansas, Fayetteville 72701
| | - E. B. Kegley
- Department of Animal Science, University of Arkansas, Fayetteville 72701
| | - J. E. Miller
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge 70803
| | - E. Smyth
- Department of Animal Science, University of Arkansas, Fayetteville 72701
- USDA, ARS, Dale Bumpers Small Farms Research Center, Booneville, AR 72927
| | - M. G. Welborn
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge 70803
| | - T. H. Terrill
- Agricultural Research Station, Fort Valley State University, Fort Valley, GA 31030
| | - J. A. Mosjidis
- Department of Crop, Soil and Environmental Sciences, Auburn University, Auburn 36849
| | - C. Rosenkrans
- Department of Animal Science, University of Arkansas, Fayetteville 72701
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Acharya M, Burke JM, Smyth E, Davis A, Lester TD, Rorie RW. 107 Effect of semen extender and storage temperature on ram sperm motility over time. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-107] [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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Burke JM, Miller JE, Terrill TH, Smyth E, Acharya M. Examination of commercially available copper oxide wire particles in combination with albendazole for control of gastrointestinal nematodes in lambs. Vet Parasitol 2015; 215:1-4. [PMID: 26790729 DOI: 10.1016/j.vetpar.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 10/14/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Control of gastrointestinal nematodes (GIN) remains a critical issue due to the prevalence of anthelmintic resistance. The objective of the experiment was to determine the efficacy of copper oxide wire particles (COWP) from three commercial sources and a combination of COWP and albendazole to control GIN and/or Haemonchus contortus in lambs. Naturally infected Katahdin lambs in early June 2014 and 2015 were randomly assigned to receive no COWP (CON; n=9 and 12) or 2g COWP in a gel capsule as Copasure(®) (COP; n=4 and 17; Animax Ltd.), copper oxide-wire form (AUS; n=7 in 2014 only; Pharmplex), Ultracruz™ (ULT; n=8 and 15; Santa Cruz Animal Health™), no COWP and albendazole (CON+alb; n=10 in 2015 only; 15mg/kg BW; Valbazen(®); Zoetis Animal Health), or COWP+alb (n=7 and 11; in 2014, lambs were administered alb on day 3). Lambs grazed grass pastures as a group and were supplemented with 227g/lamb daily of a commercial grain mix (15% crude protein) and the same amount of alfalfa pellets. Feces were collected on days 0 (day of COWP treatment), 7, and 14 for determination of fecal egg counts (FEC). Pooled (2014) or pooled treatment group feces were cultured on days 0, 7, and 14 (2015 only) to determine GIN genera. Data were analyzed using repeated measures in a mixed model, and FEC were log transformed. The predominant GIN on day 0 was H. contortus (87%) in 2014, and there was a mixed population in 2015. The mean FEC was reduced by day 7 in AUS and ULT lambs (treatment×day, P=0.001), and all of the COWP products were similar. By day 14, the AUS FEC were lower than the CON and COP groups. When examining the combination of COWP and synthetic anthelmintic, the FEC of COWP+alb were reduced to nearly 0eggs/g (back-transformed) and lower than the other groups (treatment×day, P=0.001). The percentage of H. contortus in cultured feces was reduced to a greater extent in the COWP than CON or CON+alb groups of lambs. In a mixed GIN population, the COWP products appeared to be similar in efficacy and using a combination of COWP+alb increased the efficacy not only against H. contortus, but all GIN genera present, offering options in the face of resistance to benzimidazoles.
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Affiliation(s)
- J M Burke
- Dale Bumpers Small Farms Research Center, USDA, ARS, Booneville, AR 72927, USA.
| | - J E Miller
- Department of Pathobiological Sciences, School of Veterinary Medicine and Departments of Animal Science and Veterinary Science, Louisiana State University, Baton Rouge, LA 70803, USA
| | - T H Terrill
- Fort Valley State University, Fort Valley, GA 31030, USA
| | - E Smyth
- Dale Bumpers Small Farms Research Center, USDA, ARS, Booneville, AR 72927, USA
| | - M Acharya
- University of Arkansas, Fayetteville, AR 72702, USA
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Fontana E, Smyth E, Cunningham D, Morano F, Rao S, Watkins D, Allum W, Thompson J, Waddell T, Moorcraft S, Peckitt C, Starling N, Chau I. P-079 Impact of disease biology and stage on outcomes for oesophageal and gastric adenocarcinoma (OGA) treated with neoadjuvant chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.79] [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: 11/12/2022] Open
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