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Trøseid M, Arribas JR, Assoumou L, Holten AR, Poissy J, Terzić V, Mazzaferri F, Baño JR, Eustace J, Hites M, Joannidis M, Paiva JA, Reuter J, Püntmann I, Patrick-Brown TDJH, Westerheim E, Nezvalova-Henriksen K, Beniguel L, Dahl TB, Bouscambert M, Halanova M, Péterfi Z, Tsiodras S, Rezek M, Briel M, Ünal S, Schlegel M, Ader F, Lacombe K, Amdal CD, Rodrigues S, Tonby K, Gaudet A, Heggelund L, Mootien J, Johannessen A, Møller JH, Pollan BD, Tveita AA, Kildal AB, Richard JC, Dalgard O, Simensen VC, Baldé A, de Gastines L, del Álamo M, Aydin B, Lund-Johansen F, Trabaud MA, Diallo A, Halvorsen B, Røttingen JA, Tacconelli E, Yazdanpanah Y, Olsen IC, Costagliola D, Dyrhol-Riise AM, Stiksrud B, Jenum S, MacPherson ME, Aarskog NR, Røstad K, Skeie LG, Dahl Å, Steen JK, Nur S, Segers F, Korsan KA, Sethupathy A, Sandstå AJ, Paulsen GJ, Ueland T, Michelsen A, Aukrust P, Berdal JE, Melkeraaen I, Tollefsen MM, Andreassen J, Dokken J, Müller KE, Woll BM, Opsand H, Bogen M, Rød LT, Steinsvik T, Åsheim-Hansen B, Bjerkreim RH, Berg Å, Moen S, Kvalheim S, Strand K, Gravrok B, Skogen V, Lorentzen EM, Schive SW, Rossvoll L, Hoel H, Engebråten S, Martinsson MS, Thallinger M, Ådnanes E, Hannula R, Bremnes N, Liyanarachi K, Ehrnström B, Kvalshaug M, Berge K, Bygdås M, Gustafsson L, AballiB S, Strand M, Andersen B, Aukrust P, Barratt-Due A, Henriksen KN, Kåsine T, Dyrhol-Riise AM, Berdal JE, Favory R, Nseir S, Preau S, Jourdain M, Ledoux G, Durand A, Houard M, Moreau AS, Rouzé A, Tortuyaux R, Degouy G, Levy C, Liu V, Dognon N, Mariller L, Delcourte C, Reguig Z, Cerf A, Cuvelliez M, Kipnis E, Boyer-Beysserre M, Bignon A, Parmentier L, Meddour D, Frade S, Timsit JF, Peiffer-Smadja N, Wicky PH, De Montmollin E, Bouadma L, Dessajan J, Sonneville R, Patrier J, Presente S, Sylia Z, Rioux C, Thy M, Collias L, Bouaraba Y, Dobremel N, Dureau AF, Oudeville P, Pointurier V, Rabouel Y, Stiel L, Alzina C, Ramstein C, Ait-Oufella H, Hamoudi F, Urbina T, Zerbib Y, Maizel J, Wilpotte C, Piroth L, Blot M, Sixt T, Moretto F, Charles C, Gohier S, Roux D, Le Breton C, Gernez C, Thiry I, Baboi L, Malvy D, Boyer A, Perreau P, Armellini M, De Luca G, Di Pietro OSMM, Romanin B, Brogi M, Castelli F, Amadasi S, Barchiesi F, Canovari B, Coppola N, Pisaturo M, Russo A, Occhiello L, Cataldo F, Rillo MM, Queiruga J, Seco E, Stewart S, Borobia AM, Moraga P, Prieto R, García I, Rivera C, Narro JL, Chacón N, de la Rosa S, Macías M, Barrera L, Serna A, Palomo V, Sánchez MIG, Gutiérrez D, Campos AS, Garfia MÁG, Toyos EB, Cabrera JS, Lucena MI, Lapique EL, Englert P, Khalil Z, Jacobs F, Malaise J, Mukangenzi O, Smissaert C, Hildebrand M, Martiny D, Vervacke A, Scarnière A, Yin N, Michel C, Seyler L, Allard S, Van Laethem J, Verschelden G, Meeuwissen A, De Waele A, Van Buggenhout V, Monteyne D, Noppe N, Belkhir L, Yombi JC, De Greef J, Mesland JB, De Ghellinck L, Kin V, D’Aoust C, Bouvier A, Dekeister AC, Hawia E, Gaillet A, Deshorme H, Halleux S, Galand V, Roncon-Albuquerque R, Santos LL, Vieira CB, Magalhaes R, Ferreira S, Bernardo M, Jackson A, Sadlier C, O’Connell S, Blair M, Manning E, Cusack F, Kelly N, Stephenson H, Keane R, Murphy A, Cunnane M, Keane F, O’Regan MC, de Barra E, Bellone AM, O’Regan S, Carey P, Harte J, Coakley P, Heeney A, Ryan D, Curley G, McConkey S, Sulaiman I, Costello R, McNally C, Foley C, Trainor S, Jacob B, Vengathodi S, Kent B, Bergin C, Townsend L, Kerr C, Panti N, Sanz AG, Benny B, Dea EO, Galvin N, Burke C, Galvin A, Aisiyabi S, Lobo D, Laffey J, McNicolas B, Cosgrave D, Sheehan JR, Nita C, Hanley C, Kelly C, Kernan M, Murray J, Staub T, Henin T, Damilot G, Bintener T, Colling J, Ferretti C, Werer C, Stammet P, Braquet P, Arendt V, Calvo E, Michaux C, Mediouni C, Znati A, Montanes G, Garcia L, Thomé C, Breitkopf R, Peer A, Lehner G, Bellman R, Ditlbacher A, Finkenstedt A, Zotter K, Hernandez CP, Rajsic S, Lanthaler B, Greil R, Tamás K, Kovácsné-Levang S, Sipos D, Kappéter A, Halda-Kiss B, Madarassi-Papp E, Hajdu E, Bende B, Konstantinos T, Moschopoulos C, Labrou E, Tsakona M, Grigoropoulos I, Kotanidou A, Fragkou P, Theodorakopoulou M, Pantazi E, Jahai E, Moukouli M, Siafakas D, Mühlbauer B, Dembinski R, Stich K, Schneider G, Nagy A, Grodová K, Kubelová M, Součková L, Švábová HK, Demlová R, Sonderlichová S, Unal S, Inkaya AC, de Bono S, Kartman CE, Adams DH, Crowe B, Yazdanapanah Y, Unal S, Schneider G, Mühlbauer B, Ødegård T, Bakkehøi G, Autran B, Bjørås M, Lambellerie XD, Mezzarri F, Guedj J, Esperou H, Lumbroso J, Welte T, Calmy A, Pischke S, Treweek S, Goetghebeur E, Doussau A, Weiss L, Hulstaert F, Botgros R, del Alamo M, Chung F, Lumbroso J, Zeitlinger M, Escalera BN, Csajka C, Williams C, Amstutz A, Rüegg CS, Burdet C, Massonnaud C, Belhadi D, Mentré F, Aroun M, Mentré F, Ehrmann S, Espoerou H, Burdet C, Falk RS, Bjordal K, Bakkehøi G, Ødegård T, Barratt-Due A. Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial. Crit Care 2023; 27:9. [PMID: 36627655 PMCID: PMC9830601 DOI: 10.1186/s13054-022-04205-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. METHODS Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. RESULTS Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49-69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI - 0.1% [- 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (- 3.2% [- 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. CONCLUSION This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
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Affiliation(s)
- Marius Trøseid
- grid.55325.340000 0004 0389 8485Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - José R. Arribas
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, IdiPAZ, Madrid, Spain ,grid.512890.7Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Lambert Assoumou
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Aleksander Rygh Holten
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Julien Poissy
- grid.503422.20000 0001 2242 6780Lille University, Lille, France/CHU Lille - Hôpital Roger Salengro, Lille, France ,grid.457369.aL’Institut National de La Santé Et de La Recherche Médicale (Inserm), Paris, France
| | - Vida Terzić
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Fulvia Mazzaferri
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Rodríguez Baño
- grid.411375.50000 0004 1768 164XDepartment of Medicine, Virgen Macarena University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229University of Sevilla and Biomedicines Institute of Seville (IBiS)/CSIC, Seville, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Joe Eustace
- grid.7872.a0000000123318773University College Cork, Cork, Ireland
| | - Maya Hites
- grid.412157.40000 0000 8571 829XBrussels University Hospital-Erasme, Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Medical University Innsbruck, Innsbruck, Austria
| | - José-Artur Paiva
- grid.414556.70000 0000 9375 4688Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Reuter
- grid.418041.80000 0004 0578 0421Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, 1210 Luxembourg, Luxembourg
| | - Isabel Püntmann
- Institute of Pharmacology, Hospital Group Gesundheit Nord gGmbH, Bremen, Germany
| | - Thale D. J. H. Patrick-Brown
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Elin Westerheim
- grid.55325.340000 0004 0389 8485Section for Monitoring, Clinical Trial Unit (CTU), Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova-Henriksen
- grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital and Oslo Hospital Pharmacy, Oslo, Norway
| | - Lydie Beniguel
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Tuva Børresdatter Dahl
- grid.55325.340000 0004 0389 8485Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Maude Bouscambert
- grid.413852.90000 0001 2163 3825Laboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Des Infections Respiratoires France Sud, Hospices Civils de Lyon, 69317 Lyon, France
| | - Monika Halanova
- grid.11175.330000 0004 0576 0391Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Zoltán Péterfi
- grid.9679.10000 0001 0663 94791St Department of Internal Medicine, Division of Infectology, University of Pécs, Pécs, Hungary
| | - Sotirios Tsiodras
- grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens, Athens, Greece ,grid.411449.d0000 0004 0622 4662University Hospital of Athens Attikon, Athens, Greece
| | - Michael Rezek
- grid.412554.30000 0004 0609 2751St. Anne University Hospital, Brno, Czech Republic
| | - Matthias Briel
- grid.410567.1Swiss Clinical Trial Organisation and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Serhat Ünal
- grid.411920.f0000 0004 0642 1084Hacettepe University Hospital, Ankara, Turkey
| | - Martin Schlegel
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Florence Ader
- grid.413852.90000 0001 2163 3825Hospices Civils de Lyon, Département Des Maladies Infectieuses Et Tropicales, 69004 Lyon, France ,grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007 Lyon, France
| | - Karine Lacombe
- grid.7429.80000000121866389Sorbonne Université, Institut Pierre-Louis d’Épidemiologie Et de Santé Publique, INSERM, 75013 Paris, France ,grid.412370.30000 0004 1937 1100APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses Et Tropicales, 75012 Paris, France
| | - Cecilie Delphin Amdal
- grid.55325.340000 0004 0389 8485Research support service and Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Serge Rodrigues
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Kristian Tonby
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Deptartment of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Alexandre Gaudet
- grid.410463.40000 0004 0471 8845Critical Care Center, Department of Intensive Care Medicine, CHU Lille, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection Et d’Immunité de Lille, 59000 Lille, France
| | - Lars Heggelund
- grid.459157.b0000 0004 0389 7802Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Joy Mootien
- grid.414085.c0000 0000 9480 048XService, de Réanimation Médiale, GHRMSA Hopital Emile Muller, Mulhouse, France
| | - Asgeir Johannessen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jannicke Horjen Møller
- grid.412835.90000 0004 0627 2891Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatriz Diaz Pollan
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain ,grid.81821.320000 0000 8970 9163Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), IdiPAZ, Madrid, Spain
| | - Anders Aune Tveita
- grid.414168.e0000 0004 0627 3595Department of Medicine, Bærum Hospital, Vestre Viken, Bærum, Norway
| | - Anders Benjamin Kildal
- grid.412244.50000 0004 4689 5540Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Jean-Christophe Richard
- grid.413306.30000 0004 4685 6736Service de Médecine Intensive-Réanimation, Hôpital de La Croix - Rousse - HCL, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1206-CNRS UMR 5220, Lyon, France
| | - Olav Dalgard
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XAkershus University Hospital, Lørenskog, Norway
| | - Victoria Charlotte Simensen
- grid.418193.60000 0001 1541 4204Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aliou Baldé
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Lucie de Gastines
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | | | - Burç Aydin
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Lund-Johansen
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Mary-Anne Trabaud
- grid.134996.00000 0004 0593 702XLaboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Respiratoires France Sud, 69317 Hospices Civils de LyonLyon, France
| | - Alpha Diallo
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Bente Halvorsen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - John-Arne Røttingen
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
| | - Evelina Tacconelli
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XVerona University Hospital, Verona, Italy
| | - Yazdan Yazdanpanah
- grid.512950.aUniversité de Paris, IAME, INSERM, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Hôpital Bichat, Service de Maladies Infectieuses Et Tropicales, 75018 Paris, France
| | - Inge C. Olsen
- grid.55325.340000 0004 0389 8485Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Dominique Costagliola
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
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Keane F, Park W, Varghese A, Balogun F, Yu K, El Dika I, Khalil D, Kelsen D, Reidy-Lagunes D, Ku G, Raj N, Chou J, Capanu M, Schultz N, Yaeger R, O'Reilly E. 1304P Characterizing the clinico-genomic landscape and outcomes of KRAS G12C mutated pancreas cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1436] [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] Open
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Hassan M, Awadalla M, Tan TC, Scherrer-Crosbie M, Zhang L, Zlotoff DA, Bany Bakar R, Hickey SB, Patel SA, Januzzi JL, Passeri JJ, Keane F, Jimenez R, MacDonald SM, Neilan TG. Serial measurement of global longitudinal strain among women with breast cancer treated with proton radiation therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2850] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Conventional photon radiotherapy (RT) for breast cancer is associated with reduction in global longitudinal strain (GLS), an increase in both troponin and N-terminal pro-B type natriuretic peptide (NT-proBNP), and incident heart failure. The cardiac radiation exposure with proton-RT is reduced and, thus may be associated with less cardiotoxicity.
Objectives
To test the effect of proton-RT on GLS, troponin and NT-proBNP.
Methods
A prospective observational single center study of 69 women being treated with proton-RT for breast cancer. Serial measurements of GLS, high-sensitivity cardiac troponin-I (hs-cTnI), and NT-proBNP were performed at pre-specified intervals (pre proton-RT, 4 weeks after completion of proton-RT and again at 2 months post proton-RT).
Results
The mean age was 46±11 years, BMI was 25.6±5.2 kg/m2, 32% had hypertension and mean radiation dose to the heart and left ventricle (LV) were 0.44 Gy and 0.12 Gy respectively. There was no change in LV ejection fraction (pre proton-RT vs. 4-weeks post proton-RT vs. 2 months post proton-RT, 65±5 vs. 66±5 vs. 64±4%, p=0.15), global GLS (−21.7±2.7 vs. −22.7±2.3 vs. −22.8±2.1%, p=0.24) or segmental GLS from pre-to post proton-RT. Similarly, there was no change in hs-cTnI or NT-proBNP with proton-RT. However, post proton-RT, we found that patients with a history of hypertension had lower GLS when compared to women without hypertension (−21.3±3.5 vs. −24.0±2.4%, p=0.006).
Conclusion
Proton-RT did not impact LV function, or associate with an increase in biomarkers. These data support the potential cardiac benefits of proton-RT compared to conventional RT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Hassan
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - M Awadalla
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - T C Tan
- Westmead and Blacktown Hospitals, University of Western Sydney and School of Medical Sciences, Division of Cardiology, Blacktown, Australia
| | - M Scherrer-Crosbie
- Hospital of the University of Pennsylvania, Cardiovascular Medicine Division, Philadelphia, United States of America
| | - L Zhang
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - D A Zlotoff
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - R Bany Bakar
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - S B Hickey
- Massachusetts General Hospital - Harvard Medical School, Radiation Oncology Department, Boston, United States of America
| | - S A Patel
- Massachusetts General Hospital - Harvard Medical School, Radiation Oncology Department, Boston, United States of America
| | - J L Januzzi
- Massachusetts General Hospital - Harvard Medical School, Division of Cardiology, Boston, United States of America
| | - J J Passeri
- Massachusetts General Hospital - Harvard Medical School, Division of Cardiology, Boston, United States of America
| | - F Keane
- Massachusetts General Hospital - Harvard Medical School, Radiation Oncology Department, Boston, United States of America
| | - R Jimenez
- Massachusetts General Hospital - Harvard Medical School, Radiation Oncology Department, Boston, United States of America
| | - S M MacDonald
- Massachusetts General Hospital - Harvard Medical School, Radiation Oncology Department, Boston, United States of America
| | - T G Neilan
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
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Magnin A, Iversen VC, Calvo G, Čečetková B, Dale O, Demlová R, Blaskó G, Keane F, Kovacs GL, Levy‐Marchal C, Monteiro EC, Palmisano L, Pella D, Portolés A, Rascol O, Schmid C, Tay F, von der Leyen H, Ohmann C. European survey on national harmonization in clinical research. Learn Health Syst 2021; 5:e10220. [PMID: 33889730 PMCID: PMC8051345 DOI: 10.1002/lrh2.10220] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Clinical trials remain key to the development of evidence-based medical practice. However, they are becoming increasingly complex, mainly in a multinational setting. To address these challenges, the European Union (EU) adopted the Clinical Trial Regulation EU No. 536/2014 (CTR). Once in force, the CTR will lead to more consistent rules and simplification of procedures for conducting clinical trials throughout the EU. Existing harmonization initiatives and "research infrastructures" for clinical trials may facilitate this process. This publication offers a snapshot of the current level of harmonization activities in academic clinical research in Europe. METHODS A survey was performed among the member and observer countries of the European Clinical Research Infrastructure Network (ECRIN), using a standardized questionnaire. Three rounds of data collection were performed to maximize completeness and comparability of the received answers. The survey aimed to describe the harmonization of academic clinical research processes at national level, to facilitate the exchange of expertise and experience among countries, and to identify new fields of action. RESULTS Most scientific partners already have in place various working groups and harmonization activities at national level. Furthermore, they are involved in and open to sharing their know-how and documents. Since harmonization was mainly a bottom-up approach up until now, the extent and topics dealt with are diverse and there is only little cross-networking and cross-country exchange so far. CONCLUSIONS Currently, the ECRIN member countries offer a very solid base and collaborative spirit for further aligning processes and exchanging best practices for clinical research in Europe. They can support a smooth implementation of the EU CTR and may act as single contact with consolidated expertise in a country.
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Affiliation(s)
| | | | | | - Beata Čečetková
- SLOVACRIN—Slovak Clinical Research Infrastructure NetworkKošiceSlovakia
| | - Ola Dale
- NorCRIN—Norwegian Clinical Research Infrastructure NetworkTrondheimNorway
| | - Regina Demlová
- CZECRIN—Czech Clinical Research Infrastructure NetworkBrnoCzech Republic
| | - György Blaskó
- HECRIN—Hungarian Clinical Research Infrastructure NetworkPécsHungary
| | - Fionnuala Keane
- HRB CRCI—Health Research board, Clinical Research CoordinationDublinIreland
| | - Gabor L. Kovacs
- HECRIN—Hungarian Clinical Research Infrastructure NetworkPécsHungary
| | | | - Emilia C. Monteiro
- PtCRIN—Portuguese Clinical Research Infrastructure NetworkLisbonPortugal
| | - Lucia Palmisano
- ItaCRIN—Italian Clinical Research Infrastructure NetworkRomeItaly
| | - Daniel Pella
- SLOVACRIN—Slovak Clinical Research Infrastructure NetworkKošiceSlovakia
| | | | - Olivier Rascol
- F‐CRIN—French Clinical Research Infrastructure NetworkToulouseFrance
| | | | - Fabian Tay
- SCTO—Swiss Clinical Trial OrganisationBernSwitzerland
| | | | - Christian Ohmann
- ECRIN—European Clinical Research Infrastructure NetworkParisFrance
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5
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Leddy L, Sukumar P, O'Sullivan L, Keane F, Devane D, Doran P. An investigation into the factors affecting investigator-initiated trial start-up in Ireland. Trials 2020; 21:962. [PMID: 33228755 PMCID: PMC7684941 DOI: 10.1186/s13063-020-04893-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background In common with many countries, Ireland has seen an increasing trend in the number of clinical trials conducted over the past few years. Yet, as elsewhere, trialists in Ireland face several problems and barriers in the starting-up of clinical trials. These barriers impede trial activity significantly, with consequent impacts on patient care. It is critical to understand these issues, to develop approaches to facilitate trial start up. This study identifies the challenges in conducting clinical trials in Ireland and specifically the contractual, ethical, logistical, and regulatory barriers that hinder the start-up of investigator-led trials in Ireland. Methods Data for this study were collected in two stages. In the first stage, a survey was conducted among trialists in Ireland. A total of 44 trialists responded to the survey, and information was collected about their experience in conducting clinical trials, the scale and nature of their most recently completed trial, and the details of specific barriers they encountered during the starting-up of the trial. In the second stage, nine semi-structured interviews were conducted with the awardees of 2018 Irish Health Research Board’s Definitive Intervention Feasibility Award. These interviews facilitated a deeper exploration of issues and problems in conducting clinical trials in Ireland. Results This study identified several issues and bottlenecks in starting-up clinical trials in Ireland with contracts and ethical approval cited as the major issues. The data shows that site identification and activation was also problematic in some cases. Several respondents reported difficulties in accessing dedicated time for protocol development and believe that support in this area can be greatly beneficial. It was reported that availability of skilled staff members like statisticians and data managers was as an issue, especially for small trials. Conclusion This study found that several factors impact trial initiation and progression in Ireland. Delays associated with obtaining contract and ethics approval are perceived as major barriers. Specialist supports in areas such as ethics and regulatory affairs and availability of specialised staff members in areas such as statistics and data management are key actions to enable enhanced clinical trial activity in Ireland.
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Affiliation(s)
- Lauren Leddy
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Prasanth Sukumar
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Lydia O'Sullivan
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland.,HRB Trials Methodology Research Network, NUI Galway, Galway, Ireland
| | - Fionnuala Keane
- HRB Clinical Research Coordination Ireland, Upper Mount Street, Dublin 2, Ireland
| | - Declan Devane
- HRB Trials Methodology Research Network, NUI Galway, Galway, Ireland.,National University of Ireland, Galway, Ireland
| | - Peter Doran
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland.
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6
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Miller AM, Behan R, Smith I, Griffin M, Keane F, Langan J, O'Rourke C, McAleenan N, Pandit A, Watson M. A multidisciplinary approach to online support for device research translation: regulatory change and clinical engagement. Health Policy Technol 2020; 10:S2211-8837(20)30114-3. [PMID: 33083213 PMCID: PMC7560120 DOI: 10.1016/j.hlpt.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To promote medical device EU regulatory understanding in the biomedical research community and encourage greater levels of clinical engagement to further medical device research innovation, translation and effective clinical trials. METHODS An interdisciplinary, iterative, needs-based design approach was used to develop medical device regulatory training, information and clinical expertise resources. RESULTS A multimedia based self-paced e-Learning course focusing on the 'Fundamentals of Medical Device Design and Regulation' was produced in tandem with an interactive online web portal: Medtech Translate. CONCLUSIONS Health research translation relies on both clinical input and regulation to drive progress and to ensure quality and safety standards from concept development to clinical investigation. A lack of regulatory awareness and access to clinical expertise has the potential to significantly impact on health research translation and ambition for market. Our interdisciplinary academic-regulator-clinical-industry led approach meets the need for a coordinated stakeholder response to support innovation and promote growth in the medical technology sector.
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Affiliation(s)
- Anne-Marie Miller
- Clinical Research Development Ireland, Mount St., Dublin 2, Ireland
- CÚRAM, Centre for Research in Medical Devices, NUI Galway, Ireland
| | - Robert Behan
- Clinical Research Development Ireland, Mount St., Dublin 2, Ireland
- CÚRAM, Centre for Research in Medical Devices, NUI Galway, Ireland
| | - Ian Smith
- BigTop Multimedia, Lucan, Dublin, Ireland
| | - Matthew Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM, Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Ireland
| | - Fionnuala Keane
- HRB-Clinical Research Coordination Ireland, CRDI, Mount St., Dublin 2, Ireland
| | - James Langan
- Aerogen Limited, Galway Business Park, Dangan, Galway, Ireland
| | - Colm O'Rourke
- National Standards Authority of Ireland, Northwood, Santry, Dublin 9, Ireland
| | - Niall McAleenan
- Health Products Regulatory Authority, Earlsfort Tce., Dublin 2, Ireland
| | - Abhay Pandit
- CÚRAM, Centre for Research in Medical Devices, NUI Galway, Ireland
| | - Mark Watson
- Clinical Research Development Ireland, Mount St., Dublin 2, Ireland
- CÚRAM, Centre for Research in Medical Devices, NUI Galway, Ireland
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7
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Magnin A, Iversen VC, Calvo G, Čečetková B, Dale O, Demlova R, Blasko G, Keane F, Kovacs GL, Levy-Marchal C, Monteiro EC, Palmisano L, Pella D, Portolés Pérez A, Rascol O, Schmid C, Tay F, von der Leyen H, Ohmann C. European survey on national training activities in clinical research. Trials 2019; 20:616. [PMID: 31665085 PMCID: PMC6821032 DOI: 10.1186/s13063-019-3702-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 11/17/2022] Open
Abstract
Background Investigator-initiated clinical studies (IITs) are crucial to generate reliable evidence that answers questions of day-to-day clinical practice. Many challenges make IITs a complex endeavour, for example, IITs often need to be multinational in order to recruit a sufficient number of patients. Recent studies highlighted that well-trained study personnel are a major factor to conduct such complex IITs successfully. As of today, however, no overview of the European training activities, requirements and career options for clinical study personnel exists. Methods To fill this knowledge gap, a survey was performed in all 11 member and observer countries of the European Clinical Research Infrastructure Network (ECRIN), using a standardised questionnaire. Three rounds of data collection were performed to maximize completeness and comparability of the received answers. The survey aimed to describe the landscape of academic training opportunities, to facilitate the exchange of expertise and experience among countries and to identify new fields of action. Results The survey found that training for Good Clinical Practice (GCP) and investigator training is offered in all but one country. A specific training for study nurses or study coordinators is also either provided or planned in ten out of eleven countries. A majority of countries train in monitoring and clinical pharmacovigilance and offer specific training for principal investigators but only few countries also train operators of clinical research organisations (CRO) or provide training for methodology and quality management systems (QMS). Minimal requirements for study-specific functions cover GCP in ten countries. Only three countries issued no requirements or recommendations regarding the continuous training of study personnel. Yet, only four countries developed a national strategy for training in clinical research and the career options for clinical researchers are still limited in the majority of countries. Conclusions There is a substantial and impressive investment in training and education of clinical research in the individual ECRIN countries. But so far, a systematic approach for (top-down) strategic and overarching considerations and cross-network exchange is missing. Exchange of available curricula and sets of core competencies between countries could be a starting point for improving the situation.
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Affiliation(s)
- A Magnin
- SCTO - Swiss Clinical Trial Organisation, Bern, Switzerland
| | - V Cabral Iversen
- NorCRIN - Norwegian Clinical Research Infrastructures Network, Trondheim, Norway
| | - G Calvo
- SCReN - Spanish Clinical Research Network, Madrid, Spain
| | - B Čečetková
- SLOVACRIN - Slovak Clinical Research Infrastructure Network, Bratislava, Slovakia
| | - O Dale
- NorCRIN - Norwegian Clinical Research Infrastructures Network, Trondheim, Norway
| | - R Demlova
- CZECRIN - Czech Clinical Research Infrastructure Network, Prague, Czech Republic
| | - Gy Blasko
- HECRIN - Hungarian Clinical Research Infrastructure Network, Budapest, Hungary
| | - F Keane
- HRB CRCI - Health Research board, Clinical Research Coordination Ireland, Dublin, Ireland
| | - G L Kovacs
- HECRIN - Hungarian Clinical Research Infrastructure Network, Budapest, Hungary
| | - C Levy-Marchal
- F-CRIN - French Clinical Research Infrastructure Network, Paris, France
| | - E C Monteiro
- PTCRIN - Portuguese Clinical Research Infrastructure Network, Lisboa, Portugal
| | - L Palmisano
- ItaCRIN - Italian Clinical Research Infrastructure Network, Rome, Italy
| | - D Pella
- SLOVACRIN - Slovak Clinical Research Infrastructure Network, Bratislava, Slovakia
| | | | - O Rascol
- F-CRIN - French Clinical Research Infrastructure Network, Paris, France
| | - C Schmid
- SCTO - Swiss Clinical Trial Organisation, Bern, Switzerland
| | - F Tay
- SCTO - Swiss Clinical Trial Organisation, Bern, Switzerland
| | - H von der Leyen
- KKSN - Netzwerk der Koordinierungszentren für Klinische Studien, Hannover, Germany
| | - C Ohmann
- ECRIN - European Clinical Research Infrastructure Network, Kaiserswerther Str, 70 40477, Düsseldorf, Germany.
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8
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Barrett F, Keane F, O’Doherty D, Connolly W, Matassa C, Ryan B, Doyle T, Dempsey K, Grogan L, Morris P, Hennessy B, Breathnach O, O’Shea C, Christie A. Phone triage & acute review clinics: The emerging role of the oncology specialist nurse. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz276.003] [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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9
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Greally M, Keane F, Power DG, Leonard GD. A Survey of Colorectal Cancer Surveillance Practices In Ireland, And Implementation of A Survivorship Care Plan Pilot Programme. Ir Med J 2019; 112:870. [PMID: 30892003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims The number of colorectal cancer (CRC) survivors in Ireland is rising. We aimed to survey current surveillance practices and pilot the use of survivorship care plans (SCPs) in the clinic. Methods An online survey was issued to medical oncologists (MOs) in designated cancer centres (DCC) and satellite centres. The SCP was piloted in CRC patients and a follow-up questionnaire assessing their views was issued. Results Responses from 8 DCC and satellite centres were obtained (n=13). Routine surveillance is practiced by 77% (n=10) and 69% (n=9) believe that the MO clinic is inappropriate for follow-up. Most think that the SCP is useful and that ANP-led surveillance clinics should be introduced. Of 16 patients who replied to the survey, most felt that the SCP was benecial. Sixty-two percent (n=10) were agreeable to GP follow-up using the SCP. Conclusion Surveillance practices in Ireland are heterogeneous. The SCP may be useful for streamlining follow-up practices nationally.
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Affiliation(s)
- M Greally
- Medical Oncology Department, University Hospital Galway, Galway
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - F Keane
- Medical Oncology Department, University Hospital Galway, Galway
| | - D G Power
- Medical Oncology Department, Cork and Mercy University Department, Cork
| | - G D Leonard
- Medical Oncology Department, University Hospital Galway, Galway
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10
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Keane F, Mullally W, Kieran R, O’Regan S, Nolan A, Aslan R, Hennessy B, Morris P, Grogan L, Breathnach O. Smoking patterns and attitudes to smoking cessation among patients actively receiving anti-cancer treatment. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30216-8] [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: 10/27/2022]
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11
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Keane F, Greally M, Harrold E, Barrett C, McCaffrey J. Epithelioid Angiomyolipoma - a case report and review of the literature. Ir Med J 2017; 110:604. [PMID: 29341516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Herein we present the case of a 43-year-old female in whom a left renal mass was identified incidentally on imaging performed for staging of a newly diagnosed breast carcinoma. The mass was resected and histologic examination and immunohistochemistry confirmed a diagnosis of epithelioid angiomyolipoma.
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Affiliation(s)
- F Keane
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - M Greally
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - E Harrold
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - C Barrett
- Department of Pathology, Mater Misericordiae Hospital, Dublin
| | - J McCaffrey
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
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12
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Mealy K, Keane F, Kelly P, Kelliher G. What is the future for General Surgery in Model 3 Hospitals? Ir J Med Sci 2017; 186:225-233. [PMID: 28054237 DOI: 10.1007/s11845-016-1545-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 12/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND General Surgery consultant recruitment poses considerable challenges in Model 3 Hospitals in Ireland. AIM The aim of this paper is to examine General Surgery activity and consultant staffing in order to inform future manpower and service planning. METHODS General surgical activity in Model 3 Hospitals was examined using the validated 2014 Hospital Inpatient Enquiry (HIPE) dataset. Current consultant staffing was ascertained from hospital personnel departments and all trainees on the National Surgical Training Programme were asked to complete a questionnaire on their career intentions. RESULTS Model 3 Hospitals accounted for 50% of all General Surgery discharges. In the elective setting, 51.5% of all procedures were endoscopic investigations and in the acute setting only 22% of patients underwent an operation. Most surgical procedures were of low acuity and included excision of minor lesions, appendicectomy, cholecystectomy and hernia repair. Of 76 General Surgeons who work in Model 3 Hospitals 25% were locums and 54% had not undergone formal training in Ireland. A further 22% of these surgeons will retire in the next five years. General Surgical trainees surveyed indicated an unwillingness to take up posts in Model 3 Hospitals, while 83% indicated that a post in a Model 4 Hospital is 'most desirable'. Lack of attractiveness related to issues regarding rotas, lack of ongoing skill enhancement, poor experience in the management of complex surgical conditions, limited research and academic opportunity, isolation from colleagues and poor trainee support. CONCLUSIONS These data indicated that an impending General Surgery consultant manpower crisis can only be averted in Model 3 Hospitals by either major change in the emphasis of surgical training or a significant reorganisation of surgical services.
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Affiliation(s)
- K Mealy
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland, 2 Proud's Lane, Dublin 2, Ireland.
| | - F Keane
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland, 2 Proud's Lane, Dublin 2, Ireland
| | - P Kelly
- Surgical Affairs Operations and Planning, Surgical Affairs, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - G Kelliher
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland, 2 Proud's Lane, Dublin 2, Ireland
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13
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Harding-Esch E, Sherrard-Smith E, Fuller SS, Harb A, Furegato M, Mercer C, Sadiq ST, Howell-Jones R, Nardone A, White PJ, Gates P, Pearce A, Keane F, Colver H, Nori A, Dewsnap C, Schatzberger R, Estcourt C, Dakshina S, Lowndes CM. P08.28 Patients continue to engage in risky sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Chen X, Paranjape T, Stahlhut C, McVeigh T, Keane F, Nallur S, Miller N, Kerin M, Deng Y, Yao X, Zhao H, Weidhaas JB, Slack FJ. Targeted resequencing of the microRNAome and 3'UTRome reveals functional germline DNA variants with altered prevalence in epithelial ovarian cancer. Oncogene 2014; 34:2125-37. [PMID: 24909162 DOI: 10.1038/onc.2014.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/26/2014] [Indexed: 12/24/2022]
Abstract
Ovarian cancer is a major cause of cancer deaths, yet there have been few known genetic risk factors identified, the best known of which are disruptions in protein coding sequences (BRCA1 and 2). Recent findings indicate that there are powerful genetic markers of cancer risk outside of these regions, in the noncoding mRNA control regions. To identify additional cancer-associated, functional non-protein-coding sequence germline variants associated with ovarian cancer risk, we captured DNA regions corresponding to all validated human microRNAs and the 3' untranslated regions (UTRs) of ~6000 cancer-associated genes from 31 ovarian cancer patients. Multiple single-nucleotide polymorphisms in the 3'UTR of the vascular endothelial growth factor receptor/FLT1, E2F2 and PCM1 oncogenes were highly enriched in ovarian cancer patients compared with the 1000 Genome Project. Sequenom validation in a case-control study (267 cases and 89 controls) confirmed a novel variant in the PCM1 3'UTR is significantly associated with ovarian cancer (P=0.0086). This work identifies a potential new ovarian cancer locus and further confirms that cancer resequencing efforts should not ignore the study of noncoding regions of cancer patients.
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Affiliation(s)
- X Chen
- 1] Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA [2] Program in Computational Biology and Bioinformatics, Yale University School of Medicine, New Haven, CT, USA
| | - T Paranjape
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - C Stahlhut
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA
| | - T McVeigh
- Discipline of Surgery, National University of Ireland Galway and Galway University, Hospitals, Galway, Ireland
| | - F Keane
- Yale University School of Medicine, New Haven, CT, USA
| | - S Nallur
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - N Miller
- Discipline of Surgery, National University of Ireland Galway and Galway University, Hospitals, Galway, Ireland
| | - M Kerin
- Discipline of Surgery, National University of Ireland Galway and Galway University, Hospitals, Galway, Ireland
| | - Y Deng
- Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - X Yao
- Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - H Zhao
- 1] Program in Computational Biology and Bioinformatics, Yale University School of Medicine, New Haven, CT, USA [2] Department of Genetics, Yale University School of Medicine, New Haven, CT, USA [3] Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - J B Weidhaas
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - F J Slack
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA
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15
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Keegan N, Keane F, Cuffe S, Cunningham M, Ravi N, Lee G, Kennedy MJ, Grogan W, O'Neill B, Power DG, Leonard G, Keane MM, Small C, Parker I, Moulton B, O'Reilly S, Reynolds JV. ICORG 10-14: Neo-AEGIS: A randomized clinical trial of neoadjuvant and adjuvant chemotherapy (modified MAGIC regimen) versus neoadjuvant chemoradiation (CROSS protocol) in adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps4145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Fionnuala Keane
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
| | - Sinead Cuffe
- St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - M. John Kennedy
- St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Brian O'Neill
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | | | - Maccon M. Keane
- Department of Medical Oncology, University College Hospital Galway, Galway, Ireland
| | - Cormac Small
- Department of Radiation Oncology, University College Hospital Galway, Galway, Ireland
| | - Imelda Parker
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
| | - Brian Moulton
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
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16
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Affiliation(s)
- N Glynn
- Department of Endocrinology, Beaumont Hospital, Dublin 9, Ireland.
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17
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Mercer CH, Aicken CRH, Cassell JA, Hartnell V, Davies L, Ryan J, Keane F. Not so different after all? Comparing patients attending general practice-based locally enhanced services for sexual health with patients attending genitourinary medicine. Int J STD AIDS 2013; 24:106-11. [PMID: 24400345 PMCID: PMC4138003 DOI: 10.1177/0956462412472301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Accepted: 06/10/2012] [Indexed: 11/17/2022]
Abstract
We did a cross-sectional survey of patients attending genitourinary (GU) medicine clinics (n = 933) and general practice-based Locally Enhanced Services for Sexual Health (GP-LESSH, n = 111) in Cornwall, England, in 2009/2010, to compare patients' characteristics and experiences. Patients completed a pen-and-paper questionnaire that was then linked to an extract of their clinical data. GP-LESSH patients took longer both to seek and to receive care: medians of nine and seven days, respectively, versus GU medicine patients: medians of seven and one day, respectively. GP-LESSH patients were less likely than GU medicine patients to report symptoms (19.6% versus 30.6%) and sexual risk behaviours (33.3% versus 44.7% reported new partners) since recognizing needing to seek care; 5.0% versus 10.2% were men who have sex with men). However, they were equally likely to have sexually transmitted infections (STIs) diagnosed (23.3% versus 24.8%). As GP-LESSH may operate infrequently, local services must work collaboratively to ensure that those seeking care for suspected STIs receive it promptly. Failing to do so facilitates avoidable STI transmission.
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Affiliation(s)
- C H Mercer
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
| | - C R H Aicken
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
| | - J A Cassell
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
- Brighton & Sussex Medical School, Brighton
| | | | | | | | - F Keane
- Royal Cornwall Hospitals, Cornwall, UK
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Mercer CH, Aicken CRH, Low N, Estcourt CS, White PJ, Keane F, Brook G, Rait G, Cassell JA. P2-S4.02 Don't look at your patients, look at their partners: Characteristics of sexual partnerships reported by people attending GUM clinics in England. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mercer CH, Aicken CRH, Low N, Estcourt CS, White PJ, Keane F, Brook G, Rait G, Cassell JA. O2-S1.02 Is concurrency the new serial monogamy? Evidence from a large survey of people attending contrasting genitourinary medicine (GUM) clinics in England. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.68] [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: 11/03/2022]
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Ratner E, Keane F, Yu H, Zelterman D, Rutherford T, Santin A, Schwartz P, Slack F, Levine D, Weidhaas J. RETRACTED: A 3’ UTR KRAS variant as a biomarker of poor outcome and chemotherapy resistance in ovarian cancer. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.010] [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: 11/30/2022]
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Abstract
The UK National Guidelines on HIV testing (2008) recommend routinely offering an HIV test to patients in certain clinical settings. We wished to investigate the acceptability of implementing these guidelines in a population with a low HIV prevalence. Patients accessing primary and secondary care were asked to circle one of the five responses to a series of statements regarding HIV testing. Of the 616 respondents, 579 (94%) stated they would be willing to be tested if presenting with a condition known to be associated with HIV. Four hundred and forty out of 616 (71%) stated they would be willing to be tested as part of their routine care, while 445/616 (72%) stated they would be willing to have the result in their main medical notes. Although the patients' responses were largely receptive to increased testing, we encountered notable negative attitudes to the project from professional and administrative staff. Resistance to increased HIV testing may be related to health-care workers rather than patients.
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Affiliation(s)
- R Drayton
- Department of Integrated Sexual Health, Cardiff Royal Infirmary, Cardiff, UK.
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Neale R, Knight I, Keane F. Do users of the intrauterine system (Mirena) have different genital symptoms and vaginal flora than users of the intrauterine contraceptive device? Int J STD AIDS 2009; 20:423-4. [PMID: 19451330 DOI: 10.1258/ijsa.2008.008391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The copper intrauterine contraceptive device (IUCD) is strongly associated with bacterial vaginosis (BV). Hormonal influences may play a role in the control of vaginal flora. It is unclear whether use of the progesterone-incorporated intrauterine system (IUS; Mirena) is associated with abnormal vaginal flora or genital symptoms. One hundred and seventy-two women were assessed for symptoms and abnormal vaginal flora prior to and at intervals after insertion of either a copper IUCD or an IUS. Women were significantly more likely to have developed an abnormal vaginal discharge 4-6 weeks after insertion of an IUCD compared with an IUS (27% cf. 14%, P = 0.04), although this trend was not significant six months postinsertion. More women with an IUCD developed BV compared with an IUS at 4-6 weeks and six months. However, there were insufficient numbers of women with BV to demonstrate any significant difference between the vaginal flora of the two groups.
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Affiliation(s)
- R Neale
- Department of Genitourinary Medicine, Royal Cornwall Hospital NHS Trust, Truro, Cornwall TR1 3LJ, UK.
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Olonilua O, Ross JDC, Mercer C, Keane F, Brook G, Cassell JA. The limits of health-care seeking behaviour: how long will patients travel for STI care? Evidence from England's 'Patient Access and the Transmission of Sexually Transmitted Infections' ('PATSI') study. Int J STD AIDS 2009; 19:814-6. [PMID: 19050210 DOI: 10.1258/ijsa.2008.008205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SUMMARY The objective of this study was to identify factors associated with (i) longer patient travel time to genitourinary (GU) medicine clinics and (ii) not attending the nearest clinic. Questionnaires were completed by 4600 new attendees from seven sociodemographically and geographically different GU clinics across England between October 2004 and March 2005. These data were then linked to the routine clinic database. Median travel time was 25 minutes and varied significantly by clinic (P < 0.001) but not by gender (P = 0.96). Of all the respondents, 10% spent at least one hour getting to a GU clinic and this was significantly more likely in patients with less education, those who travelled by public transport and those who did not attend their closest clinic. Longer travel times were not associated with delays in seeking care. Patients reporting a previous sexually transmitted infection (STI) diagnosis were more likely not to go to their nearest GU clinic (P = 0.0006), as were those who used/tried to use other health-care providers prior to attending the clinic (P = 0.007). To facilitate access to STI care, comprehensive local services need to be provided to avoid long journey times, especially for those who have to rely on public transport to get to clinic.
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Joyce M, Thirion P, Kiernan F, Byrnes C, Kelly P, Keane F, Neary P. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy. Eur J Surg Oncol 2008; 35:348-51. [PMID: 18358678 DOI: 10.1016/j.ejso.2008.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 01/31/2008] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.
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Affiliation(s)
- M Joyce
- Division of Colorectal Surgery, Minimally Invasive Surgery, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
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Neale R, Keane F, Saulsbury N, Haddon L, Osborne R. Who attends primary care services prior to attendance at genitourinary services and what level of care have they received? Sex Transm Infect 2008; 84:233-4. [PMID: 18283092 DOI: 10.1136/sti.2007.028498] [Citation(s) in RCA: 6] [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: 11/03/2022] Open
Abstract
OBJECTIVE To determine the proportion of patients initially attending primary care services and describe the care received prior to attending genitourinary medicine (GUM) clinics. METHOD A cross-sectional survey of 1000 new patients attending GUM services in Cornwall between June and December 2006. Patients were asked during consultation whether they had attended primary care before coming and what examination, investigation and management had been carried out there. RESULTS 35% (348/1000) of patients had attended primary care initially. Genital examination had been carried out in primary care on 60% (111/185) female and 58% (93/159) male patients (p = 0.78). Chlamydia testing had been carried out in 27% (46/171) female and 6% (8/139) male patients (p<0.005). 33% (100/301) patients seen in primary care had been offered treatment. 74% (68/92) patients with genital warts had been correctly diagnosed in primary care and 9% (8/92) of these offered treatment. CONCLUSIONS The majority of these patients, including those given a diagnosis and/or offered treatment in primary care, had not had a chlamydia test or any other investigations. With the potential "fall out" of patients between primary care and GUM services, this may represent a missed opportunity to detect and appropriately manage sexually transmitted infections.
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Affiliation(s)
- R Neale
- Department of GU medicine, Royal Cornwall Hospital, Truro, TR1 3LJ, UK.
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Keane F, Ison CA, Noble H, Estcourt C. Bacterial vaginosis. Sex Transm Infect 2006; 82 Suppl 4:iv16-8. [PMID: 17151045 PMCID: PMC2563898 DOI: 10.1136/sti.2006.023119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- F Keane
- Department of GU Medicine, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK.
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Abstract
BACKGROUND Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma. METHOD A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair. CONCLUSION TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.
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Affiliation(s)
- M Quinlan
- Department of Colorectal Surgery, The Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Ireland
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Wan H, Dopping-Hepenstal PJC, Gratian MJ, Stone MG, Zhu G, Purkis PE, South AP, Keane F, Armstrong DKB, Buxton RS, McGrath JA, Eady RAJ. Striate palmoplantar keratoderma arising from desmoplakin and desmoglein 1 mutations is associated with contrasting perturbations of desmosomes and the keratin filament network. Br J Dermatol 2004; 150:878-91. [PMID: 15149499 DOI: 10.1111/j.1365-2133.2004.05996.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several hereditary human diseases are now known to be caused by distinct mutations in genes encoding various desmosome components. Although the effects of some of these mutant genes have been analysed by targeted disruption experiments in mouse models, little is known about the cell and tissue changes in affected human patients. OBJECTIVES To investigate the effects of heterozygous nonsense mutations in desmoplakin (Dp) and desmoglein (Dsg) 1 which cause the autosomal dominant disorder striate palmoplantar keratoderma (SPPK), focusing on changes in desmosome structure and composition and the associated keratin intermediate filament (KIF) network in palm skin, and in cultured keratinocytes generated from the same site. METHODS We analysed palm and nonpalm skin sections from four SPPK patients with Dp mutations and one patient with a Dsg1 mutation with respect to tissue and subcellular morphologies, and correlated the in vivo and in vitro findings. RESULTS Using electron microscopy, we found abnormalities of desmosomes and cell-cell adhesion in the suprabasal layers in the epidermis from patients with both Dsg1- and Dp-associated SPPK. These changes were more advanced in skin from patients with Dp mutations. Both Dp and Dsg1 mutations were accompanied by significantly reduced numbers of desmosomes in the suprabasal layers, while decreased desmosome size was evident only in Dsg1-associated SPPK. Confocal microscopy analysis showed marked differences in the expression of keratins and of desmosome components, both between the two types of SPPK, and between SPPK and normal skin. The expression of keratins K5, K14 and K10 was reduced in Dsg1-associated SPPK skin, whereas perinuclear aggregation of keratin filaments was more evident in Dp-associated SPPK. In both types of SPPK upregulation of K16 was pronounced and involucrin labelling was abnormal. CONCLUSIONS Mutations in Dp and Dsg1 genes causing SPPK may be associated with perturbations in epidermal differentiation accompanied by a marked disruption of several components of the epidermal scaffold including desmosomes and the KIF network.
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Affiliation(s)
- H Wan
- Genetic Skin Disease Group, Divison of Skin Scinces, The Rayne Institute, Guy's, King's and St Thomas' School of Medicine, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
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Forsum U, Jakobsson T, Larsson PG, Schmidt H, Beverly A, Bjørnerem A, Carlsson B, Csango P, Donders G, Hay P, Ison C, Keane F, McDonald H, Moi H, Platz-Christensen JJ, Schwebke J. An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis. APMIS 2002; 110:811-8. [PMID: 12596717 DOI: 10.1034/j.1600-0463.2002.1101107.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.
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Affiliation(s)
- U Forsum
- Dept. of Molecular and Clinical Medicine, Linköpings Universitet, Sweden.
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Keane F, O'Cuinn G. Two broad-specificity dipeptide hydrolysing activities from cytoplasm of guinea pig brain, both of which contain prolinase but neither of which contain carnosinase activity. Neurosci Res 2002; 44:111-20. [PMID: 12204299 DOI: 10.1016/s0168-0102(02)00082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Two dipeptide hydrolysing activities were purified from cytoplasm of guinea pig brain. Dipeptide hydrolase I has been shown to be a strict dipeptidase requiring a free amino and a free carboxy terminus, while dipeptide hydrolase II displays very low activity against Leu-Leu-Leu. Of the 41 dipeptides presented to both enzymes, 25 were hydrolysed by both enzymes, while six (including carnosine) were hydrolysed by neither. Six were hydrolysed solely by dipeptide hydrolase I and four were hydrolysed solely by Pro-Leu hydrolase II. Kinetic analysis suggested that dipeptides which were hydrolysed with unfavourable kinetics or which were not hydrolysed by one dipeptide hydrolase were generally hydrolysed with more favourable kinetics by the other dipeptide hydrolase. Dipeptide hydrolase I displays optimum activity at pH 9.0, while dipeptide hydrolase II was optimally active at pH 8.0. Both enzymes were inhibited by 1,10-phenanthroline, p-chloromercuribenzoate and bestatin. Dipeptide hydrolase II was more strongly inhibited by arphamenine B than was dipeptide hydrolase I. Dipeptide hydrolase II was also inhibited by N-ethyl maleimide, while dipeptide hydrolase I was inhibited by dithiothreitol. Native M(r) values of 70,000 and 67,000 were computed for dipeptide hydrolase I and dipeptide hydrolase II, respectively. Sodium dodecyl sulphate polyacrylamide gel electrophoresis conducted with each enzyme under denaturing conditions suggested that both enzymes were comprised of a single polypeptide chain.
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Affiliation(s)
- Fionnuala Keane
- Department of Biochemistry, National University of Ireland, Galway, Ireland
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MacConmara M, O'Hanlon D, Kiely M, Connolly Y, Jeffers M, Keane F. An evaluation of the prognostic significance of vascular endothelial growth factor in node positive primary breast carcinoma. Int J Oncol 2002. [DOI: 10.3892/ijo.20.4.717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Keane F, Phillips S. Running sexual healthcare seminars for primary healthcare professionals in Cornwall. Int J STD AIDS 2001; 12:761-2. [PMID: 11719929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Elling SV, Keane F, O'Sullivan D, O'Keane C, O'Loughlin S. Linear IgA disease--a review of four patients. Ir Med J 1998; 91:167-8. [PMID: 9973751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Four cases of Linear IgA Disease (LAD) seen over a five year period are reviewed and our most recent LAD patient is described in detail. We summarise data on our patients and outline clinicopathologic features, aetiology and management of this unusual but important condition.
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Affiliation(s)
- S V Elling
- Departments of Dermatology and Pathology, Mater Hospital, Dublin
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Abstract
A neonatal presentation of Caroli's disease with severe cardiac and progressive renal pathology is described. The availability of small paediatric endoscopes ensured early diagnosis. Despite aggressive medical management, the baby died with severe bleeding complications before potentially life saving multiple organ transplantation could take place.
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Affiliation(s)
- F Keane
- Department of Child Health, King's College Hospital, London
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Affiliation(s)
- J Eustace
- Department of Nephrology, Meath Hospital, Dublin, Ireland
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Abstract
Homozygous homocystinuria, the most common genetic disorder of transulphuration, is associated with elevated plasma concentrations of homocystine, homocysteine, multiple clinical abnormalities and life-threatening thromboembolism. Several instances of vascular aneurysms have also been documented. More recently, an association between premature occlusive vascular disease and the heterozygous state has been proposed. We now report an unusual case in whom multiple aneurysms were associated with heterozygous homocystinuria.
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Affiliation(s)
- N Colwell
- Cardiology Department, Adelaide Hospital, Dublin, Ireland
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Thornes D, Daly L, Lynch G, Browne H, Tanner A, Keane F, O'Loughlin S, Corrigan T, Daly P, Edwards G. Prevention of early recurrence of high risk malignant melanoma by coumarin. Irish Melanoma Group. Eur J Surg Oncol 1989; 15:431-5. [PMID: 2676609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Coumarin (1,2-benzopyrone) as a daily oral dose of 50 mg was evaluated in a multicentre prospectively randomized, double-blind, placebo-controlled trial to prevent early recurrence of malignant melanoma TNM Stage IB (Breslow thickness greater than 1.70 mm) and Stage II. Intake for the trial started in 1984 and was stopped prematurely, after review, in 1987. There were two recurrences in 13 treated patients and 10 in 14 controls which was significant (P 0.01). The sites of the metastases differed in each group, being local and in bone in the treated group, and in lymph nodes, skin and lung in the control group. There were no toxic effects associated with coumarin treatment and all patients without recurrence are now receiving coumarin.
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Affiliation(s)
- D Thornes
- Byrnes Research Centre, Beaumont Hospital, Dublin, Eire
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Issa M, Feeley M, Kerin M, Tanner A, Keane F. Umbilical deposits from internal malignancy: Sister Mary Joseph's nodule. Ir Med J 1987; 80:152-3. [PMID: 3597039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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McGee D, Hurley MF, Shinkwin M, Kirwan. WO, Brady HR, O’Donoghue DP, Maxwell RJ, Parks. TG, Habba SF, Doyle JS, McCoy GF, Parks TG, Keane F, Stephens R, O’Connor M, Byrne PJ, Hennessy TP, Gallagher C, Lennon J, Crowe J, O’Connell D, Browne HJ, Legge D, Kelleher D, Bloomfield J, Whelan A, Weir D, O’Donoghue DP, FitzGerald O, Conalty ML, Courtney DF, Clanachan AS, Scott GW, Shattock AG, McKeever U, Feighery C, Weir D, Cryan EM, Stevens FM, Fottrell PF, McNicholl B, McCarthy F, Arthurs Y, Doyle GD, Fielding JF, O’Grady JG, Stevens FM, Fottrell PF, McNicholl B, O’Gorman TA, McCarthy F, Sheahan DG, West AB, Stephens RB, Hennessy TP, McEntee G, Gorey TF, Heffernan SJ, Duignan JP, Duignan J, Wesler M, O’Higgins N, O’Malley E, MacLean LD, Watson RGK, Devery R, Collins PB, Johnson AH. Irish Society of Gastroenterology. Ir J Med Sci 1982. [DOI: 10.1007/bf02940197] [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: 11/30/2022]
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