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Joseph N, Robertson F, Lucocq J, Pande R, Powell-Brett S, Swainston K, Sharp L, Exley C, Roberts K, Pandanaboyana S. A multicentre prospective evaluation of health-related quality of life and patient related outcomes in pancreatic and peripancreatic cancer: PROMCAN study. HPB (Oxford) 2024; 26:648-655. [PMID: 38350737 DOI: 10.1016/j.hpb.2024.01.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The temporal evolution of HRQoL and the importance of other PROs to patients, following resection for pancreatic and peripancreatic malignancy remains unexplored. METHODS Patients undergoing pancreatic resection between 2021 and 2022 were enrolled from 2 UK HPB centres. Patients completed the EORTC QLQ-C30, QLQ-PAN26 tools and rated 56 PROs preoperatively (T1), at discharge (T2), 6-weeks (T3), 3-months (T4) and 6-months (T5) postoperatively. ANOVA followed by post-hoc analysis was used to examine patterns in HRQoL through time. Multivariable ANOVA was used to identify impact of clinical factors on HRQoL. RESULTS 63 patients were recruited [median age, 72 (IQR 41-85); 39/63 male]. Physical functioning declined from 70.4 (26.2) at T1 to 53.5 (20.9) at T2 (p = 0.016). Global QoL score increased significantly from 41.0 (23.0) at T2 to 60.0 (26.1) at T5 (p = 0.007), as did role functioning [21.1 (27.9) at T2 to 59.4 (32.8) at T5, p < 0.001]. Chemotherapy status and the postoperative complications did not significantly change HRQoL. General QoL and health were the only PROs rated as 'very important' (scores 7-9) by more than 80 % of participants at five time-points. CONCLUSION Recuperation of HRQoL measures is seen at 6-months postoperative and was not affected by chemotherapy or postoperative complications. Notably, PROs important to patients varied over time.
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Affiliation(s)
- Nejo Joseph
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Francis Robertson
- Department of HPB Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - James Lucocq
- Department of General Surgery, NHS Lothian, United Kingdom
| | - Rupaly Pande
- HPB and Transplant Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sarah Powell-Brett
- HPB and Transplant Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Kate Swainston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Sharp
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine Exley
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Keith Roberts
- HPB and Transplant Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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2
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Lucocq J, Hawkyard J, Haugk B, Mownah O, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Feretis M, Balakrishnan A, Ceresa C, Davidson B, Pande R, Dasari B, Tanno L, Karavias D, Helliwell J, Young A, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, Van Laarhoven S, Robertson F, Nawara H, Doyle J, Bhogal R, Harrison E, Roalso M, Ciprani D, Aroori S, Ratnayake B, Koea J, Capurso G, Bellotti R, Stättner S, Alsaoudi T, Bhardwaj N, Rajesh S, Jeffery F, Connor S, Cameron A, Jamieson N, Sheen A, Mittal A, Samra J, Gill A, Roberts K, Søreide K, Pandanaboyana S. Adjuvant chemotherapy for adenocarcinoma arising from intraductal papillary mucinous neoplasia: multicentre ADENO-IPMN study. Br J Surg 2024; 111:znae100. [PMID: 38659247 DOI: 10.1093/bjs/znae100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The clinical impact of adjuvant chemotherapy after resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia is unclear. The aim of this study was to identify factors related to receipt of adjuvant chemotherapy and its impact on recurrence and survival. METHODS This was a multicentre retrospective study of patients undergoing pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia between January 2010 and December 2020 at 18 centres. Recurrence and survival outcomes for patients who did and did not receive adjuvant chemotherapy were compared using propensity score matching. RESULTS Of 459 patients who underwent pancreatic resection, 275 (59.9%) received adjuvant chemotherapy (gemcitabine 51.3%, gemcitabine-capecitabine 21.8%, FOLFIRINOX 8.0%, other 18.9%). Median follow-up was 78 months. The overall recurrence rate was 45.5% and the median time to recurrence was 33 months. In univariable analysis in the matched cohort, adjuvant chemotherapy was not associated with reduced overall (P = 0.713), locoregional (P = 0.283) or systemic (P = 0.592) recurrence, disease-free survival (P = 0.284) or overall survival (P = 0.455). Adjuvant chemotherapy was not associated with reduced site-specific recurrence. In multivariable analysis, there was no association between adjuvant chemotherapy and overall recurrence (HR 0.89, 95% c.i. 0.57 to 1.40), disease-free survival (HR 0.86, 0.59 to 1.30) or overall survival (HR 0.77, 0.50 to 1.20). Adjuvant chemotherapy was not associated with reduced recurrence in any high-risk subgroup (for example, lymph node-positive, higher AJCC stage, poor differentiation). No particular chemotherapy regimen resulted in superior outcomes. CONCLUSION Chemotherapy following resection of adenocarcinoma arising from intraductal papillary mucinous neoplasia does not appear to influence recurrence rates, recurrence patterns or survival.
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MESH Headings
- Humans
- Female
- Male
- Retrospective Studies
- Aged
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/therapy
- Pancreatic Neoplasms/surgery
- Chemotherapy, Adjuvant
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Pancreatectomy
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/therapy
- Adenocarcinoma, Mucinous/mortality
- Gemcitabine
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/therapeutic use
- Deoxycytidine/administration & dosage
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/drug therapy
- Carcinoma, Pancreatic Ductal/therapy
- Carcinoma, Pancreatic Ductal/surgery
- Capecitabine/administration & dosage
- Capecitabine/therapeutic use
- Pancreatic Intraductal Neoplasms/pathology
- Pancreatic Intraductal Neoplasms/therapy
- Pancreatic Intraductal Neoplasms/mortality
- Pancreatic Intraductal Neoplasms/surgery
- Adenocarcinoma/pathology
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Propensity Score
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Affiliation(s)
- James Lucocq
- Department of General Surgery, NHS Lothian, Edinburgh, UK
| | - Jake Hawkyard
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Beate Haugk
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omar Mownah
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | - Krishna Menon
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | - Takaki Furukawa
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Inoue
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuki Hirose
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Michael Feretis
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Balakrishnan
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Carlo Ceresa
- Hepatobiliary and Pancreatic Surgery Unit, Royal Free Hospital, London, UK
| | - Brian Davidson
- Hepatobiliary and Pancreatic Surgery Unit, Royal Free Hospital, London, UK
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Bobby Dasari
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Lulu Tanno
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Dimitrios Karavias
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Jack Helliwell
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alistair Young
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Quentin Nunes
- Department of Hepatopancreatobiliary Surgery, East Lancashire Teaching Hospitals NHS Trust, Blackburn, UK
| | - Tomas Urbonas
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael Silva
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Gordon-Weeks
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jenifer Barrie
- Nottingham Hepato-Pancreatico-Biliary Service, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Dhanny Gomez
- Nottingham Hepato-Pancreatico-Biliary Service, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Stijn Van Laarhoven
- Department of General Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Francis Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hossain Nawara
- Department of General Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Joseph Doyle
- Gastrointestinal Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ricky Bhogal
- Gastrointestinal Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Harrison
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Marcus Roalso
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Debora Ciprani
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Somaiah Aroori
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Bathiya Ratnayake
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Tareq Alsaoudi
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Neil Bhardwaj
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Srujan Rajesh
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fraser Jeffery
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Saxon Connor
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Andrew Cameron
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Amy Sheen
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jas Samra
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony Gill
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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3
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Al-Leswas D, Baxter N, Lim WB, Robertson F, Ratnayake B, Samanta J, Capurso G, de-Madaria E, Drewes AM, Windsor J, Pandanaboyana S. The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis. HPB (Oxford) 2023; 25:162-171. [PMID: 36593161 DOI: 10.1016/j.hpb.2022.12.004] [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] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP. METHODS The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis. RESULTS A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively. CONCLUSION EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.
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Affiliation(s)
- Dhya Al-Leswas
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Nesta Baxter
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Wei B Lim
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Francis Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital; Department of Clinical Medicine, Miguel Hernández University; ISABIAL, Alicante, Spain
| | - Asbjørn M Drewes
- Department of Gastroenterology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - John Windsor
- HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand; Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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4
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Pillai S, McInally N, Lambert A, Monteith Z, Robertson F, Sutton D, Nailon W, Huang Z. PO-1585 End-to-end verification of DIBH Treatment technique using CIRS Dynamic Thorax phantom. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03549-6] [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: 10/18/2022]
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5
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Platt E, Klootwijk E, Salama A, Davidson B, Robertson F. Literature review of the mechanisms of acute kidney injury secondary to acute liver injury. World J Nephrol 2022; 11:13-29. [PMID: 35117976 PMCID: PMC8790308 DOI: 10.5527/wjn.v11.i1.13] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
People exposed to liver ischaemia reperfusion (IR) injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality. Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury (AKI) in this setting, but the mediators have not yet been identified. Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.
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Affiliation(s)
- Esther Platt
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Enriko Klootwijk
- Department of Renal Medicine, University College London, London NW3 2PF, United Kingdom
| | - Alan Salama
- Department of Renal Medicine, University College London, London NW3 2PF, United Kingdom
| | - Brian Davidson
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Francis Robertson
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
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6
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Diaz-Nieto R, Lykoudis P, Robertson F, Sharma D, Moore K, Malago M, Davidson BR. A simple scoring model for predicting early graft failure and postoperative mortality after liver transplantation. Ann Hepatol 2020; 18:902-912. [PMID: 31405576 DOI: 10.1016/j.aohep.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Graft failure and postoperative mortality are the most serious complications after liver transplantation. The aim of this study is to establish a prognostic scoring system to predict graft and patient survival based on serum transaminases levels that are routinely used during the postoperative period in human cadaveric liver transplants. PATIENTS AND METHODS Postoperative graft failure and patient mortality after liver transplant were analyzed from a consecutive series of 1299 patients undergoing cadaveric liver transplantation. This was correlated with serum liver function tests and the rate of reduction in transaminase levels over the first postoperative week. A cut-off transaminase level correlating with graft and patient survival was calculated and incorporated into a scoring system. RESULTS Aspartate-aminotransferase (AST) on postoperative day one showed significant correlation with early graft failure for levels above 723U/dl and early postoperative mortality for levels above 750U/dl. AST reduction rate (day 1 to 3) greater than 1.8 correlated with reduced graft failure and greater than 2 with mortality. Alanine-aminotransferase (ALT) reduction in the first 48h post transplantation also correlated with outcomes. CONCLUSION A scoring system with these three variables allowed us to classify our patients into three groups of risk for early graft failure and mortality.
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Affiliation(s)
- Rafael Diaz-Nieto
- HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom; Royal Free Campus, University College London, London, United Kingdom.
| | - Panagis Lykoudis
- HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom; Royal Free Campus, University College London, London, United Kingdom
| | - Francis Robertson
- Royal Free Campus, University College London, London, United Kingdom
| | - Dinesh Sharma
- HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom
| | - Kevin Moore
- Royal Free Campus, University College London, London, United Kingdom
| | - Massimo Malago
- HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom
| | - Brian R Davidson
- HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom; Royal Free Campus, University College London, London, United Kingdom
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Qureshi AM, Davies LK, Patel PA, Rennie A, Robertson F. Determinants of Radiation Dose in Selective Ophthalmic Artery Chemosurgery for Retinoblastoma. AJNR Am J Neuroradiol 2019; 40:713-717. [PMID: 30872423 DOI: 10.3174/ajnr.a6000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Retinoblastoma is the most common pediatric ocular neoplasm. Multimodality treatment approaches are commonplace, and selective ophthalmic artery chemosurgery has emerged as a safe and effective treatment in selected patients. Minimizing radiation dose in this highly radiosensitive patient cohort is critical. We explore which procedural factors affect the radiation dose in a single-center cohort of children managed in the UK National Retinoblastoma Service. MATERIALS AND METHODS A retrospective review was performed of 177 selective ophthalmic artery chemosurgery procedures in 48 patients with retinoblastoma (2013-2017). Medical records, angiographic imaging, and radiation dosimetry data (including total fluoroscopic screening time, skin dose, and dose-area product) were reviewed. RESULTS The mean fluoroscopic time was 13.5 ± 13 minutes, the mean dose-area product was 11.7 ± 9.7 Gy.cm2, and the mean total skin dose was 260.9 ± 211.6 mGy. One hundred sixty-three of 177 procedures (92.1%) were technically successful. In 14 (7.9%), the initial attempt was unsuccessful (successful in 13/14 re-attempts). Screening time and radiation dose were associated with drug-delivery microcatheter location and patient age; screening time was associated with treatment cycle. CONCLUSIONS In selective ophthalmic artery chemosurgery, a microcatheter tip position in the proximal or ostial ophthalmic artery and patient age 2 years or younger were associated with reduced fluoroscopic screening time and radiation dose; treatment beyond the first cycle was associated with reduced fluoroscopic screening time.
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Affiliation(s)
- A M Qureshi
- From the Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - L K Davies
- From the Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - P A Patel
- From the Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - A Rennie
- From the Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - F Robertson
- From the Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK.
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8
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Otano I, Escors D, Schurich A, Singh H, Robertson F, Davidson BR, Fusai G, Vargas FA, Tan ZMD, Aw JYJ, Hansi N, Kennedy PTF, Xue SA, Stauss HJ, Bertoletti A, Pavesi A, Maini MK. Molecular Recalibration of PD-1+ Antigen-Specific T Cells from Blood and Liver. Mol Ther 2018; 26:2553-2566. [PMID: 30217730 PMCID: PMC6225092 DOI: 10.1016/j.ymthe.2018.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 02/06/2023] Open
Abstract
Checkpoint inhibitors and adoptive cell therapy provide promising options for treating solid cancers such as HBV-related HCC, but they have limitations. We tested the potential to combine advantages of each approach, genetically reprogramming T cells specific for viral tumor antigens to overcome exhaustion by down-modulating the co-inhibitory receptor PD-1. We developed a novel lentiviral transduction protocol to achieve preferential targeting of endogenous or TCR-redirected, antigen-specific CD8 T cells for shRNA knockdown of PD-1 and tested functional consequences for antitumor immunity. Antigen-specific and intrahepatic CD8 T cells transduced with lentiviral (LV)-shPD-1 consistently had a marked reduction in PD-1 compared to those transduced with a control lentiviral vector. PD-1 knockdown of human T cells rescued antitumor effector function and promoted killing of hepatoma cells in a 3D microdevice recapitulating the pro-inflammatory PD-L1hi liver microenvironment. However, upon repetitive stimulation, PD-1 knockdown drove T cell senescence and induction of other co-inhibitory pathways. We provide the proof of principle that T cells with endogenous or genetically engineered specificity for HBV-associated HCC viral antigens can be targeted for functional genetic editing. We show that PD-1 knockdown enhances immediate tumor killing but is limited by compensatory engagement of alternative co-inhibitory and senescence program upon repetitive stimulation.
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MESH Headings
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/therapeutic use
- Antigens, Viral/immunology
- CD8-Positive T-Lymphocytes/immunology
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Carcinoma, Hepatocellular/virology
- Genetic Vectors/genetics
- Hepatitis B virus/immunology
- Hepatitis B virus/pathogenicity
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/pathology
- Hepatitis B, Chronic/therapy
- Hepatitis B, Chronic/virology
- Humans
- Immunotherapy, Adoptive/methods
- Lentivirus/genetics
- Liver/immunology
- Liver/metabolism
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Liver Neoplasms/virology
- Programmed Cell Death 1 Receptor/genetics
- Programmed Cell Death 1 Receptor/immunology
- Programmed Cell Death 1 Receptor/therapeutic use
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/therapeutic use
- Tumor Microenvironment/genetics
- Tumor Microenvironment/immunology
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Affiliation(s)
- Itziar Otano
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK; Division of Immunity and Immunotherapy, Centre for Applied Medical Research, Pamplona, Spain; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - David Escors
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK; Navarrabiomed-Biomedical Research Centre, IdiSNA, Pamplona, Spain
| | - Anna Schurich
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Harsimran Singh
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK
| | | | - Brian R Davidson
- Department of Surgery and Interventional Science, UCL, London, UK
| | - Giuseppe Fusai
- Department of Surgery and Interventional Science, UCL, London, UK
| | | | - Zhi M D Tan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jia Y J Aw
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Navjyot Hansi
- Centre for Immunobiology, Blizard Institute, Bart's and the London School of Medicine and Dentistry, QMUL, London, UK
| | - Patrick T F Kennedy
- Centre for Immunobiology, Blizard Institute, Bart's and the London School of Medicine and Dentistry, QMUL, London, UK
| | - Shao-An Xue
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK; Genetic Engineering Laboratory, School of Biological and Environmental Engineering, Xi'an University, Xi'an, China
| | - Hans J Stauss
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK
| | - Antonio Bertoletti
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore; Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Andrea Pavesi
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore.
| | - Mala K Maini
- Division of Infection and Immunity, Institute of Immunity and Transplantation, UCL, London, UK.
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9
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Hammarberg K, Trounson A, McBain J, Matthews P, Robertson T, Robertson F, Magli C, Mhlanga T, Makurumure T, Marechera F. Improving access to ART in low-income settings through knowledge transfer: a case study from Zimbabwe. Hum Reprod Open 2018; 2018:hoy017. [PMID: 30895258 PMCID: PMC6276666 DOI: 10.1093/hropen/hoy017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
It may be assumed that infertility is not a problem in resource-poor areas where fertility rates are high. However, evidence overwhelmingly shows that childlessness is highly stigmatized in these settings and that women who are unable to bear children suffer significant social and psychological consequences. The World Health Organization has recommended that infertility be considered a global health problem and stated the need for ART to be adapted to low-resource settings. This paper describes a model for improving access to ART in low-resource settings. Experienced ART health professionals from Australia and Italy representing medical science, embryology, nursing and counselling used knowledge transfer to support a clinician, a laboratory scientist and a nurse to establish an ART service in Harare, Zimbabwe. Support and mentorship provided between October 2016 and December 2017 included: hosting the clinician and the embryologist for the new service in established ART clinics for short periods and providing them with dedicated mentorship and training during their stay; funding an experienced embryologist to travel to Zimbabwe (three times) to oversee the setting up of the lab and provide hands-on embryology training; funding a scientist and a nurse to travel to Zimbabwe to troubleshoot and establish protocols for record keeping and psychosocial care; and contributing approximately AUD $15,000 to the purchase of some equipment. By 31 March 2018, the team at IVF Zimbabwe had performed 166 ART procedures, which at time of writing had resulted in 16 births and 4 ongoing pregnancies. This case study demonstrates that with mentorship and modest financial support from ART experts from high-income settings, health professionals in low-income settings can deliver affordable ART with successful outcomes.
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Affiliation(s)
- K Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - A Trounson
- Centre for Cancer Research, Monash University and Hudson Institute of Medical Research, Melbourne 3168, Australia
| | - J McBain
- Melbourne IVF, Melbourne 3002, Australia
| | - P Matthews
- Consultant Embryologist, Melbourne 3000, Australia
| | - T Robertson
- Retired Medical and Embryology practitioners, IVF Zimbabwe, Harare 263, Zimbabwe
| | - F Robertson
- Retired Medical and Embryology practitioners, IVF Zimbabwe, Harare 263, Zimbabwe
| | - C Magli
- SISMER, 40138 Bologna, Italy
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10
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Pallett LJ, Davies J, Colbeck EJ, Robertson F, Hansi N, Easom NJW, Burton AR, Stegmann KA, Schurich A, Swadling L, Gill US, Male V, Luong T, Gander A, Davidson BR, Kennedy PTF, Maini MK. IL-2 high tissue-resident T cells in the human liver: Sentinels for hepatotropic infection. J Exp Med 2017; 214:1567-1580. [PMID: 28526759 PMCID: PMC5461007 DOI: 10.1084/jem.20162115] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/11/2017] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
The liver provides a tolerogenic immune niche exploited by several highly prevalent pathogens as well as by primary and metastatic tumors. We have sampled healthy and hepatitis B virus (HBV)-infected human livers to probe for a subset of T cells specialized to overcome local constraints and mediate immunity. We characterize a population of T-betloEomesloBlimp-1hiHobitlo T cells found within the intrahepatic but not the circulating memory CD8 T cell pool expressing liver-homing/retention markers (CD69+CD103+ CXCR6+CXCR3+). These tissue-resident memory T cells (TRM) are preferentially expanded in patients with partial immune control of HBV infection and can remain in the liver after the resolution of infection, including compartmentalized responses against epitopes within all major HBV proteins. Sequential IL-15 or antigen exposure followed by TGFβ induces liver-adapted TRM, including their signature high expression of exhaustion markers PD-1 and CD39. We suggest that these inhibitory molecules, together with paradoxically robust, rapid, cell-autonomous IL-2 and IFNγ production, equip liver CD8 TRM to survive while exerting local noncytolytic hepatic immunosurveillance.
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Affiliation(s)
- Laura J Pallett
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Jessica Davies
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Emily J Colbeck
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Francis Robertson
- Centre for Digestive Diseases, Institute of Liver and Digestive Health, University College London, London, England, UK
| | - Navjyot Hansi
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, UK
| | - Nicholas J W Easom
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Alice R Burton
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Kerstin A Stegmann
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Anna Schurich
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Leo Swadling
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - Upkar S Gill
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, UK
| | - Victoria Male
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
| | - TuVinh Luong
- Centre for Digestive Diseases, Institute of Liver and Digestive Health, University College London, London, England, UK
| | - Amir Gander
- Centre for Digestive Diseases, Institute of Liver and Digestive Health, University College London, London, England, UK
| | - Brian R Davidson
- Centre for Digestive Diseases, Institute of Liver and Digestive Health, University College London, London, England, UK
| | - Patrick T F Kennedy
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, UK
| | - Mala K Maini
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, England, UK
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11
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Canny A, Robertson F, Knight P, Redpath A, Witham MD. 142An Evaluation Of The Psychometric Properties Of The Indicator Of Relative Need (IORN) Instrument. Age Ageing 2017. [DOI: 10.1093/ageing/afx068.142] [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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12
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Darling AL, Hart KH, Gossiel F, Robertson F, Hunt J, Hill TR, Johnsen S, Berry JL, Eastell R, Vieth R, Lanham-New SA. Higher bone resorption excretion in South Asian women vs. White Caucasians and increased bone loss with higher seasonal cycling of vitamin D: Results from the D-FINES cohort study. Bone 2017; 98:47-53. [PMID: 28286239 DOI: 10.1016/j.bone.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023]
Abstract
Few data exist on bone turnover in South Asian women and it is not well elucidated as to whether Western dwelling South Asian women have different bone resorption levels to that of women from European ethnic backgrounds. This study assessed bone resorption levels in UK dwelling South Asian and Caucasian women as well as evaluating whether seasonal variation in 25-hydroxyvitamin D [25(OH)D] is associated with bone resorption in either ethnic group. Data for seasonal measures of urinary N-telopeptide of collagen (uNTX) and serum 25(OH)D were analysed from n=373 women (four groups; South Asian postmenopausal n=44, South Asian premenopausal n=50, Caucasian postmenopausal n=144, Caucasian premenopausal n=135) (mean (±SD) age 48 (14) years; age range 18-79years) who participated in the longitudinal D-FINES (Diet, Food Intake, Nutrition and Exposure to the Sun in Southern England) cohort study (2006-2007). A mixed between-within subjects ANOVA (n=192) showed a between subjects effect of the four groups (P<0.001) on uNTX concentration, but no significant main effect of season (P=0.163). Bonferroni adjusted Post hoc tests (P≤0.008) suggested that there was no significant difference between the postmenopausal Asian and premenopausal Asian groups. Season specific age-matched-pairs analyses showed that in winter (P=0.04) and spring (P=0.007), premenopausal Asian women had a 16 to 20nmolBCE/mmol Cr higher uNTX than premenopausal Caucasian women. The (amplitude/mesor) ratio (i.e. seasonal change) for 25(OH)D was predictive of uNTX, with estimate (SD)=0.213 (0.015) and 95% CI (0.182, 0.245; P<0.001) in a non-linear mixed model (n=154). This showed that individuals with a higher seasonal change in 25(OH)D, adjusted for overall 25(OH)D concentration, showed increased levels of uNTX. Although the effect size was smaller than for the amplitude/mesor ratio, the mesor for 25(OH)D concentration was also predictive of uNTX, with estimate (SD)=-0.035 (0.004), and 95% CI (-0.043, -0.028; P<0.001). This study demonstrates higher levels of uNTX in premenopausal South Asian women than would be expected for their age, being greater than same-age Caucasian women, and similar to postmenopausal Asian women. This highlights potentially higher than expected bone resorption levels in premenopausal South Asian women which, if not offset by concurrent increased bone formation, may have future clinical and public health implications which warrant further investigation. Individuals with a larger seasonal change in 25(OH)D concentration showed an increased bone resorption, an association which was larger than that of the 25(OH)D yearly average, suggesting it may be as important clinically to ensure a stable and steady 25(OH)D concentration, as well as one that is high enough to be optimal for bone health.
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Affiliation(s)
- A L Darling
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - K H Hart
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - F Gossiel
- Bone Biochemistry Laboratory, Department of Human Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - F Robertson
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - J Hunt
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - T R Hill
- School of Agriculture, Food and Rural Development and Human Nutrition Research Centre, Agriculture Building, Newcastle University, NE1 7RU, UK
| | - S Johnsen
- Surrey Clinical Research Centre, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - J L Berry
- Specialist Assay Laboratory (Vitamin D), Manchester Academic Health Sciences Centre, Manchester Royal Infirmary, M13 9WL, UK
| | - R Eastell
- Bone Biochemistry Laboratory, Department of Human Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - R Vieth
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Ave., Toronto, ON M5G 1X5, Canada
| | - S A Lanham-New
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey GU2 7XH, UK
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13
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Huang WC, Easom NJ, Tang XZ, Gill US, Singh H, Robertson F, Chang C, Trowsdale J, Davidson BR, Rosenberg WM, Fusai G, Toubert A, Kennedy PT, Peppa D, Maini MK. T Cells Infiltrating Diseased Liver Express Ligands for the NKG2D Stress Surveillance System. J Immunol 2016; 198:1172-1182. [PMID: 28031333 PMCID: PMC5253436 DOI: 10.4049/jimmunol.1601313] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/22/2016] [Indexed: 12/23/2022]
Abstract
NK cells, which are highly enriched in the liver, are potent regulators of antiviral T cells and immunopathology in persistent viral infection. We investigated the role of the NKG2D axis in T cell/NK cell interactions in hepatitis B. Activated and hepatitis B virus (HBV)-specific T cells, particularly the CD4 fraction, expressed NKG2D ligands (NKG2DL), which were not found on T cells from healthy controls (p < 0.001). NKG2DL-expressing T cells were strikingly enriched within HBV-infected livers compared with the periphery or to healthy livers (p < 0.001). NKG2D+NK cells were also increased and preferentially activated in the HBV-infected liver (p < 0.001), in direct proportion to the percentage of MICA/B-expressing CD4 T cells colocated within freshly isolated liver tissue (p < 0.001). This suggests that NKG2DL induced on T cells within a diseased organ can calibrate NKG2D-dependent activation of local NK cells; furthermore, NKG2D blockade could rescue HBV-specific and MICA/B-expressing T cells from HBV-infected livers. To our knowledge, this is the first ex vivo demonstration that non-virally infected human T cells can express NKG2DL, with implications for stress surveillance by the large number of NKG2D-expressing NK cells sequestered in the liver.
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Affiliation(s)
- Wei-Chen Huang
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom.,Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Nicholas J Easom
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom
| | - Xin-Zi Tang
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom
| | - Upkar S Gill
- Centre for Immunobiology, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Harsimran Singh
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom.,Institute for Liver and Digestive Health, University College London, London NW3 2PF, United Kingdom
| | - Francis Robertson
- Department of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Chiwen Chang
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom; and
| | - John Trowsdale
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom; and
| | - Brian R Davidson
- Institute for Liver and Digestive Health, University College London, London NW3 2PF, United Kingdom.,Department of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - William M Rosenberg
- Institute for Liver and Digestive Health, University College London, London NW3 2PF, United Kingdom
| | - Giuseppe Fusai
- Institute for Liver and Digestive Health, University College London, London NW3 2PF, United Kingdom.,Department of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Antoine Toubert
- Université Paris Diderot, Sorbonne Paris Cité, INSERM UMRS 1160, AP-HP, Hôpital Saint-Louis, Paris 75013, France
| | - Patrick T Kennedy
- Centre for Immunobiology, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Dimitra Peppa
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London WC1E 6JF, United Kingdom;
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14
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Holmes M, Robertson F, Little F, Cotton M, Dobbels E, van der Kouwe A, Laughton B, Meintjes E. O50. Regional differences in absolute metabolite level couplings in a longitudinal study of children. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.058] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Wilkes S, Burden‐Teh E, Robertson F, Grindlay D, Selby N. Skin and soft tissue infections and acute kidney injury: a systematic review. Br J Dermatol 2016; 175:182-4. [DOI: 10.1111/bjd.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S.R. Wilkes
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - E. Burden‐Teh
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - F. Robertson
- Division of Medical Sciences and Graduate Entry Medicine University of Nottingham Nottingham U.K
| | - D. Grindlay
- Centre of Evidence‐Based Dermatology School of Medicine University of Nottingham Nottingham U.K
| | - N.M. Selby
- Division of Medical Sciences and Graduate Entry Medicine University of Nottingham Nottingham U.K
- Department of Renal Medicine Royal Derby Hospital Derby U.K
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16
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Robertson F. Increasing accessibility to antenatal classes through podcasts. Rural Remote Health 2016. [DOI: 10.22605/rrh4124] [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] Open
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17
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Stegmann KA, Robertson F, Hansi N, Gill U, Pallant C, Christophides T, Pallett LJ, Peppa D, Dunn C, Fusai G, Male V, Davidson BR, Kennedy P, Maini MK. CXCR6 marks a novel subset of T-bet(lo)Eomes(hi) natural killer cells residing in human liver. Sci Rep 2016; 6:26157. [PMID: 27210614 PMCID: PMC4876507 DOI: 10.1038/srep26157] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [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: 02/16/2016] [Accepted: 04/27/2016] [Indexed: 12/15/2022] Open
Abstract
Natural killer cells (NK) are highly enriched in the human liver, where they can regulate immunity and immunopathology. We probed them for a liver-resident subset, distinct from conventional bone-marrow-derived NK. CXCR6+ NK were strikingly enriched in healthy and diseased liver compared to blood (p < 0.0001). Human hepatic CXCR6+ NK had an immature phenotype (predominantly CD56brightCD16−CD57−), and expressed the tissue-residency marker CD69. CXCR6+ NK produced fewer cytotoxic mediators and pro-inflammatory cytokines than the non-liver-specific CXCR6− fraction. Instead CXCR6+ NK could upregulate TRAIL, a key death ligand in hepatitis pathogenesis. CXCR6 demarcated liver NK into two transcriptionally distinct populations: T-bethiEomeslo(CXCR6−) and T-betloEomeshi(CXCR6+); the latter was virtually absent in the periphery. The small circulating CXCR6+ subset was predominantly T-bethiEomeslo, suggesting its lineage was closer to CXCR6− peripheral than CXCR6+ liver NK. These data reveal a large subset of human liver-resident T-betloEomeshi NK, distinguished by their surface expression of CXCR6, adapted for hepatic tolerance and inducible anti-viral immunity.
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Affiliation(s)
- Kerstin A Stegmann
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Francis Robertson
- Department of Surgery and Interventional Science, UCL, Royal Free Hospital London, London, United Kingdom
| | - Navjyot Hansi
- Centre for Digestive Diseases, Blizard Institute, Bart's and the London School of Medicine and Dentistry, London, UK
| | - Upkar Gill
- Centre for Digestive Diseases, Blizard Institute, Bart's and the London School of Medicine and Dentistry, London, UK
| | - Celeste Pallant
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Theodoros Christophides
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Laura J Pallett
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Dimitra Peppa
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Claire Dunn
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Giuseppe Fusai
- Department of Surgery and Interventional Science, UCL, Royal Free Hospital London, London, United Kingdom
| | - Victoria Male
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Brian R Davidson
- Department of Surgery and Interventional Science, UCL, Royal Free Hospital London, London, United Kingdom
| | - Patrick Kennedy
- Centre for Digestive Diseases, Blizard Institute, Bart's and the London School of Medicine and Dentistry, London, UK
| | - Mala K Maini
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
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18
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Gemmete JJ, Chaudhary N, Elias AE, Toma AK, Pandey AS, Parker RA, Davagnanam I, Maher CO, Brew S, Robertson F. Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers. AJNR Am J Neuroradiol 2013; 34:1974-9. [PMID: 23620076 DOI: 10.3174/ajnr.a3522] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity with progressive spinal cord symptoms. The aim of this study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas that were primarily treated with endovascular embolization. MATERIALS AND METHODS A retrospective review was performed of all patients from 1997-2010 who underwent treatment at 2 academic referral centers for a spinal dural arteriovenous fistula. Follow-up was performed by clinical examination, and functional status was measured by use of the Aminoff-Logue Disability Scale, McCormick classification grading, and mRS scores. The nonparametric Wilcoxon signed rank test was used to compare pretreatment and posttreatment Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and mRS scores. P values < .05 were considered significant. RESULTS A total of 38 patients were included. Five patients (2 endovascular, 3 surgical) were lost to follow-up and therefore were excluded from the analysis, 29 patients were initially treated from an endovascular approach (9 Onyx, 20 cyanoacrylate), and 4 patients were treated from a standard surgical approach. Five patients in the endovascular group subsequently underwent surgery for various reasons. The clinical improvements in the Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and the mRS scores were statistically significant (P < .05, Wilcoxon signed rank test). CONCLUSIONS We conclude that endovascular treatment of spinal dural arteriovenous fistulas can result in good clinical outcomes. Surgery remains the treatment of choice when safe embolization of the proximal radicular draining vein cannot be obtained or because the shunting artery of the spinal dural arteriovenous fistula also supplies the anterior spinal, posterior spinal, or a radiculomedullary artery.
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19
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Abstract
Expression of the inducible isoform of the cyclooxygenase gene (PGHS-2, COX-2) which codes for the enzyme that catalyzes formation of prostaglandins, was detected in 13/13 human breast tumors of high grade but not in samples of normal breast tissue. There was a statistically significant linear association between COX-2 gene expression and high (>50%) tumor cell density (p<0.01), with COX-2 protein localized to tumor cells. These results indicate that COX-2 gene expression may be useful as a molecular biomarker for human breast tumors and may also predict sensitivity to treatment with nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- M Parrett
- OHIO STATE UNIV,DEPT MED MICROBIOL & IMMUNOL,COLL MED,COLUMBUS,OH 43210. OHIO STATE UNIV,COLL MED,DEPT PATHOL,COLUMBUS,OH 43210. OHIO STATE UNIV,COLL MED,SCH PUBL HLTH,COLUMBUS,OH 43210. OHIO STATE UNIV,COLL MED,CTR COMPREHENS CANC,COLUMBUS,OH 43210
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20
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Joarder F, Abouissa H, Robertson F, Parrett M, Alshafie G, Harris R. Growth arrest of DMBA-induced mammary carcinogenesis with ibuprofen treatment in female Sprague-Dawley rats. Oncol Rep 2012; 4:1271-3. [PMID: 21590235 DOI: 10.3892/or.4.6.1271] [Citation(s) in RCA: 5] [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: 11/05/2022] Open
Abstract
We examined effects of ibuprofen on the growth and development of DMBA-induced mammary cancers in mature female Sprague-Dawley rats. Ibuprofen was added to the standard diet at approximately 1,000 mg/kg rodent chow, resulting in an average daily dose of 25 mg per day per 0.25 kg rat. After five weeks of ibuprofen treatment, there was a 37% reduction in tumor volume compared to a 260% increase in the volume of tumors in untreated rats (p<0.001). These results suggest that ibuprofen may have potential in the chemoprevention and treatment of breast cancer.
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Affiliation(s)
- F Joarder
- OHIO STATE UNIV, SCH PUBL HLTH, CTR COMPREHENS CANC, COLL MED & PUBL HLTH, COLUMBUS, OH 43210 USA. OHIO STATE UNIV, DEPT SURG, COLUMBUS, OH 43210 USA. OHIO STATE UNIV, DEPT MED MICROBIOL & IMMUNOL, COLUMBUS, OH 43210 USA
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Robertson F, Geddes J, Ridley D, McLeod G, Cheng K. Patients with Type 2 diabetes mellitus have a worse functional outcome post knee arthroplasty: a matched cohort study. Knee 2012; 19:286-9. [PMID: 21715174 DOI: 10.1016/j.knee.2011.06.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 02/02/2023]
Abstract
Knee arthroplasty provides not only pain relief but also an improvement in function and range of movement. Limited joint mobility is a common complication of diabetes mellitus. We therefore examined functional outcome post total knee arthroplasty in a cohort of subjects with (n=367) and a cohort matched for age, sex, BMI and functional movement at baseline, without diabetes mellitus (n=367). Participants were examined at baseline (pre-operatively), 1, 5 and 10 years post TKA. There was no significant difference in fixed flexion, maximal flexion or total range of movement between the two groups at baseline. By 1 year the group with diabetes had a significantly lower maximal flexion (p<0.001), total range of movement (p<0.001) and Knee Society Score (p=0.034). Similar results were observed at years 5 (except for the KSS) and 10 post procedure. At 5 years post arthroplasty a significant increase was observed in fixed flexion (p=0.026) in the diabetic group. Ten years post arthroplasty yielded similar results. This study demonstrates that the pre-operative presence of diabetes mellitus leads to a worse outcome post knee arthroplasty, although no significant difference was demonstrable in KSS at 5 years (p=0.35) suggesting patient satisfaction remains high during this period.
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Affiliation(s)
- Francis Robertson
- Department of General Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh, United Kingdom
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Kirmi O, Murphy E, Carecchio M, Sulkin T, Rankin J, Robertson F. Teaching neuroimages: progressive asymmetric parkinsonism and tendon xanthomas. Neurology 2011; 77:e97-8. [PMID: 22025465 DOI: 10.1212/wnl.0b013e318234325e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- O Kirmi
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Van Laere SJ, Ueno NT, Finetti P, Vermeulen PB, Lucci A, Birnbaum D, Robertson F, Iwamoto T, van Dam PA, Woodward WA, Viens P, Dirix LY, Reuben JM, Bertucci F. An integrated analysis of three distinct IBC/non-IBC affymetrix gene expression data sets to study the transcriptional heterogeneity both between IBC and non-IBC and within IBC. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10571] [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: 11/20/2022] Open
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Debeb BG, Xu W, Lacerda L, Hortobagyi GN, Robertson F, Ueno NN, Lucci A, Reuben JM, Buchholz TA, Woodward WA. Abstract P4-04-05: Histone Deacetylase Inhibitors Increase Markers of the Dedifferentiated Cancer Stem Cell Phenotype in Human Breast Cancer Cells. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-04-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
It has been suggested that differentiated cancer cells can de-differentiate into the cancer stem cell phenotype (Meyers et al., 2009; Gupta et al., 2009) and that Histone Deacetylase (HDAC) inhibitors enable efficient induction of pluripotent stem cells from adult fibroblasts (Huangfu et al., 2009). Moreover, we have recently demonstrated that the HDAC inhibitor valproic acid radiosensitized breast cancer cells grown on plastic with serum while it radioprotected breast cancer cells grown in stem cell promoting culture conditions (Debeb et al., 2010). Based on these data, we hypothesized that HDAC inhibitors increase the cancer stem cell population via dedifferentiation of differentiated cancer cells. To examine our hypothesis, Sum159 breast cancer cells were FACS-sorted based on ALDH activity and subsequently treated with one of two HDAC inhibitors, valproic acid or SAHA (suberoylanilide hydroxamic acid). After sorting, ALDH-negative cells were treated either with valproic acid, SAHA, or vehicle. After a week, the percentage of ALDH-positive cells (passage 0, P0) was examined with flow cytometry while the remaining cells were passaged and incubated with and without valproic acid or SAHA for a week and the percentage of ALDH-positive cells again evaluated (P1). This was repeated for the third time (P2). Samples from each generation were also collected to examine the protein expression. On average, a 3-fold increase in ALDH positive cells was seen in valproic acid-treated cells (35.6% vs.12.6%) and a 1.5-fold increase in SAHA-treated cells (41% vs. 28%) compared to vehicle-treated controls. This effect was maintained through multiple passages. Moreover, the expression of Beta-catenin and EMT associated genes like vimentin, fibronectin, n-cadherin, which have been implicated in generating cancer stem cells was significantly increased withtreatment in initial and passaged cells. Further functional endpoint studies are needed to validate these in vitro marker-based findings.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-04-05.
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Affiliation(s)
- BG Debeb
- The University of Texas MD Anderson Cancer Center, Houston
| | - W Xu
- The University of Texas MD Anderson Cancer Center, Houston
| | - L Lacerda
- The University of Texas MD Anderson Cancer Center, Houston
| | - GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston
| | - F Robertson
- The University of Texas MD Anderson Cancer Center, Houston
| | - NN Ueno
- The University of Texas MD Anderson Cancer Center, Houston
| | - A Lucci
- The University of Texas MD Anderson Cancer Center, Houston
| | - JM Reuben
- The University of Texas MD Anderson Cancer Center, Houston
| | - TA Buchholz
- The University of Texas MD Anderson Cancer Center, Houston
| | - WA. Woodward
- The University of Texas MD Anderson Cancer Center, Houston
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Li C, Lee B, Woodward W, Ueno N, Robertson F, Reuben J, Cristofanilli M. p53 Mutation in Inflammatory Breast Cancer Cell Lines. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Inflammatory breast cancer (IBC) is the most aggressive manifestation of primary breast cancer and represents 1% to 2% of primary breast cancer in the United States. IBC is characterized by an acute inflammation of the skin of the affected breast generally believed to be caused by blockage of the dermal lymphatics by tumor emboli. Wild type (WT) p53 is a tumor suppressor gene, which induces apoptosis and p53 mutations are associated with poor prognosis in breast cancer. Compared with locally advanced breast cancers, IBC patients have higher levels of mutated p53 protein that has been associated with more aggressive tumors, anthracycline resistance, shorter progression free survival, shorter overall survival, and less favorable long-term outcome. The aim of this study was to determine if there are unique genetic variations in IBC cell lines that would provide specific genetic p53 mutations that could be exploited for targeted therapy with the intent of improving response to treatment and overall survival in IBC.Materials and Methods: Genomic DNA was extracted from six breast cancer cell lines (MDA-453, SUM149, MCF-7, KPL4, MDA321, and SUM190) and the immortalized human mammary epithelial cells (HMLE) using the Qiagen DNA Blood Mini Kit (Valencia, CA). Among the 6 breast cancer cell lines, KPL-4, SUM149 and SUM190 are IBC cell lines; MDA231 and SUM149 have basal-like phenotype; MCF-7 has wild-type p53; SUM190 and KPL-4 are Her2 amplified. The DNA purity and concentration were determined by spectrophotometric measurements of absorbance at 260nm and 280 nm. Polymerase chainreaction (PCR) was performed to amplify the fragments of exons 2-11 of the p53gene using consensus primers. The PCR products were scanned and identified using the Agilent Bioanalyzer 2100. DNA sequencing was performed on PCR products in the ABI PRISM 310 Genetic Analyzer. The BLAST search was used to identify p53 mutations compared with the reference sequence, X54156, from Genbank.Results: We screened 2-11 exon sequences of the p53 gene in the 7 human breast cell lines. We identified two IBC cell lines (SUM149, SUM-190) with a p53 gene alteration that predicted a change in the encoded protein, SUM149 at exon 7 (ATG to ATA, Met-237-Ile) and SUM190 at exon 9 (CAG to TAG, Gln -317-stop). Both mutations have been previously reported. Five nonsense mutations were identified in two other cell lines, MDA-453 and MDA321. No mutations were identified in KPL4 and HMLE cells.Conclusions: The p53 mutation profile in breast cancer cell lines suggests an additional biological feature for the characterization of IBC. Furthermore, these data support the previously reported association between p53 status and chemo- and radioresistance in this disease responsible for poor prognosis. Therapies directed to restore p53 function should be explored in IBC models and in clinical trials.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3161.
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Affiliation(s)
- C. Li
- 1MD Anderson Cancer Center, TX,
| | - B. Lee
- 1MD Anderson Cancer Center, TX,
| | | | - N. Ueno
- 2MD Anderson Cancer Center, TX,
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Roos A, Robertson F, Carey P, Vythilingum B, Stein DJ. A Near-Infrared Spectroscopy Study of Prefrontal Activation to Affective Stimuli in Pregnant Women. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71558-7] [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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Ueno NT, Kazansky A, LaFortune TA, Lucci A, Krishnamurthy S, Hung M, Hortobagyi GN, Woodward W, Reuben JM, Robertson F, Cristofanilli M, Zhang D. Suppression of mesenchymal phenotype in inflammatory breast cancer by EGFR tyrosine kinase inhibitor erlotinib: a novel approach to suppressing metastasis. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-2042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #2042
Background: Inflammatory breast cancer (IBC) is a rare subtype well known for its propensity for rapid metastasis. The cause of this rapid metastasis in IBC is unknown. An immunohistochemical analysis of 44 cases of IBC showed HER2 overexpression in 48% of patients and epidermal growth factor receptor (EGFR) overexpression in 30% of patients. EGFR overexpression was the only poor prognostic factor: the 5-year overall survival rate was significantly lower for women with EGFR-positive disease than for women with EGFR-negative disease (P=0.01). HER2 overexpression was not a prognostic factor. The association between EGFR overexpression and increased risk of death indicated that EGFR may represent a potential therapeutic target in IBC. We hypothesized that suppression of the EGFR pathway inhibits proliferation and metastasis of IBC.
 Methods: SUM149 IBC cells, which express low levels of HER2 and high levels of EGFR, were treated with siRNA against EGFR and with the EGFR tyrosine kinase inhibitor erlotinib.
 Results: EGFR siRNA knockdown (but not non-targeting siRNA control) inhibited the proliferation of SUM149 cells. SUM149 cells were sensitive to EGFR tyrosine kinase inhibitor erlotinib in a 2-dimensional (2-D) culture system (median inhibitory concentration [IC50] = 0.90 µM). When we activated ERK by transfecting constitutively active MEK1 in SUM149 cells, the cells showed more resistance to erlotinib. Moreover, ERK siRNA knockdown sensitized SUM149 cells to erlotinib. Further, when we cultured the SUM149 cells in matrigel by using the 3-D culture system (100% matrigel in the bottom layer and cultured medium with 5% FBS and 2% matrigel in the top layer), erlotinib treatment changed the molecular phenotype of SUM149 cells from mesenchymal (a phenotype characterized by low beta-catenin expression and high vimentin and fibronectin expression) to epithelial (recovery of beta-catenin to the sites of cell-cell contacts; downregulation of fibronectin). This reversal of the mesenchymal phenotype, a hallmark of inhibition of epithelial-to-mesenchymal transition (EMT), was ERK dependent. Interestingly, the erlotinib concentration that inhibited the mesenchymal phenotype (0.1 mcM) was one log lower than the concentration that inhibited proliferation (1 mcM).
 Conclusion: Inhibition of tumor growth and EMT in SUM149 IBC cell lines is dependent on the ERK pathway through the EGFR pathway. The erlotinib dose needed to produce an anti-mesenchymal effect is much lower than the cytotoxic dose. Thus, we speculate ERK pathway to be important in inhibiting metastasis in IBC. We are currently investigating the effects of erlotinib in a xenograft model of IBC. Our study provides a rationale for developing novel treatment strategies targeting the EGFR and ERK pathways to inhibit the growth and metastasis of IBC.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2042.
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Affiliation(s)
- NT Ueno
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - A Kazansky
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - TA LaFortune
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - A Lucci
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - S Krishnamurthy
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - M Hung
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - GN Hortobagyi
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - W Woodward
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - JM Reuben
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - F Robertson
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - M Cristofanilli
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - D Zhang
- 1 The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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Tasciotti E, Bhavane R, Godin-Vilentchouk B, Serda R, Liu X, Robertson F, Ferrari M. A multistage nanodelivery system for therapeutic applications and medical imaging: in vivo biodistribution and efficacy study in a murine orthotopic breast cancer model. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #2160
The ability to deliver therapeutic compounds specifically to diseased sites is crucial for effectively treating human illnesses. Nanotechnology is emerging as a tool for resolving challenges in the delivery of poorly administrable drugs by transforming them into nanometer-sized particles (nanotherapeutics). The progress thus far gave rise to a large number of nanotherapeutics, but the accomplishment of the original objective, which is to increase drug concentration at target sites, has not been fully realized. A series of biological barriers pose as insurmountable obstacles which limit or completely abolish the ability to selectively deliver a therapeutic agent. We hypothesized that a multi-stage system for systemic delivery (MSDS) could be designed to interact with and successfully overcome sequential biological barriers. We developed a MSDS using biodegradable, biocompatible silicon particles optimally sized and shaped to travel into the blood flow, avoid RES, marginate and adhere to tumor vasculature. The first stage carriers (FSCs) contain nanopores of specific size that can load, carry, release over time, and deliver multiple types of second stage nanoparticles (SSNs). The nanoparticles can be optimized to reach, through vessels fenestrations, the tumor environment and finally release their therapeutic payload into target cells.
 
 The ease in chemically modifying the silicon surface permits the attachment of fluorescent and radiolabeled imaging molecules to the FSCs. Fluorescent and magnetic SSNs can be loaded into the pores of the FSCs. Once assembled, the resulting MSDS can be imaged using different in vivo imaging modalities from its administration to its final localization into the body. We further modified our FSCs with PEG molecules to increase their circulation time and with antibodies directed against the VEGFR2 membrane protein to increase the localization of the MSDS in tumor associated vessels. We monitored the biodistribution of all MSDSs and characterized their biocompatibility in the different tissues. Finally, we loaded the pores of the FSCs with a lipidic nanoformulation of the potent anti cancer drug doxorubicin (dox-liposomes and dox-micelles) and followed the efficacy of this treatment. Taken together, these studies provide first time evidence that silicon nanoporous particles can be used as effective carriers for the simultaneous delivery of different nanotherapeutics in vivo.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2160.
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Affiliation(s)
- E Tasciotti
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
| | - R Bhavane
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
| | | | - R Serda
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
| | - X Liu
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
| | - F Robertson
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
| | - M Ferrari
- 1 Nanomedicine, Institute for Molecular Medicine, Houston, TX
- 2 Experimental Therapeutics, MD Anderson Cancer Center, Houston, TX
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Affiliation(s)
- R. M. Snapka
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Medical Microbiology and Immunology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - S. Ge
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - J. Trask
- Department of Medical Microbiology and Immunology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - F. Robertson
- Department of Medical Microbiology and Immunology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Abstract
Nutrients exported from grazing systems contribute to eutrophication of surface waters. In this study the contributions of soil, pasture-plants, and dung to P exports in overland flow were compared using simulated rainfall. The treatments were (i) grazed pasture-plants (isolated from soil by application of petrolatum to the soil surface), (ii) grazed pasture-plants and supporting soil, (iii) grazed pasture-plants and soil and treading, and (iv) grazed pasture-plants and soil and treading and dung. In general, dissolved reactive P (DRP) accounted for the majority of the P exported and P losses decreased in the order: treading and dung treatment>treading>pasture-plants and soil>pasture-plants. Very little dissolved organic P was lost in overland flow and the effects of treading diminished with time. Over a normal grazing cycle (30 d), the portion of P lost from pasture-plants was approximately half that lost from pasture-plants and soil, one-third that lost from treaded pasture-plants and soil, and one-quarter that lost from treaded pasture-plants, soil, and dung. The DRP in the pasture-plants treatment was approximately half that in the pasture-plants and soil treatment and suggests that a significant portion of the P exported from these systems is derived directly from pasture-plants. Due to higher proportions of particulate P (PP) in the treaded and dung treatments, DRP accounted for less of total P than in the pasture-plants and pasture-plants and soil treatments. Lower infiltration capacities probably caused by mechanical disaggregation at the soil surface are consistent with the higher proportions of PP in the treading treatments. These results were used to estimate P exports from a field trial site in Southland, New Zealand. The results suggested that P export attributable to fertilizer, dung, pasture-plants, and soil components were approximately 10, 30, 20, and 40%, respectively. These results suggest that since 90% of the P exports are derived from the soil-plant system and dung returns, managements to lessen P exports should continue to focus on maintaining soil P within the optimal range for pasture-plant production and maintaining soil surface properties that maximize infiltration and minimize overland flow.
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Affiliation(s)
- R W McDowell
- AgResearch Limited, Invermay Agricultural Centre, Private Bag 50034, Mosgiel, New Zealand.
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Abstract
A case of growing skull fracture associated with unrecognized extradural haematoma is presented together with the relevant radiology. The pathophysiology of growing skull fracture is reviewed in light of this previously unreported case.
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Affiliation(s)
- M Crocker
- Department of Neurosurgery, King's College Hospital, London, UK.
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March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, Brooks PM, Cass C, Coolican M, Neil M, Pinczewski L, Quain S, Robertson F, Ruff S, Walter W, Zicat B. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage 2004; 12:400-8. [PMID: 15094139 DOI: 10.1016/j.joca.2004.02.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2002] [Accepted: 02/03/2004] [Indexed: 02/02/2023]
Abstract
AIMS This study aims to address medical and non-medical direct costs and health outcomes of bilateral and unilateral total knee replacement from the patients' perspective during the first year post-surgery. METHODS Osteoarthritis patients undergoing primary unilateral total knee or bilateral total knee replacement (TKR) surgery at three Sydney hospitals were eligible. Patients completed questionnaires pre-operatively to record expenses during the previous three months and health status immediately prior to surgery. Patients then maintained detailed prospective cost diaries and completed SF-36 and WOMAC Index each three months for the first post-operative year. RESULTS Pre-operatively, no significant differences in health status were found between patients undergoing unilateral TKR and bilateral TKR. Both unilateral and bilateral TKR patients showed improvements in pain, stiffness and function from pre-surgery to 12 months post-surgery. Patients who had bilateral TKR spent an average of 12.3 days in acute hospital and patients who had unilateral TKR 13.6 days. Totally uncemented prostheses were used in 6% of unilateral replacements and 48% of bilateral replacements. In hospital, patients who had bilateral TKR experienced significantly more complications, mainly thromboembolic, than patients who had unilateral TKR. Regression analysis showed that for every one point increase in the pre-operative SF-36 physical score (i.e. improving physical status) out-of-pocket costs decreased by 94%. Out-of-pocket costs for female patients were 3.3 times greater than for males. CONCLUSION Patients undergoing bilateral TKR and unilateral TKR had a similar length of stay in hospital and similar out-of-pocket expenditures. Bilateral replacement patients reported better physical function and general health with fewer health care visits one year post procedure. Patients requiring bilateral TKR have some additional information to aid their decision making. While their risk of peri-operative complications is higher, they have an excellent chance of good health outcomes at 12 months and are not going to be doubly "out-of-pocket" for the experience.
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Affiliation(s)
- L M March
- Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Sydney, St Leonards NSW 2065, Australia
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Snapka RM, Ge S, Trask J, Robertson F. Unbalanced growth in mouse cells with amplified dhfr genes. Cell Prolif 2003; 30:385-99. [PMID: 9650531 PMCID: PMC6496445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
When grown in the absence of methotrexate, cells carrying unstably amplified dihydrofolate reductase (dhfr) genes have a growth disadvantage that is a function of their level of gene amplification. Although this growth disadvantage is thought to drive the loss of unstably amplified dhfr genes in the absence of methotrexate, its mechanism is not understood. The present studies of murine cell lines with different levels of dhfr gene amplification demonstrate that such cells experience increased unbalanced growth (excess RNA and protein content relative to DNA content) with increased levels of dhfr gene amplification. Stathmokinetic analysis of a cell line with unstably amplified dhfr genes showed that the unbalanced growth was associated with a very low rate of G1/S transit, which suggests that amplified DNA sequences may activate a cell cycle checkpoint at the G1/S boundary. Hydroxyurea, which is known to induce rapid elimination of amplified genes at sub-cytotoxic concentrations, also inhibits the cell cycle at the G1/S transition and causes unbalanced growth. Earlier work has shown that hydroxyurea selectively targets those cells within the heterogeneous drug resistant cell populations which have the highest amplified gene dosage. The finding that unstable gene amplification and hydroxyurea have similar effects on the cell suggests that hydroxyurea may achieve this selective targeting by pushing those cells with the highest levels of gene amplification over a critical stress threshold to cause growth arrest or cell death.
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Affiliation(s)
- R M Snapka
- Department of Radiology, Ohio State University College of Medicine, Columbus 43210, USA
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35
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Abstract
A scoring system could be used in all situations where grading of deep leg vein thrombosis (DVT), including mapping of its distribution, is needed. It should also be used in epidemiological studies of DVT in further analysis of different risk groups suffering from DVT. Several scoring systems have been developed during the last three decades but have resulted in various complex and impractical systems. A scoring system should be easy to follow without any risk of misunderstanding and misinterpretation. All vein segments of importance should be defined and be possible to be included. This review describes and compares the scoring systems according to Marder et al., Arnesen et al., a subcommittee of venous disease and Björgell et al.
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Affiliation(s)
- O Björgell
- Department of Diagnostic Radiology, Malmö University Hospital, Sweden
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Abstract
The spleen is generally not considered a challenge to the radiologist. Most often it poses a problem by anomalies or an irregular but normal contrast enhancement; however, a variety of inflammatory, infectious and neoplastic diseases may involve the spleen. CT and ultrasonography are screening modalities for the spleen. For problem solving, MR imaging can be helpful, especially due to its free choice of the imaging plane and because of the high resolution in contrast MR imaging. Splenic angiography as a diagnostic tool has generally been replaced by CT, ultrasound, or MR and is now used as an interventional method, e. g., in non-surgical management of patients with chronic idiopathic thrombocytopenia or in patients with splenic trauma. This article reviews the radiology of the spleen, including anatomy, embryology, splenomegaly, splenic injury, infarction, cysts, tumors, abscesses, sarcoidosis, and AIDS. Knowledge about the use of different imaging modalities and underlying gross and microscopic pathologic features leads to a better understanding of the radiologic findings.
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Affiliation(s)
- F Robertson
- Department of Diagnostic Radiology, Lund University, Malmö University Hospital, Sweden
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Abstract
Since its inception in 1957 the BMA's annual film competition has fulfilled three roles--promoting the effective use of film and video in medical education, encouraging the production of high quality audiovisual material, and helping to increase the holdings of its film library. The BMA awards recognise programmes for their clinical accuracy, educational value and creative use of the medium.
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Margiotta M, Benton L, Robertson F, Greco RS. Role of adhesion molecules in leukocyte binding to endothelial cells adherent to vascular grafts. J Am Coll Surg 1994; 179:689-95. [PMID: 7524973] [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: 01/25/2023]
Abstract
BACKGROUND The localization of leukocytes to vascular grafts is an essential part of healing and infection resistance. The mechanisms involved in this process are only partly understood. STUDY DESIGN Human saphenous vein endothelial cells (HSVEC) were grown on control polystyrene culture ware and expanded polytetrafluoroethylene (ePTFE). The binding of monoclonal antibodies against the intercellular adhesion molecule (ICAM-1) and the E-selectin by adherent HSVEC was determined by flow cytometry. Peripheral blood leukocytes (PBL) were cocultured with HSVEC adherent to ePTFE and leukocyte binding was determined with and without the addition of a protein kinase C inhibitor. RESULTS HSVEC adherent to ePTFE constitutively bound anti-ICAM-1 antibodies, which were attenuated by the protein kinase C inhibitor, H-7. HSVEC adherent to ePTFE bound significantly greater numbers of leukocytes than those on control (58 versus 41 percent, p < 0.05). Incubation with H-7 decreased leukocyte binding to HSVEC significantly (p < 0.005). Coculture of PBL with HSVEC adherent to ePTFE caused a tenfold increase in binding of anti-E-selectin antibodies (p < 0.0005). CONCLUSIONS These data indicate that PBL binding to HSVEC adherent to ePTFE is, at least in part, ICAM-1 to HSVEC adherent to ePTFE is, at least in part, ICAM-1 and E-selection dependent.
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Affiliation(s)
- M Margiotta
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903-0019
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Elix JA, Elix JA, Robertson F, Robertson F, Wardlaw JH, Wardlaw JH, Willis AC, Willis AC. Isolation and Structure Determination of Demethylchodatin—a New Lichen Xanthone. Aust J Chem 1994. [DOI: 10.1071/ch9942291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The structure of demethylchodatin, a xanthone from the lichen Lecanora pachysoma, has been established by X-ray analysis of the corresponding triacetate derivative. Crystals of demethylchodatin triacetate are monoclinic, P 21/a, a 10.120(3), b 11.278(3), c 19.173(4) Ǻ, β 94.68(3)°; Z 4. Refinement of 1411 data with I > 3σ(I) gave conventional R factors of 0.041 and 0.033.
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Abstract
We recently reported the presence of an organ-specific 40 kD colonic protein which acts as an autoantigen(s) in patients with ulcerative colitis. Using a specific monoclonal antibody directed against 40 kD protein (7E12H12, IgM isotype), in conjunction with immunocytochemistry and flow cytometry, we examined the presence of the 40 kD protein on human colon cancer cells, DLD-1, and also characterized the ability of cytokines, IFN-gamma and tumour necrosis factor, to modulate the expression of this protein on these tumour cells. The presence of the 40 kD protein was localized to the plasma membrane; less was present within the cytoplasm. Following exposure to IFN-gamma (10-1000 U/ml), DLD-1 colon tumour cells showed a dose- and time-dependent increase in 7E12H12 antibody associated immunofluorescence, with the maximum 7E12H12 antibody binding observed with 100 U/ml IFN-gamma at 48 h. In contrast, tumour necrosis factor did not alter the levels of anti-40 kD antibody binding over that of control cells. Since IFN-gamma is also known to induce class II major histocompatibility antigens, we examined the possibility of cross-reactivity of HLA class II antigens and Mr 40 kD epitope. Neither pre-incubation of DLD-1 colon tumour cells with anti-HLA class II antibodies followed by 7E12H12 nor co-incubation of both antibodies altered the amount of 7E12H12 antibody binding. Using a direct ELISA, a highly enriched preparation of Mr 40 kD protein reactive to anti-40 kD antibody did not react with HLA class II antibodies. The present results suggest that 40 kD protein is present on DLD-1 human colon tumour cells and that although the 40 kD protein epitope expression is increased by the lymphocyte-derived cytokine, IFN-gamma, the epitope is separate and distinct from the class II HLA antigens. Further studies on the 40 KD protein may elucidate its autoantigenic role in the pathogenesis of inflammatory bowel disease.
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Affiliation(s)
- K M Das
- Department of Medicine, UMDNJ-Robert Wood Johnson Medical School & University Hospital (Rutgers Medical School), New Brunswick 08903
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Ho MW, Stone TA, Jerman I, Bolton J, Bolton H, Goodwin BC, Saunders PT, Robertson F. Brief exposures to weak static magnetic field during early embryogenesis cause cuticular pattern abnormalities in Drosophila larvae. Phys Med Biol 1992; 37:1171-9. [PMID: 1609003 DOI: 10.1088/0031-9155/37/5/011] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M W Ho
- Development Dynamics Research Group, Open University, Milton Keynes, UK
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Weston BJ, Henderson DC, Seal S, Spackman V, Robertson F, Dewdney JM. Stimulatory effects of FK156 in a panel of tests designed to detect changes in immune function. Int J Immunopharmacol 1991; 13:117-24. [PMID: 2071288 DOI: 10.1016/0192-0561(91)90087-n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a need to evaluate the utility of experimental models in immune function assessment if these are to be accepted in preclinical safety studies. We have evaluated a panel of tests measuring cellularity and functions of the lymphoid system in the Fischer rat in order to determine whether they would detect immunostimulation, rather than suppression. Injection of the peptide immunostimulant FK156 (D-lactyl-L-alanyl-y-D-glutamyl-(L)-meso-diaminopimelyl- (L)-glycine) increased the numbers of macrophages recovered from the peritoneal cavity, and stimulated their activity, as measured by chemiluminescence, adherence, and secretion of interleukin 1. In vitro, T lymphocytes had an increased background incorporation of tritiated thymidine, increased response to sub-optimal concentrations of concanavalin A, and an increase in secretion of interleukin 2 at optimal concentrations of concanavalin A. There was no change in the proliferative responses of B lymphocytes in vitro. Antibody responses to tetanus toxoid in vivo were increased. These changes were not reflected in consistent, statistically significant alterations in the numbers of lymphocytes bearing either lineage markers or the interleukin 2 receptor as a marker of activation.
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Affiliation(s)
- B J Weston
- SmithKline Beecham Pharmaceuticals, Biosciences Research Centre, Epsom, Surrey, U.K
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Neville RG, Robertson F, Livingstone S, Crombie IK. A classification of prescription errors. J R Coll Gen Pract 1989; 39:110-2. [PMID: 2555487 PMCID: PMC1711802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three independent methods of study of prescription errors led to the development of a classification of errors based on the potential effects and inconvenience to patients, pharmacists and doctors. Four types of error are described: type A (potentially serious to patient); type B (major nuisance - pharmacist/doctor contact required); type C (minor nuisance - pharmacist must use professional judgement); and type D (trivial). The types of frequency of errors are detailed for a group of eight principals from one health centre. There were a total of 504 errors from 15,916 prescription items (3.17%) during a three month observation period. A close correspondence was found between individual doctor's types of error rates, suggesting that doctors who make type C and D errors are also likely to make type B (major nuisance) errors. A system of feedback of errors from each doctor was devised. No significant reduction was seen in error rates, possibly because the group of self selected doctors taking part had low error rates initially. It is suggested that pharmacists and doctors should work closely together to prevent the potentially harmful consequences of prescription errors.
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Spruance SL, McKeough M, Sugibayashi K, Robertson F, Gaede P, Clark DS. Effect of azone and propylene glycol on penetration of trifluorothymidine through skin and efficacy of different topical formulations against cutaneous herpes simplex virus infections in guinea pigs. Antimicrob Agents Chemother 1984; 26:819-23. [PMID: 6441511 PMCID: PMC180031 DOI: 10.1128/aac.26.6.819] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Tropical formulations of 5-trifluoromethyl-2'-deoxyuridine (TFT) containing different concentrations of TFT, Azone (Nelson Research and Development, Irvine, Calif.), and propylene glycol were evaluated for their potential efficacy in the treatment of cutaneous herpes simplex virus infections by in vitro studies of TFT penetration through skin and in vivo studies of therapeutic activity against herpes simplex virus type 1 infections in the dorsal cutaneous guinea pig model. Azone dramatically increased TFT penetration through human and guinea pig skin. Unexpectedly, high concentrations of propylene glycol were also associated with increased penetration. Studies in the guinea pig model revealed increased efficacy with Azone-propylene glycol-containing formulations, consistent with the in vitro drug diffusion results. A formulation containing 1% TFT, 5% Azone, and 80% propylene glycol decreased lesion area, in comparison to the drug vehicle control, more effectively than 5% acyclovir in polyethylene glycol (reduction of 70 versus 46%, P = 0.03). These studies demonstrate the value of penetration-enhancing agents and the need for careful preclinical evaluations in the development of topical antiviral agents.
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Pinals RS, Robertson F, Blechman WJ. A double-blind comparison of high and low doses of levamisole in rheumatoid arthritis. J Rheumatol 1981; 8:949-951. [PMID: 7328569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A randomized, double-blind study was performed to compare the efficacy of 2 different regimens for levamisole in the treatment of rheumatoid arthritis over a period of six months. A dose of 150 mg once weekly was shown to be less efficacious than 150 mg on 3 consecutive days. Although the low dose produced fewer adverse effects, only subjective improvement was demonstrated. Only 14% of patients responded to the low dose, according to defined criteria, compared with 45% response to the high dose.
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Robertson F. Anti-inflation program only part of the solution. Ont Dent 1976; 53:6-7. [PMID: 1075471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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(W.T.F.), Robertson F. Manual of Mathematics for Students of Agriculture. Biometrics 1965. [DOI: 10.2307/2528114] [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: 11/10/2022]
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