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Johnson DE, Granville R, Lovett E, Runau F, Chaudhri S. Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes. Ann R Coll Surg Engl 2023; 105:132-135. [PMID: 35446708 PMCID: PMC9889171 DOI: 10.1308/rcsann.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review. METHODS All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used. RESULTS A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05). CONCLUSIONS Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.
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Affiliation(s)
- DE Johnson
- University Hospitals of Leicester NHS Trust, UK
| | - R Granville
- University Hospitals of Leicester NHS Trust, UK
| | - E Lovett
- University Hospitals of Leicester NHS Trust, UK
| | - F Runau
- University Hospitals of Leicester NHS Trust, UK
| | - S Chaudhri
- University Hospitals of Leicester NHS Trust, UK
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2
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Norman RL, Singh R, Muskett FW, Parrott EL, Rufini A, Langridge JI, Runau F, Dennison A, Shaw JA, Piletska E, Canfarotta F, Ng LL, Piletsky S, Jones DJL. Mass spectrometric detection of KRAS protein mutations using molecular imprinting. Nanoscale 2021; 13:20401-20411. [PMID: 34854867 PMCID: PMC8675027 DOI: 10.1039/d1nr03180e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/27/2021] [Indexed: 05/07/2023]
Abstract
Cancer is a disease of cellular evolution where single base changes in the genetic code can have significant impact on the translation of proteins and their activity. Thus, in cancer research there is significant interest in methods that can determine mutations and identify the significant binding sites (epitopes) of antibodies to proteins in order to develop novel therapies. Nano molecularly imprinted polymers (nanoMIPs) provide an alternative to antibodies as reagents capable of specifically capturing target molecules depending on their structure. In this study, we used nanoMIPs to capture KRAS, a critical oncogene, to identify mutations which when present are indicative of oncological progress. Herein, coupling nanoMIPs (capture) and liquid chromatography-mass spectrometry (detection), LC-MS has allowed us to investigate mutational assignment and epitope discovery. Specifically, we have shown epitope discovery by generating nanoMIPs to a recombinant KRAS protein and identifying three regions of the protein which have been previously assigned as epitopes using much more time-consuming protocols. The mutation status of the released tryptic peptide was identified by LC-MS following capture of the conserved region of KRAS using nanoMIPS, which were tryptically digested, thus releasing the sequence of a non-conserved (mutated) region. This approach was tested in cell lines where we showed the effective genotyping of a KRAS cell line and in the plasma of cancer patients, thus demonstrating its ability to diagnose precisely the mutational status of a patient. This work provides a clear line-of-sight for the use of nanoMIPs to its translation from research into diagnostic and clinical utility.
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Affiliation(s)
- Rachel L Norman
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Rajinder Singh
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Frederick W Muskett
- Department of Molecular and Cell Biology, University of Leicester, LE1 7RH Leicester, UK
- Leicester Institute of Structural and Chemical Biology, University of Leicester, LE1 7RH Leicester, UK
| | - Emma L Parrott
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Alessandro Rufini
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | | | - Franscois Runau
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Ashley Dennison
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Jacqui A Shaw
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
| | - Elena Piletska
- MIP Diagnostics, The Exchange Building, Colworth Park, MK44 1LQ, Bedford, UK
- School of Chemistry, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE1 7RH, UK
| | - Sergey Piletsky
- MIP Diagnostics, The Exchange Building, Colworth Park, MK44 1LQ, Bedford, UK
- School of Chemistry, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Donald J L Jones
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, LE1 5WW, UK.
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE1 7RH, UK
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3
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Rajesh S, Cox MJ, Runau F. Molecular advances in pancreatic cancer: A genomic, proteomic and metabolomic approach. World J Gastroenterol 2021; 27:5171-5180. [PMID: 34497442 PMCID: PMC8384751 DOI: 10.3748/wjg.v27.i31.5171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/11/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) represents a challenging pathology with very poor outcomes and is increasing in incidence within the general population. The majority of patients are diagnosed incidentally with insidious symptoms and hence present late in the disease process. This significantly affects patient outcomes: the only cure is surgical resection but only up to 20% of patients present with resectable disease at the time of clinical presentation. The use of “omic” technology is expanding rapidly in the field of personalised medicine - using genomic, proteomic and metabolomic approaches allows researchers and clinicians to delve deep into the core molecular processes of this difficult disease. This review gives an overview of the current findings in PDAC using these “omic” approaches and summarises useful markers in aiding clinicians treating PDAC. Future strategies incorporating these findings and potential application of these methods are presented in this review article.
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Affiliation(s)
- Srujan Rajesh
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Michael J Cox
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Franscois Runau
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
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Chavda V, Siaw O, Chaudhri S, Runau F. Management of early rectal cancer; current surgical options and future direction. World J Gastrointest Surg 2021; 13:655-667. [PMID: 34354799 PMCID: PMC8316852 DOI: 10.4240/wjgs.v13.i7.655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer is the second commonest cause of cancer death within the United Kingdom. Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease. The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and, more recently, transanal minimally invasive surgery. Owing to the risks of local recurrence, the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer (T1N0M0 disease). The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established. However, results of high-quality research such as the GRECCAR II, TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future, when used in combination with oncological therapies. The aim of our review is to provide an overview in the current management of early rectal cancer, the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.
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Affiliation(s)
- Vijay Chavda
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Oliver Siaw
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Sanjay Chaudhri
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Franscois Runau
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
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5
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Sharabiany S, van Dam JJW, Sparenberg S, Blok RD, Singh B, Chaudhri S, Runau F, van Geloven AAW, van de Ven AWH, Lapid O, Hompes R, Tanis PJ, Musters GD. A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer. Tech Coloproctol 2021; 25:1123-1132. [PMID: 34263363 PMCID: PMC8419133 DOI: 10.1007/s10151-021-02496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Methods Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Results Twenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). Conclusions The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.
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Affiliation(s)
- S Sharabiany
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J W van Dam
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - S Sparenberg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R D Blok
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B Singh
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - S Chaudhri
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - F Runau
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | | | | | - O Lapid
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - G D Musters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands.
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Collins A, Spooner S, Horne J, Chainrai M, Runau F, Bourne T, Moss EL, Davies Q, Chattopadhyay S, Bharathan R. Peri-operative Variables Associated With Prolonged Intensive Care Stay Following Cytoreductive Surgery for Ovarian Cancer. Anticancer Res 2021; 41:3059-3065. [PMID: 34083298 DOI: 10.21873/anticanres.15089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Peri-operative variables associated with prolonged Intensive Care Unit (ICU) admission following cytoreductive surgery for ovarian cancer were investigated. PATIENTS AND METHODS A retrospective review was carried out of patients admitted to the ICU following cytoreductive surgery for ovarian cancer in a single tertiary referral centre from 2015-2019. Patients were categorized according to length of ICU stay (<48 h and ≥48 h), and peri-operative variables were compared across the two groups. RESULTS A total of 56 patients were admitted to the ICU post-operatively, 37 for <48 h and 19 for ≥48 h (range=3-11 days). Greater duration of procedure and estimated blood loss, bowel resection, higher post-operative lactate level, lower post-operative albumin level and requirement for post-operative blood products were associated with prolonged ICU stay. Increased intraoperative fluid requirement was an independent predictor of extended ICU stay. CONCLUSION Utilizing identified intra-operative risk factors to perform individualized risk assessments might improve planning of ICU resources. Optimizing intraoperative fluid management may improve short-term patient outcomes.
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Affiliation(s)
- Anna Collins
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K.; .,Leicester Cancer Research Centre, University of Leicester, Leicester, U.K
| | - Stephanie Spooner
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Jonathan Horne
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Mira Chainrai
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Franscois Runau
- Department of Colorectal Surgery, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Tim Bourne
- Department of Anaesthesia, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Esther L Moss
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K.,Leicester Cancer Research Centre, University of Leicester, Leicester, U.K
| | - Quentin Davies
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Supratik Chattopadhyay
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Rasiah Bharathan
- Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, U.K
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Basamh M, Rajendiran A, Chung WY, Runau F, Sangal S. Management of appendicitis during the COVID pandemic: Lessons from the first month of the outbreak. Br J Surg 2020; 107:e450-e451. [PMID: 32776508 DOI: 10.1002/bjs.11910] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mohammed Basamh
- Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK
| | - Ashwin Rajendiran
- Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK
| | - Wen Y Chung
- Department of Hepatobiliary and Pancreatic surgery, Leicester General Hospital, Leicester, UK
| | - Franscois Runau
- Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK
| | - Sam Sangal
- Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK
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8
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Runau F, Arshad A, Isherwood JD, Sandhu JK, Ng LL, Dennison AR, Jones DJL. Proteomic Characterization of Circulating Molecular Perturbations Associated With Pancreatic Adenocarcinoma Following Intravenous ω-3 Fatty Acid and Gemcitabine Administration: A Pilot Study. JPEN J Parenter Enteral Nutr 2020; 45:738-750. [PMID: 32716569 DOI: 10.1002/jpen.1952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Administration of intravenous ω-3 fatty acid (ω-3FA) in advanced pancreatic adenocarcinoma patients receiving gemcitabine chemotherapy shows disease stabilization and improved progression-free survival. Using high-definition plasma proteomics, the underlying biological mechanisms responsible for these clinical effects are investigated. METHODS AND RESULTS A pilot study involving plasma that was collected at baseline from 13 patients with histologically confirmed, unresectable pancreatic adenocarcinoma (baseline group) after 1-month treatment with intravenous gemcitabine and ω-3FA (treatment group) and intravenous gemcitabine only (control group) and was prepared for proteomic analysis. A 2-arm study comparing baseline vs treatment and treatment vs control was performed. Proteins were isolated from plasma with extensive immunodepletion, then digested and labeled with isobaric tandem mass tag peptide tags. Samples were then combined, fractionated, and injected into a QExactive-Orbitrap Mass-Spectrometer and analyzed on Proteome Discoverer and Scaffold with ensuing bioinformatics analysis. Selective reaction monitoring analysis was performed for verification. In total, 3476 proteins were identified. Anti-inflammatory markers (C-reactive protein, haptoglobin, and serum amyloid-A1) were reduced in the treatment group. Enrichment analysis showed angiogenesis downregulation, complement immune systems upregulation, and epigenetic modifications on histones. Pathway analysis identified direct action via the Pi3K-AKT pathway. Serum amyloid-A1 significantly reduced (P < .001) as a potential biomarker of efficacy for ω-3FA. CONCLUSIONS This pilot study demonstrates administration of ω-3FA has potential anti-inflammatory, antiangiogenic, and proapoptotic effects via direct interaction with cancer-signaling pathways in patients with advanced pancreatic adenocarcinoma. Further studies in a larger sample size is required to validate the clinical correlation found in this preliminary study.
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Affiliation(s)
- Franscois Runau
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Ali Arshad
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - John D Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Jatinderpal K Sandhu
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Ashley R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Donald J L Jones
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.,Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
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Isherwood J, Arshad A, Chung WY, Runau F, Cooke J, Pollard C, Howells L, Fishwick J, Thompson J, Metcalfe M, Steward W, Dennison A. Myeloid derived suppressor cells are reduced and T regulatory cells stabilised in patients with advanced pancreatic cancer treated with gemcitabine and intravenous omega 3. Ann Transl Med 2020; 8:172. [PMID: 32309319 PMCID: PMC7154395 DOI: 10.21037/atm.2020.02.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Pancreatic adenocarcinoma (PAC) is a devastating condition, with the majority of patients presenting with metastatic or locally advanced disease. In these patients their disease is classified as advanced pancreatic cancer (APC), which is incurable and associated with survivals generally of a few months. The overall survival (OS) for pancreatic cancer has not changed significantly in the past forty years with multiple trials demonstrating disappointing results. Immune modulatory cells particularly myeloid derived suppressor cells (MDSCs) and T regulatory cells (Tregs) are important mediators in PAC. Omega 3 fatty acids (ω-3FAs) have been shown to have anti-inflammatory properties and there is now evidence demonstrating the benefit of ω-3FAs in PAC. Methods This was a single-center cohort study investigating intravenous ω-3FAs and gemcitabine chemotherapy versus gemcitabine therapy only in patients with APC. Here, we investigated levels of MDSCs and Tregs and examined how these changes correlated with survival. Results Eighteen trial and nine control patients were recruited. There was a significant benefit in progression-free survival (PFS) in trial compared to control patients (P=0.0003). Median survival in trial patients was 5.65 months compared to 1.8 months in control patients. There was no significant benefit in OS in trial compared to control patients (P=0.13). Median survival in trial patients was 7 months compared to 2.9 months in control patients. MDSCs were significantly decreased in trial patients (P=0.0001) but not control patients. Conversely Tregs were significantly increased in control patients (P=0.005) but not in trial patients. Conclusions Administration of ω-3FAs with gemcitabine chemotherapy in APC results in a significant decrease of MDSCs and stability of Tregs. This may be secondary to the reduction of pro-inflammatory mediators. A phase three randomized trial is justified to further examine these effects.
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Affiliation(s)
- John Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Ali Arshad
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Wen Yuan Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Franscois Runau
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Jill Cooke
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Cristina Pollard
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Lynne Howells
- Leicester Cancer Research Centre, Leicester Royal Infirmary, Leicester, UK
| | - Jenny Fishwick
- Leicester Cancer Research Centre, Leicester Royal Infirmary, Leicester, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matthew Metcalfe
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - William Steward
- Leicester Cancer Research Centre, Leicester Royal Infirmary, Leicester, UK
| | - Ashley Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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10
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Kumar R, Chung WY, Runau F, Isherwood JD, Kuan KG, West K, Garcea G, Dennison AR. Ex vivo normothermic porcine pancreas: A physiological model for preservation and transplant study. Int J Surg 2018; 54:206-215. [PMID: 29730077 DOI: 10.1016/j.ijsu.2018.04.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/04/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION An ex vivo normothermic porcine pancreas perfusion (ENPPP) model was established to investigate effects of machine perfusion pressures on graft preservation. METHODOLOGY Nine porcine pancreata were perfused with autologous blood at 50 mmHg (control) pressure. Graft viability was compared against four ex-vivo porcine pancreata perfused at 20 mmHg ('low') pressure. Arterio-venous oxygen gas differentials, biochemistry, and graft insulin responses to glucose stimulation were compared. Immunohistochemistry stains compared the cellular viability. RESULTS Control pancreata were perfused for a median of 3 h (range 2-4 h) with a mean pressure 50 mmHg and graft flow 141 mL min-1. In comparison, all of the 'low' pressure models were perfused for 4 h, with mean perfusion pressure 20 mmHg and graft flow 40 mL.min-1. All pancreata demonstrated cellular viability with evidence of oxygen consumption with preserved endocrine and exocrine function. However, following statistical analysis, the 'low' pressure perfusion of porcine pancreata compared favourably in important biochemical and immunohistochemistry cellular profiles; potentially arguing for an improved method for graft preservation. CONCLUSION ENPPP will facilitate whole organ preservation to be studied in further detail and avoids use of expensive live animals. ENPPP is reproducible and mimics a "donation after circulatory death" scenario.
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Affiliation(s)
- Rohan Kumar
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom.
| | - Wen Yuan Chung
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - Franscois Runau
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - John David Isherwood
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - Kean Guan Kuan
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - Kevin West
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - Giuseppe Garcea
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
| | - Ashley Robert Dennison
- Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, United Kingdom
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11
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Isherwood J, Arshad A, Chung W, Runau F, Cooke J, Pollard C, Thompson J, Metcalfe M, Dennison A. SUN-P107: Parenteral Omega 3 Significantly Reduces Myeloid-Derived Suppressor Cells in Palliative Pancreatic Patients Receiving Gemcitabine and Intravenous Omega 3 Compared to Patients Receiving Gemcitabine only Treatment. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martin N, Isherwood J, Madden M, Narayanan V, Mustafa N, Bhangal C, Farah S, Jones S, Runau F, Arshad A, Chung W, Dennison A. MON-P095: The Effect of Fish Oil-Supplemented Gemcitabine Treatment on Leukotriene B4 Levels in Pancreatic Cancer. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Runau F, Collins A, Fenech GA, Ford E, Dimitriou N, Chaudhri S, Yeung JMC. A single institution's long-term follow-up of patients with pathological complete response in locally advanced rectal adenocarcinoma following neoadjuvant chemoradiotherapy. Int J Colorectal Dis 2017; 32:341-348. [PMID: 27885480 DOI: 10.1007/s00384-016-2712-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This paper aimed to study the long term follow-up of patients with primary rectal adenocarcinoma receiving neoadjuvant chemoradiotherapy who obtained a pathological complete response (pCR) and identify factors predicting complete response. METHODS Retrospective review of notes, histology, pre-operative full blood count and imaging of patients with primary rectal adenocarcinoma diagnosed in our institute from 2000 to 2012 from a prospectively maintained database were used. SPSS version 22.0 was used for statistical analysis. RESULTS Three hundred eighty patients diagnosed with primary rectal adenocarcinoma were identified, 277 received neoadjuvant chemoradiotherapy followed by curative resection. Forty-six patients obtained a pCR (ypT0N0) with no local recurrence and two metastatic recurrences on follow-up. Patients with a pCR have a significantly improved overall survival and disease-free survival compared to a non-pCR (150.0 and 136.1 vs 77.5 and 84.7 months, p = 0.001). On univariate analysis, increased tumour height above anal verge, low lymph node yield, high pre-operative haemoglobin and a low neutrophil-lymphocyte ratio are significant factors identifying a pCR. Multivariable analysis of the above factors confirmed tumour height above anal verge as significant in obtaining a pCR. CONCLUSION Patients with rectal adenocarcinoma who develop a pCR following neoadjuvant chemoradiotherapy have improved overall and disease-free survival. We have identified distance from anal verge, low lymph node yield, high pre-operative haemoglobin and low neutrophil-lymphocyte ratio as significant predictors of developing a pCR.
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Affiliation(s)
- Franscois Runau
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
| | - Anna Collins
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Glenn Ace Fenech
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Eleanor Ford
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Nikoletta Dimitriou
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Sanjay Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Justin M C Yeung
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
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Isherwood J, Arshad A, Chung W, Runau F, El-tweri A, Cooke J, Pollard C, Steward W, Metcalfe M, Dennison A. SUN-P085: Parenteral Omega 3 Significantly Increases Endothelial Progenitor Cells in Palliative Pancreatic Patients Receiving Gemcitabine and Intravenous Omega 3. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30428-9] [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: 11/26/2022]
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Arshad A, Isherwood J, Mann C, Cooke J, Pollard C, Runau F, Morgan B, Steward W, Metcalfe M, Dennison A. Intravenous ω-3 Fatty Acids Plus Gemcitabine. JPEN J Parenter Enteral Nutr 2016. [PMID: 26220200 DOI: 10.1177/0148607115595221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Marine-derived ω-3 fatty acids (ω-3FAs) have proven antitumor activity in vivo and in vitro and improve quality of life (QOL) in clinical cancer studies. These changes may be mediated by reduction in circulating proangiogenic and proinflammatory factors. In this first study of intravenous ω-3FAs as a therapy in cancer patients, we aimed to assess if it could augment the antitumor activity of gemcitabine in patients with advanced pancreatic cancer and improve QOL. MATERIALS AND METHODS Patients were administered gemcitabine 1000 mg/m3 weekly followed by up to 100 g (200 mg/mL) of ω-3 rich lipid emulsion for 3 weeks followed by a rest week. This was continued for up to 6 cycles, progression, unacceptable toxicity, patient request, or death. The primary outcome measure was objective response rate, with secondary outcome measures of overall and progression free survival, QOL scores, and adverse events. RESULTS Fifty patients were recruited. Response rate was 14.3% and disease control rate was 85.7%. Overall and progression free survival were 5.9 and 4.8 months, respectively. Increase in global health of > 10% over baseline was seen in 47.2% of patients. More than 50% of patients had > 10% increase in QOL scores in generic symptom scores and both disease-specific domains. Grade 3/4 adverse events were thrombocytopenia (8%), neutropenia (12%), nausea or vomiting (4%), and chills (6%). CONCLUSION Intravenous ω-3FAs in combination with gemcitabine shows evidence of improved activity and benefit to QOL in patients with advanced pancreas cancer and is worthy of investigation in a randomized phase III trial.
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Affiliation(s)
- Ali Arshad
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - John Isherwood
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Christopher Mann
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Jill Cooke
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Cristina Pollard
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Franscois Runau
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Bruno Morgan
- 2 Department of Radiology, University Hospitals of Leicester, Leicester, UK
| | - William Steward
- 3 Department of Medical Oncology, University Hospitals of Leicester, Leicester, UK
| | - Matthew Metcalfe
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
| | - Ashley Dennison
- 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
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Runau F, Chaudhri S. Trephine defunctioning loop ileostomy: a simple technique using an Alexis wound protector - a video vignette. Colorectal Dis 2015; 17:827-8. [PMID: 26047125 DOI: 10.1111/codi.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Affiliation(s)
- F Runau
- Department of Colorectal Surgery, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - S Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
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Runau F, Arshad A, Isherwood J, Norris L, Howells L, Metcalfe M, Dennison A. Potential for proteomic approaches in determining efficacy biomarkers following administration of fish oils rich in omega-3 fatty acids: application in pancreatic cancers. Nutr Clin Pract 2015; 30:363-70. [PMID: 25616520 DOI: 10.1177/0884533614567337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pancreatic cancer is a disease with a significantly poor prognosis. Despite modern advances in other medical, surgical, and oncologic therapy, the outcome from pancreatic cancer has improved little over the last 40 years. To improve the management of this difficult disease, trials investigating the use of dietary and parenteral fish oils rich in omega-3 (ω-3) fatty acids, exhibiting proven anti-inflammatory and anticarcinogenic properties, have revealed favorable results in pancreatic cancers. Proteomics is the large-scale study of proteins that attempts to characterize the complete set of proteins encoded by the genome of an organism and that, with the use of sensitive mass spectrometric-based techniques, has allowed high-throughput analysis of the proteome to aid identification of putative biomarkers pertinent to given disease states. These biomarkers provide useful insight into potentially discovering new markers for early detection or elucidating the efficacy of treatment on pancreatic cancers. Here, our review identifies potential proteomic-based biomarkers in pancreatic cancer relating to apoptosis, cell proliferation, angiogenesis, and metabolic regulation in clinical studies. We also reviewed proteomic biomarkers from the administration of ω-3 fatty acids that act on similar anticarcinogenic pathways as above and reflect that proteomic studies on the effect of ω-3 fatty acids in pancreatic cancer will yield favorable results.
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Affiliation(s)
- Franscois Runau
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Ali Arshad
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - John Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Leonie Norris
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - Lynne Howells
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - Matthew Metcalfe
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Ashley Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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Abstract
Right upper quadrant pain is a common presenting complaint to the general and hepatobiliary surgical team. Differential diagnoses include gallstones, cholecystitis, liver and pancreatic pathology. A 64-year-old man presented to our general surgical unit with right upper quadrant pain and deranged liver function tests. He underwent ultrasonography several times as well as magnetic resonance cholangiopancreatography (MRCP) in pursuit of hepatobiliary pathology. However, it was the identification of an empyema on MRCP that led to computed tomography of the thorax and the eventual discovery of the cause of the pain: a paraspinal abscess causing T10/T11 discitis. Right upper quadrant pain and deranged liver function tests justify hepatobiliary investigation. Nevertheless, after several negative tests, the differential diagnoses should be broadened and referred pain considered.
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Affiliation(s)
- G Cheyne
- University Hospitals of Leicester NHS Trust, UK
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Runau F, Norris L, Isherwood J, Metcalfe M, Brown K, Dennison AR. Label free proteomics: a methodology for identifying protein biomarkers in pancreatic cancer. Ann R Coll Surg Engl 2013; 95:e22-4. [DOI: 10.1308/rcsann.2013.95.6.e22] [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: 11/22/2022] Open
Abstract
The 2013 Alpine Liver and Pancreatic Surgery meeting was held in Madonna di Campiglio, Italy. The meeting was organised by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The following abstracts were selected for presentation at the meeting.
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Affiliation(s)
- F Runau
- University Hospitals of Leicester NHS Trust, UK
| | | | - J Isherwood
- University Hospitals of Leicester NHS Trust, UK
| | - M Metcalfe
- University Hospitals of Leicester NHS Trust, UK
| | | | - AR Dennison
- University Hospitals of Leicester NHS Trust, UK
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Isherwood J, Arshad A, Runau F, Mann C, Cooke J, Pollard C, Steward W, Metcalfe M, Dennison A. PP103-SUN QUALITY OF LIFE IMPROVEMENT IN PATIENTS WITH ADVANCED PANCREATIC CANCER TREATED WITH GEMCITABINE AND INTRAVENOUS OMEGA-3 RICH LIPID EMULSION. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Affiliation(s)
- F Runau
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, UK.
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Runau F, Ali M, Healy P, DaSilva I, Alam S, Kaushik M, Shokuhi S. Factors affecting seroma collection by suction drainage post-mastectomy. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.092] [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] Open
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Runau F, Bloch B, Green T. An innovative technique for removal of a broken intramedullary hip screw. Ann R Coll Surg Engl 2011; 93:323-4. [DOI: 10.1308/rcsann.2011.93.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- F Runau
- Department of Trauma and Orthopaedics Leicester Royal Infirmary, Leicester, UK
| | - B Bloch
- Department of Trauma and Orthopaedics Leicester Royal Infirmary, Leicester, UK
| | - T Green
- Department of Trauma and Orthopaedics Leicester Royal Infirmary, Leicester, UK
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Runau F, Healy P, Ali M, DeSilva I, Alam S, Shokuhi S. Factors affecting seroma collection by suction drainage post-mastectomy. Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.357] [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: 10/15/2022]
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Runau F, McCarthy M. The Cost of Open vs Endovascular Repair in Emergency Abdominal Aortic Aneurysms in a Tertiray Centre. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.101] [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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